Appropriations for construction would be authorized beginning with fiscal year 1966. The appropriations authorized for construction of collegiate schools would be $5 million the fist year and $10 million in each of the following 3 years. The appropriations authorized for construction of hospital and associate degree schools would be $10 million the first year, and $15 million in each of the 3 succeeding

years.

Grants for the costs of construction of new schools or for major expansion of existing schools could equal up to 66% percent of such costs. Other grants under this authorization could not exceed 50 percent of construction costs.

Under section 3 of the bill, collegiate schools of nursing would not be eligible for construction funds under Public Law 88-129 after June 30, 1964. However, funds for construction of these facilities under H.R. 11241 would not be authorized until fiscal year 1966. Since, several applications have been received under Public Law 88-129 from nursing schools which could begin construction in fiscal year 1965, and we anticipate that funds would be available for these projects under that law, we recommend that section 3 of the bill be amended to strike "1964" wherever it appears and insert in lieu thereof "1965", in order that these projects which were submitted in good faith under the existing law will not have to be delayed until fiscal year 1966 when funds would first become available under H.R. 11241.

The last clause of section 3(b) of H.R. 11241 also provides for nonduplication between this bill and certain hospital construction provisions of title VI of the Public Health Service Act. This provision would, in order to avoid such duplication, exclude from title VI of the act authority for construction of hospital facilities for nurse training since these facilities would be eligible for aid under H.R. 11241. However, this provision of the bill was addressed to title VI of the act prior to its amendment by the recently passed Hospital and Medical Facilities Amendments of 1964. It is necessary to address this provision of the bill to title VI as changed by those amendments. To do this, section 3(b) of H.R. 11241 must be changed so that its amendment of the Hill-Burton program (striking out "nurses' home and training facilities" and inserting instead "nurses home facilities") is addressed to the new section 625(c) of the Public Health Service Act instead of the old section 631(e). The enactment of H.R. 11241 authorizing grants for construction of nurses training facilities and elminating grants for such training from the Hill-Burton program also makes it necessary that we delete from the newly revised title VI of the Public Health Service Act the provision for giving special consideration in determining priority of construction projects, to hospital facilities which would include new or expanded nurse training facilities. This would be accomplished by adding, before the period at the end of section 3(b) of H.R. 11241", and section 603 (a) of such Act is amended by striking out clause (4), by striking out 'and' following the semicolon at the end of clause (3), and by inserting 'and' after the semicolon at the end of clause (2)".

IMPROVEMENT IN NURSE TRAINING

H.R. 11241 would authorize a new program of project grants totaling $17 million over a 5-year period to enable public and nonprofit private collegiate and associate degree schools of nursing to strengthen, improve, and expand programs to teach and train nurses.

The bill also contains a provision, not included in the administration bill (which you introduced as S. 2529), which would authorize a 5-year program of grants totaling $41 million to public and nonprofit private, accredited diploma schools of nursing to defray a portion of the cost of training students of nursing whose enrollment in such schools can be reasonably attributable to this legislation, in order to prevent further attrition of such schools and to reduce the deficit incurred by the hospital schools (which deficit is borne by the patients in those hospitals). These grants would be paid to public and nonprofit private diploma schools of nursing on a formula basis. For each fiscal year of the program each school would be entitled to an amount equal to the product of $250 times the sum of (1) the number of students enrolled in the school on a full-time basis who received a loan for that year of $100 or more under this legislation and (2) the number by which the full-time enrollment in such school during the year exceeds the average enrollment in such school during a 3-year base period established by the legislation. In no case could a school for any year receive more than the product of $100 and the full-time enrollment in the school for that year.

The administration bill would authorize project grants to diploma schools as well as to collegiate and associate degree schools to strengthen, expand, or

improve programs of nurse training; and it would authorize project grants to these schools and to other agencies, organizations and institutions for the develop ment of new or improved methods of (1) recruiting persons into the nursing profession, (2) training nurses, and (3) utilizing nursing personnel. The authori zation for these purposes over a 5-year period would total $58.8 million.

Although the provisions and the purposes stated in the House-passed bill with respect to Federal assistance to diploma schools differ from those of the administration bill, both bills would provide assistance to diploma schools to help them meet the costs of training nurses. Consequently, while we feel the approach of the administration bill is preferable, we think the Federal financial assistance authorized by the House-passed bill will result in strengthened and enlarged programs for training of nurses in the diploma schools, and we therefore would have no objection to its enactment.

EXTENSION OF TRAINEESHIPS FOR ADVANCED TRAINING OF PROFESSIONAL NURSES

H.R. 11241 would extend for 5 years the program for advanced training of professional nurses for teaching, supervision, and administration, and would expand the program to include other professional nursing specialties determined by the Surgeon General to require advanced training. The bill would authorize appropriations totaling $50 million for this program over the next 5 years.

The professional nurse traineeship program was established in 1956. It expired June 30, 1964. Continuation and expansion of this program has been recommended by the Surgeon General's Consultant Group on Nursing and by the 1963 conference called to evaluate the program. Both recommended that enrollment in long-term training be at least doubled by 1970, and that funds for short-term training be doubled within 5 years. The $50 million authorized in H.R. 11241, although $22,525,000 less than the estimates submitted by this Department as a reasonable basis for reaching these goals, will assist greatly in the expansion of the program.

LOANS TO STUDENTS

To help remove the financial barrier to attendance at schools of nursing, the bill would authorize a loan program, with a forgiveness clause, for students in all types of professional nursing schools. This program would be patterned generally after that for medical and dental students contained in Public Law 88-129, the Health Professions Educational Assistance Act of 1963.

Students in need of financial assistance who are pursuing a full-time course of study in collegiate, associate degree, or diploma schools of nursing would be eligible for loans, with preference given to students entering as first-year students after enactment of the bill. The maximum amount of a loan could not exceed $1,000 a year, with interest computed only for periods during which the loan is repayable at 3 percent per year or the "going Federal rate," whichever is the higher. Under the administration bill, the maximum amount of a loan could not exceed $1,000 a year for collegiate students, and $500 a year for associate degree or diploma school students. We have no objection to the $1,000 maximum for all students.

The loans would be repayable over a 10-year period beginning after the first year after graduation; and up to 50 percent of the amount of the loan would be cancelled at the rate of 10 percent for each complete year of full-time employment as a professional nurse in any public or nonprofit private institution or agency. The administration bill would allow up to 60 percent of the loan to be "forgiven." Although we prefer 60-percent forgiveness, particularly as an incentive for continuing the practice of nursing, we would not object to the 50-percent provision.

Loan funds would be established in schools of nursing wishing to participate in the program under agreement with the Secretary of Health, Education, and Welfare. The school would be required to provide $1 for every $9 of Federal contribution to the loan fund. Loans would be administered by the schools, and students would make applications to the schools.

The total cost of this program over a 5-year period is estimated at $85 million, a substantial portion of which will be repayable to the United States.

SCHOLARSHIPS

H.R. 11241 omits one program of assistance to nursing students which is included in the administration bill-namely, a nationwide competitive scholarship program. The purpose of this program is to stimulate interest among a greater number of highly qualified secondary school graduates in attending collegiate schools of nursing, and to attract public attention to the urgency of this need. The scholarships would be allocated among the States in proportion to the number of high school graduates, but with a minimum allocation of 5 per State; 1,000 scholarships would be made available each year to entering students, and the students would continue to receive scholarships until the completion of their nursing course. The amount of an individual scholarship would be based on need for financial assistance, with a maximum of $1,000 a year. The cost of this program is estimated at $750,000 the first year, rising to $3 million in the fourth year. Although we believe this program would contribute greatly to developing a national awareness of the urgent need for nurses and in attracting outstanding high school graduates into the field, we would not object to enactment of H.R. 11241 without this program.

PLANNING GRANTS

H.R. 11241 has no provision for planning grants. The administration bill would authorize $4.4 million for 2 years for matching grants to State, interstate, regional, or local planning area agencies to assist them in surveying their present and future needs for nurses and in planning for the development of and improvement of nurse training facilities, personnel, and programs required to meet their needs. These planning groups would also play a major role in encouraging training and service agencies and institutions to undertake appropriate action to increase school capacity and enrollment, improve training programs and faculty, and improve the effectiveness of nursing services through the most efficient utilization of nursing personnel.

Although the administration proposal, embodied in S. 2529, would provide for a more comprehensive and intensive attack on the nursing shortage, we believe that the difference between the bills is largely one of degree, and we would therefore recommend that H.R. 11241, with the technical amendments suggested above, be enacted.

The Bureau of the Budget advises that if H.R. 11241 is amended as recommended above, its enactment would be in accord with the program of the President.

Sincerely,

ANTHONY J. CELEBREZZE, Secretary.

88TH CONGRESS 2D SESSION

H. R. 11083

IN THE SENATE OF THE UNITED STATES

JULY 22, 1964

Read twice and referred to the Committee on Labor and Public Welfare

AN ACT

To amend the Public Health Service Act to extend the authorization for assistance in the provision of graduate or specialized public health training, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 3 That this Act may be cited as the "Graduate Public Health 4 Training Amendments of 1964".

5 SEC. 2. (a) Subsection (a) of section 306 of the Public 6 Health Service Act (42 U.S.C. 242d), relating to trainee7 ships for professional public health personnel, is amended by 8 striking out "seven" and inserting in lieu thereof "twelve" 9 and by inserting immediately after "Congress may deter10 mine," the following: "but not to exceed $4,500,000 for the

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fiscal year ending June 30, 1965, $7,000,000 for the fiscal

year ending June 30, 1966, $8,000,000 for the fiscal year

ending June 30, 1967, and $10,000,000 each for the fiscal

year ending June 30, 1968, and the succeeding fiscal 5 year,".

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(b) Subsection (e) of such section is amended by add7 ing at the end thereof the following new sentence: "The 8 Surgeon General shall, between June 30, 1967, and Decem9 ber 1, 1967, call a similar conference, and shall submit to 10 the Congress, on or before January 1, 1968, a report of 11 such conference, including any recommendations by it relat12 ing to the limitation, extension, or modification of this 13 section."

14 SEC. 3. (a) Subsection (a) of section 309 of the 15 Public Health Service Act (42 U.S.C. 242g), relating to 16 project grants to schools for graduate public health training, 17 is amended by striking out "June 30, 1965" and inserting 18 in lieu thereof "June 30, 1964, $2,500,000 for the fiscal

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year ending June 30, 1965, $4,000,000 for the fiscal year 20 ending June 30, 1966, $5,000,000 for the fiscal year ending 21 June 30, 1967, $7,000,000 for the fiscal year ending June 22 30, 1968, and $9,000,000 for the fiscal year ending June 23 30, 1969".

24 (b) Effective in the case of grants from appropriations 25 for any fiscal year beginning after June 30, 1964, such

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