PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Sep 16, 2026
Educating Future Nurses Act
This bill establishes a permanent National Graduate Nurse Education Program to provide clinical training to advanced practice registered nurses (APRNs), particularly with respect to services for Medicare beneficiaries. (The Centers for Medicare & Medicaid Services conducted a similar demonstration program from 2012-2016.)
Under the program, hospitals may receive payments for the costs associated with providing clinical education to APRNs. Hospitals must partner with nursing schools, regional hospitals or health systems, or non-hospital community providers (e.g., nursing homes) to provide qualifying clinical education. Such education must consist of clinical experience in primary, preventive, transitional, acute, and chronic care, as well as other services that are appropriate for Medicare beneficiaries; at least half of this education must be provided in non-hospital, community-based settings.
Participating hospitals must report annually on their programs, subject to payment reductions.
People & committees
Rep. Underwood, Lauren [D-IL-14] · D–IL
Legislative record
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Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 8, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-09-16 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Educating Future Nurses Act would create a national program paying eligible hospitals for clinical training of advanced practice nurses. Hospitals would work with nursing schools and community care providers and reimburse their partners. Reimbursement would be limited to costs tied to increased enrollment compared with a specified past graduation average. At least half of the training would generally occur in community settings outside hospitals, with possible exceptions for hospitals in rural or medically underserved areas.
This Act may be cited as the Educating Future Nurses Act.
The Secretary shall establish a national graduate nurse education program under this title under which an eligible hospital may receive payment for the hospital's reasonable costs (described in paragraph (2)) for the provision of qualified clinical education to advanced practice registered nurses.
Eligible hospitals participating in the program shall enter into written agreements pursuant to subsection (b)(1) in order to reimburse the eligible partners of the hospital the share of the costs attributable to each partner.
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 an accredited school of nursing that provides qualified clinical education during the year and for which the hospital is being reimbursed under the program, as compared to the average number of advanced practice registered nurses who graduated in each year during the period beginning on January 1, 2024, and ending on December 31, 2025
at least half of which is provided in a non-hospital community-based care setting.
The Secretary may waive the requirement under subparagraph (A)(ii) with respect to eligible hospitals located in rural or medically underserved areas.
The bill would add a national graduate nurse education program to Title XVIII of the Social Security Act. It would require the Secretary to establish the program and allow eligible hospitals to receive payments.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1866G the following new section: 1866H. National graduate nurse education program
The Secretary shall establish a national graduate nurse education program under this title under which an eligible hospital may receive payment for the hospital's reasonable costs (described in paragraph (2)) for the provision of qualified clinical education to advanced practice registered nurses.
The proposed program would cover clinical nurse specialists, nurse practitioners, certified registered nurse anesthetists, and certified nurse-midwives, using definitions in existing law.
The term advanced practice registered nurse includes the following: (A) A clinical nurse specialist (as defined in subsection (aa)(5) of section 1861). (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).
An eligible hospital, including a critical access hospital as defined in existing law, would need written agreements with at least one accredited nursing school and at least two community care settings outside hospitals.
The term eligible hospital means a hospital (as defined in subsection (e) of section 1861) 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.
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)(1)) with the eligible hospital participating in the program.
Community training partners could include health centers, rural clinics, nurse-managed clinics, retail clinics, practitioner offices, schools, nursing homes, hospice programs, long-term care facilities, and home health agencies. These settings would need written agreements with the participating hospital; the Secretary could also approve other non-hospital settings.
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)(1)) with the eligible hospital participating in the program. Such settings include Federally qualified health centers, rural health clinics, nurse managed clinics, ambulatory practices (including retail clinics), accountable care organizations, physician or practitioner offices, schools, nursing homes, hospice programs, long-term care facilities, home health agencies, and other non-hospital settings as determined appropriate by the Secretary.
Covered training would need to prepare nurses to provide primary, preventive, transitional, and acute care, chronic care management, and other appropriate services to people covered under the specified Part A or Part B provisions.
The term qualified clinical education means education— (i) that provides an advanced practice registered nurse with the clinical skills necessary to provide primary care, preventive care, transitional care, acute care, chronic care management, and other services appropriate for individuals entitled to, or enrolled for, benefits under part A, or enrolled under part B
At least half of qualifying clinical education would have to occur in community settings outside hospitals. The Secretary could waive that requirement for eligible hospitals located in rural or medically underserved areas.
(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 qualified education 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.
Reimbursable costs would be reasonable clinical education costs determined by the Secretary, using the bill's reference to the existing statutory definition of reasonable costs.
Subject to subparagraph (B), the costs described in this paragraph are the reasonable costs (as described in section 1861(v)) of each eligible hospital for the clinical education costs (as determined by the Secretary) that are attributable to providing advanced practice registered nurses with qualified clinical education.
Annual reimbursement would be capped at costs attributable to increased enrollment in the participating nursing school's qualifying program. The comparison would use the school's average annual number of graduates from January 1, 2024, through December 31, 2025—not its past enrollment.
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 an accredited school of nursing that provides qualified clinical education during the year and for which the hospital is being reimbursed under the program, as compared to the average number of advanced practice registered nurses who graduated in each year during the period beginning on January 1, 2024, and ending on December 31, 2025 (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 program.
The Secretary would establish training-network regions based on hospital referral regions. Only one Graduate Nurse Education Hub could participate in each region, and each hospital or partner could participate in only one hub.
The Secretary shall establish regions for Graduate Nurse Education Hubs described in subsection (b) under the program based on hospital referral regions.
Only one Graduate Nurse Education Hub may participate in the program with respect to each region established by the Secretary under subparagraph (A). (ii) Eligible hospitals and eligible partners An eligible hospital or eligible partner may only participate in one Graduate Nurse Education Hub under the program.
To receive payment, a hospital would need agreements stating its partners' training responsibilities and its own duty to reimburse their attributable costs promptly.
No payment shall be made under this section to an eligible hospital unless such hospital meets the following requirements: (1) The hospital has in effect a written agreement with the eligible partners of the hospital. Such written agreement shall describe, at a minimum— (A) the obligations of the eligible partners with respect to the provision of qualified clinical education; and (B) the obligation of the eligible hospital to reimburse such eligible partners (in a timely manner) for the costs of such qualified clinical education that are attributable to such partner.
A participating hospital would have to lead a hub with nursing-school, hospital or health-system, and community-care partnerships. Nursing schools would share leadership, and the hospital, schools, and other partners would develop and approve oversight under the Secretary's requirements.
The hospital demonstrates to the Secretary that it is leading a Graduate Nurse Education (GNE) Hub which has established and will maintain the following in order to provide qualified clinical education to advanced practice registered nurses: (A) Partnerships with one or more— (i) applicable schools of nursing; (ii) hospitals or health systems in a regional area; and (iii) applicable non-hospital community-based care settings. (B) A governance structure that includes one or more applicable schools of nursing in the leadership and an oversight process that is developed and approved by the hospital, participating applicable schools of nursing, and other hub partners, in accordance with requirements established by the Secretary.
Hubs would need processes for prompt partner reimbursement, coordination of training sites and clinical instructors, and consideration of local, state, and regional workforce needs. Supporting innovation and care delivery based on value is a stated purpose of the workforce process, not an established result.
(C) A process for timely reimbursement of eligible partners for the costs of such qualified clinical education that are attributable to such partner. (D) An adequate system for coordination of clinical education sites and preceptors. (E) A process for taking into consideration local, State, and regional workforce needs to facilitate innovation and value-based delivery of health care.
The payment formula would multiply a hospital's applicable per-student rate by the total number of advanced practice nurses receiving qualifying training through that hospital under the program.
The amount of payment under this section to an eligible hospital shall for each year of the program shall be equal to the applicable per-student rate (as defined in paragraph (2)) multiplied by the total number of advanced practice registered nurses receiving qualified clinical education through the eligible hospital under the program.
The first-year per-student rate would use data from the earlier Graduate Nurse Education Demonstration, adjusted upward or downward for changes in the specified consumer price index, a measure of consumer prices. Later rates would adjust the previous year's rate using the index change over the 12 months ending in June of the previous year.
(A) for the first year of the program, a per-student rate determined by the Secretary based on data from the Graduate Nurse Education Demonstration established under section 5509 of the Patient Protection and Affordable Care Act (Public Law 111–148), increased or decreased by the percentage change in the consumer price index for all urban consumers (all items; United States city average) from the last year of the Graduate Nurse Education Demonstration established under section 5509 for which such data is available to the June preceding such first year of the program under this section; and (B) for a subsequent year, the amount determined under this paragraph for the preceding year, increased or decreased by the percentage change in the consumer price index for all urban consumers (all items; United States city average) for the 12-month period ending with June of the previous year.
Program payments would have to add to, rather than replace, other federal funds available that year for advanced practice nurse clinical education or training.
Payments under this section in any given year shall supplement, not supplant, other Federal funds that have been made available in the year for advanced practice registered nurse clinical education or training.
The Secretary could waive requirements of Titles XI and XVIII of the Social Security Act as necessary to operate the program. The proposal would also make chapter 35 of title 44 inapplicable to implementation; the bundle does not reproduce those outside requirements.
The Secretary may waive such requirements of title XI and this title as may be necessary to carry out the program. (6) Administration Chapter 35 of title 44, United States Code, shall not apply to the implementation of this section.
Hospitals would submit annual reports covering the immediately preceding completed academic year, in the Secretary's required format. Reports would describe training types, partnerships, student numbers, and training changes, including reported benefits and changes aimed at patient-care quality and safety. The first report's training-change comparison would run from the first year the hospital received payment.
The report required under this paragraph for an eligible hospital for a year is a report that includes (in a form and manner specified by the Secretary) the following information for the academic year completed immediately prior to such year: (A) The types of qualified clinical education provided to advanced practice registered nurses under the program. (B) The type and number of academic or practice partnerships established as a result of working together in a Graduate Nurse Education (GNE) Hub. (C) The number of advanced practice registered nurse students receiving qualified clinical education through the eligible hospital under the program. (D) Any changes in qualified clinical education made during such academic year (except that the first report submitted by the eligible hospital under this paragraph shall be for such changes since the first year in which the hospital received payment under this section), including— (i) changes in curricula, clinical education experiences, and types of clinical education, and benefits that have resulted from such changes; and (ii) changes for purposes of measuring and improving the quality and safety of patient care.
Reports would also count graduates caring for people in the hospital's service area or state, patients treated, and patient visits. They would report the number and percentage of graduates entering facilities primarily serving designated shortage areas or medically underserved communities, or located in rural areas. The Secretary could require other information.
(E) The numbers of advanced practice registered nurses who graduated from their program at the end of such academic year and care for individuals within the borders of the service area of the hospital or within the borders of the State in which the hospital is located. (F) The number of patients treated by advanced practice registered nurses under the program. (G) The number of visits by patients treated by such advanced practice registered nurses. (H) Of the number of advanced practice registered nurses who graduated from their program at the end of such academic year, the number and percentage of such advanced practice registered nurses who entered practice at a health care facility— (i) primarily serving a health professional shortage area with a designation in effect under section 332 of the Public Health Service Act or a medically underserved community (as defined in section 799B of such Act); or (ii) located in a rural area (as defined in section 1886(d)(2)(D)). (I) Other information as deemed appropriate by the Secretary.
A missing or incomplete annual report would trigger a 25 percent payment reduction. For missing information in a submitted report, the Secretary would first have to give notice and 30 days to supply it; timely correction would prevent that reduction. Hospitals could not pass the reduction on to their partners.
The amount payable under this section to an eligible hospital shall be reduced by 25 percent if the Secretary determines that— (i) the hospital has failed to provide the Secretary the report required under paragraph (2) for the year; or (ii) such report fails to provide the information required under any subparagraph of such paragraph.
Before imposing a reduction under subparagraph (A) on the basis of a hospital's failure to provide information described in subparagraph (A)(ii), the Secretary shall provide notice to the hospital of such failure and the Secretary's intention to impose such reduction and shall provide the hospital with the opportunity to provide the required information within a period of 30 days beginning on the date of such notice. If the hospital provides such information within such period, no reduction shall be made under subparagraph (A) on the basis of the previous failure to provide such information.
In the case where the amount payable under this section to an eligible hospital is reduced pursuant to subparagraph (A), the eligible hospital may not make any corresponding reductions in payment to eligible partners.
Within two years after enactment of the proposed section, the Secretary would have to report to Congress on hospital submissions, program results, and recommended improvements.
Not later than 2 years after the date of the enactment of this section, the Secretary shall submit to Congress a report— (A) summarizing the information submitted in reports to the Secretary under paragraph (2); (B) describing the results of the program carried out under this section; and (C) making recommendations for improvements to the program.
The bill would direct transfers from the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds into the Centers for Medicare & Medicaid Services Program Management Account. The Secretary would determine the necessary amounts and each fund's share; this provision supplies no fixed dollar amount.
For purposes of carrying the program under this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate, of such sums as the Secretary determines necessary, to the Centers for Medicare & Medicaid Services Program Management Account.
The supplied official-actions snapshot, updated October 8, 2026, records introduction in the House on September 16, 2026, and referral that day to the Ways and Means and Energy and Commerce committees for provisions within their respective jurisdictions.
Source snapshot updated 2026-10-08T19:25:25Z. 2026-09-16: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2026-09-16: Introduced in House
A closer look
Reviewed version: Introduced in House · 2026-09-16. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No spending direction to a particular named recipient or place was identified in the complete supplied introduced text. This conclusion is limited to that version; the source set does not establish formal earmark status in accompanying materials or other versions.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied introduced text contains a geographically limited exception to a general training requirement. Identifying this exception does not establish improper purpose or effects.
Eligible hospitals located in rural or medically underserved areas could receive a waiver of the requirement that at least half of qualifying training occur in community settings outside hospitals. This is a discretionary exception within the main nurse-training policy, rather than an automatic exemption.
(ii) subject to subparagraph (B), at least half of which is provided in a non-hospital community-based care setting.
The Secretary may waive the requirement under subparagraph (A)(ii) with respect to eligible hospitals located in rural or medically underserved areas.
Full text preserved for this analysis. Legislative record snapshot: Oct 8, 2026. How PlainBill uses AI