[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7994 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7994
To support the direct care professional workforce, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 15, 2024
Mrs. Dingell introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, Ways and Means, the Judiciary, House
Administration, and Oversight and Accountability, 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
_______________________________________________________________________
A BILL
To support the direct care professional workforce, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) In General.--This Act may be cited as the ``Long-Term Care
Workforce Support Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Definitions.
TITLE I--IMPROVING REIMBURSEMENT
Sec. 101. Additional support for Medicaid long-term care services
provided by direct care professionals.
Sec. 102. Additional support for Medicaid long-term care services and
direct care professionals.
Sec. 103. Making permanent the State option to extend protection under
Medicaid for recipients of home and
community-based services against spousal
impoverishment.
Sec. 104. Permanent extension of money follows the person rebalancing
demonstration.
TITLE II--TRAINING, RECRUITMENT, CAREER ADVANCEMENT, AND WORKER
SUPPORTS
Subtitle A--Improving Workforce Training
Chapter 1--Grants for Supporting the Direct Care Professional Workforce
Sec. 201. Definitions.
Sec. 202. Authority to award grants.
Sec. 203. Project plans.
Sec. 204. Uses of funds; supplement, not supplant.
Chapter 2--Other Workforce Training Grants
Sec. 205. Workforce investment activities grants for domestic workers.
Sec. 206. Direct care professional career advancement demonstration
projects.
Sec. 207. Pathways to health careers.
Sec. 208. Increasing workforce diversity in allied health professionals
and direct support professionals.
Subtitle B--Improving Workforce Recruitment
Sec. 211. Technical assistance center for building the direct care
professional workforce.
Sec. 212. Report on efforts to enhance the direct care professional
workforce.
Sec. 213. Comprehensive geriatric education.
Sec. 214. Review of the availability and quality of apprenticeship
programs in long-term care settings.
Sec. 215. Rural health workforce grant program.
Subtitle C--Providing Career Advancement Opportunities; Assessment of
Worker Well-being
Sec. 221. Assessment of direct care professional well-being.
Sec. 222. National Direct Care Professional Training Standards
Commission.
Subtitle D--Increasing Supports for the Existing Direct Care
Professional Workforce
Sec. 231. Mental health services.
Sec. 232. Dissemination of best practices with respect to mental health
of direct care professionals.
Sec. 233. Education and awareness initiative encouraging use of mental
health and substance use disorder services
by direct care professionals.
Sec. 234. Direct care professional training grants.
Sec. 235. Credit for certain health care professionals.
Sec. 236. Direct Care Professional Workforce Equity Technical
Assistance Center.
TITLE III--WORKFORCE LABOR PROTECTIONS
Subtitle A--Long-term Care Workforce Wage Theft Prevention and Wage
Recovery Act
Sec. 301. Definitions.
Sec. 302. Direct care professional workforce wage theft prevention and
wage recovery grant program.
Subtitle B--Direct Care Professional Rights
Sec. 311. Definitions.
Sec. 312. Written agreements.
Sec. 313. Fair scheduling practices.
Sec. 314. Right to request and receive temporary changes to scheduled
work hours due to personal events.
Sec. 315. Privacy.
Sec. 316. Breaks for meals and rest.
Sec. 317. Prohibited acts.
Sec. 318. Enforcement authority.
Sec. 319. Effect on existing employment benefits and other laws.
Subtitle C--Workplace Violence Prevention for Health Care and Social
Services Workers Act
Sec. 321. Workplace Violence Prevention Standard.
Sec. 322. Scope and application.
Sec. 323. Requirements for Workplace Violence Prevention Standard.
Sec. 324. Rules of construction.
Sec. 325. Definitions.
Sec. 326. Application of the Workplace Violence Prevention Standard to
certain facilities receiving Medicare
funds.
Subtitle D--Improving Access to Job Benefits
Sec. 331. Definitions.
Sec. 332. Paid sick time.
Sec. 333. Notice requirement.
Sec. 334. Prohibited acts.
Sec. 335. Enforcement authority.
Sec. 336. Education and outreach.
Sec. 337. Effect on existing employment benefits.
Sec. 338. Encouragement of more generous leave policies.
Sec. 339. Regulations.
Sec. 339A. Effective date.
Sec. 339B. Collection of data and further study.
TITLE IV--NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY
Sec. 401. Definitions.
Sec. 402. National Direct Care Professional Compensation Strategy.
Sec. 403. National Direct Care Professional Compensation Advisory
Council.
Sec. 404. Sunset provision.
TITLE V--IMPROVING OVERSIGHT AND ACCOUNTABILITY
Sec. 501. Evaluation of implementation and outcomes.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress finds the following:
(1) The nearly 5,000,000 direct care professionals in the
United States play a vital role in supporting the health, well-
being, and independence of older individuals and people with
disabilities.
(2) The United States faces a growing crisis in its direct
care professional workforce at the same time that demand for
services is rising at unprecedented rates.
(3) There will be an estimated 9,300,000 total direct care
professional job openings from 2021 to 2031, including new jobs
to support the growing number of people who need care and to
fill the jobs of such professionals leaving the direct care
professional workforce.
(4) Workforce turnover and shortages have a direct impact
on older individuals, people with disabilities, and their
families who suffer because they cannot get the high-quality
care that they need and deserve.
(5) The median hourly wage for all direct care
professionals in 2022 was only $15.43, with home care workers
earning the least.
(6) One in 8 direct care professionals live in poverty and
three quarters earn less than the average living wage in their
State.
(7) Forty-six percent of direct care professionals rely on
public assistance, such as Medicaid, food and nutrition
assistance, or cash assistance.
(8) Direct care professionals report high levels of burnout
and professional fatigue from their physically and emotionally
demanding work, lack of respect for the essential, skilled care
they provide, and lasting trauma from battling the COVID-19
pandemic, all of which further drives high turnover.
(9) The long-term care industry is struggling to hire and
retain direct care professionals, with a national turnover rate
between 77 to nearly 100 percent.
(10) Ninety-two percent of nursing home respondents and
nearly 70 percent of assisted living facilities surveyed report
significant or severe workforce shortages.
(11) More than half of nursing homes surveyed in 2022
reported that they limited new patient admissions due to
staffing shortages.
(12) A survey of State home and community-based services
(referred to in this section as ``HCBS'') programs showed that
every State reports a shortage of workers, and in 43 States,
some HCBS providers have closed permanently.
(13) The low-quality of direct care professional jobs
reflects and perpetuates the racial and gender inequities faced
by direct care professionals, who are disproportionately women,
immigrants, and people of color.
(14) Efforts to support the direct care professional
workforce have focused on specific care settings, even though
these issues are widespread across the long-term care landscape
and direct care professionals across settings face similar
challenges of low wages, few benefits, limited training and
support, worker exploitation, and a lack of meaningful career
ladders.
(15) Stabilizing, growing, and supporting the direct care
professional workforce across the continuum of long-term care
is essential to ensuring a strong, qualified pipeline of
workers, and improving the lives of direct care professionals
and the older individuals, people with disabilities, and the
families and communities that they support.
(b) Purposes.--The purposes of this Act are as follows:
(1) To increase the capacity of the direct care
professional workforce to ensure that older individuals, people
with disabilities, and their families receive the services they
need in the settings of their choice as they deserve to live
healthy, independent lives.
(2) To increase compensation so that direct care
professionals are paid a living wage and have access to
essential job benefits, and so that direct care professional
jobs are good jobs.
(3) To ensure that direct care professionals are treated
with respect, provided with a safe working environment,
protected from exploitation, and fairly compensated for the
skilled work they do.
(4) To improve access to and quality of long-term care,
including collecting meaningful and actionable data on the
direct care professional workforce and the people they support.
(5) To eliminate the race, gender, sexual orientation, age,
and gender identity disparities that exist across the direct
care professional workforce.
(6) To strengthen the direct care professional workforce in
order to support the 53,000,000 unpaid family caregivers who
are often providing complex services and supports to their
loved ones who are older individuals and people with
disabilities in their homes, communities, and residential
settings.
SEC. 3. DEFINITIONS.
In this Act:
(1) Activities of daily living.--The term ``activities of
daily living'' means basic, personal, everyday activities,
including tasks such as eating, toileting, grooming, dressing,
bathing, and transferring.
(2) Aging and disability resource center.--The term ``Aging
and Disability Resource Center'' has the meaning given such
term in section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002).
(3) Apprenticeship program.--The term ``apprenticeship
program'' means an apprenticeship program registered under the
Act of August 16, 1937 (commonly known as the ``National
Apprenticeship Act''; 50 Stat. 664, chapter 663; 29 U.S.C. 50
et seq.), including any requirement, standard, or rule
promulgated under such Act.
(4) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Finance of the Senate;
(B) the Committee on Health, Education, Labor, and
Pensions of the Senate;
(C) the Special Committee on Aging of the Senate;
(D) the Committee on Ways and Means of the House of
Representatives;
(E) the Committee on Energy and Commerce of the
House of Representatives; and
(F) the Committee on Education and the Workforce of
the House of Representatives.
(5) Area agency on aging.--The term ``area agency on
aging'' has the meaning given such term in section 102 of the
Older Americans Act of 1965 (42 U.S.C. 3002).
(6) Assisted living facility.--The term ``assisted living
facility'' means an adult care facility that--
(A) is a residential care setting licensed and
regulated by the State in which the facility is located
(or, if there is no State law providing for such
licensing and regulation by the State, by the
municipality or other political subdivision in which
the facility is located);
(B)(i) makes available to residents supportive
services to assist the residents in carrying out
activities of daily living;
(ii) provides 24-hour on-site monitoring, personal
care planning, food services, and personal care; and
(iii) may make available to residents home health
care services, such as nursing and therapy; and
(C) provides dwelling units for residents, each of
which may contain a full kitchen, bedroom, and
bathroom, and which includes common rooms and other
facilities appropriate for the provision of supportive
services to the residents of the facility.
(7) Certified nursing assistant.--The term ``certified
nursing assistant'' means a nurse aide who has completed a
State-approved training and competency evaluation program.
(8) Commerce.--Except as provided in section 331, the term
``commerce'' has the meaning given such term in section 3 of
the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
(9) Community or technical college.--The term ``community
or technical college'' means a public institution of higher
education at which the highest degree that is predominantly
awarded to students is an associate's degree, including Tribal
Colleges or Universities receiving grants under section 316 of
the Higher Education Act of 1965 (20 U.S.C. 1059c) that offer a
2-year program for completion of such degree and State public
institutions of higher education that offer such a 2-year
program.
(10) Developmental disability.--The term ``developmental
disability'' has the meaning given such term in section 102 of
the Developmental Disabilities Assistance and Bill of Rights
Act of 2000 (42 U.S.C. 15002).
(11) Direct care professional.--The term ``direct care
professional'' means--
(A) a personal or home care aide;
(B) a home and community-based services worker;
(C) a direct support professional;
(D) a certified nursing assistant;
(E) a nurse aide or nursing assistant;
(F) a respite care provider;
(G) a paid family caregiver;
(H) a home health aide;
(I) a private duty nurse; or
(J) any other individual providing relevant
services (as determined by the Secretary of Health and
Human Services) for compensation, in the course of the
profession of such individual, at a long-term care
setting to a resident of such setting.
(12) Direct care professional manager.--The term ``direct
care professional manager'' means a person who is a manager, or
supervisory staff, with coaching, training, managerial,
supervisory, or other oversight responsibilities of direct care
professionals.
(13) Direct care professional workforce.--The term ``direct
care professional workforce'' means the broad workforce of
direct care professionals across all long-term care settings.
(14) Disability.--The term ``disability'', except as
provided in paragraph (10), has the meaning given such term in
section 3 of the Americans with Disabilities Act of 1990 (42
U.S.C. 12102).
(15) Domestic partner.--
(A) In general.--The term ``domestic partner'',
with respect to an individual, means another individual
with whom the individual is in a committed
relationship.
(B) Committed relationship defined.--The term
``committed relationship'' for purposes of subparagraph
(A)--
(i) means a relationship between 2
individuals, each at least 18 years of age, in
which both individuals share responsibility for
a significant measure of each other's common
welfare; and
(ii) includes any such relationship between
2 individuals, including individuals of the
same sex, that is granted legal recognition by
a State or political subdivision of a State as
a marriage or analogous relationship, including
a civil union or domestic partnership.
(16) Employ.--The term ``employ'' has the meaning given the
term in section 3 of the Fair Labor Standards Act of 1938 (29
U.S.C. 203).
(17) Employee; employer.--Except as provided in section
331, the terms ``employee'' and ``employer'' have the meanings
given such terms in section 3 of such Act.
(18) Home and community-based services.--The term ``home
and community-based services'' means any of the following
(whether provided on a fee-for-service, risk, or other basis):
(A) Home health care services authorized under
paragraph (7) of section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)).
(B) Personal care services authorized under
paragraph (24) of such section.
(C) PACE services authorized under paragraph (26)
of such section.
(D) Home and community-based services authorized
under subsections (b), (c), (i), (j), and (k) of
section 1915 of such Act (42 U.S.C. 1396n), such
services authorized under a waiver under section 1115
of such Act (42 U.S.C. 1315), and such services
provided through coverage authorized under section 1937
of such Act (42 U.S.C. 1396u-7).
(E) Case management services authorized under
section 1905(a)(19) of the Social Security Act (42
U.S.C. 1396d(a)(19)) and section 1915(g) of such Act
(42 U.S.C. 1396n(g)).
(F) Rehabilitative services, including those
related to behavioral health, described in section
1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).
(G) Such other services specified by the Secretary
of Health and Human Services.
(19) Home and community-based services setting.--The term
``home and community-based services setting'' means a setting
where home and community-based services authorized under State
options described in subsection (c) or (i) of section 1915 of
the Social Security Act (42 U.S.C. 1396n) or, as relevant,
demonstration projects authorized under section 1115 of such
Act (42 U.S.C. 1315), are provided to individuals enrolled for
medical assistance under a State plan under title XIX (or under
a waiver of such a plan).
(20) Home and community-based services worker.--The term
``home and community-based services worker''--
(A) means an individual who provides home and
community-based services for compensation; and
(B) may include individuals described in
subparagraph (A) who are physical therapists,
occupational therapists, or speech or language
therapists.
(21) Indian tribe; tribal organization.--The terms ``Indian
Tribe'' and ``Tribal organization'' have the meanings given
such terms in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304).
(22) Institution of higher education.--The term
``institution of higher education'' means--
(A) an institution of higher education defined in
section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001); or
(B) an institution of higher education defined in
section 102(a)(1)(B) of such Act (20 U.S.C.
1002(a)(1)(B)).
(23) Instrumental activities of daily living.--The term
``instrumental activities of daily living'' means tasks that
are not necessary for fundamental functioning, but allow an
individual to live independently in a community of daily
living. Such tasks include--
(A) housekeeping and room cleaning;
(B) meal preparation;
(C) taking medications;
(D) laundry;
(E) transportation;
(F) shopping for groceries, clothing, or other
items;
(G) managing communications, such as using the
telephone;
(H) managing finances;
(I) writing letters; and
(J) obtaining appointments.
(24) Local educational agency.--The term ``local
educational agency'' has the meaning given the term in section
8101 of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801).
(25) Long-term care services.--The term ``long-term care
services'' means any services provided by a direct care
professional in a long-term care setting.
(26) Long-term care setting.--The term ``long-term care
setting'' means--
(A) a nursing home;
(B) a home and community-based services setting;
(C) an assisted living facility;
(D) an intermediate care facility;
(E) a State home, as defined in section 101(19) of
title 38, United States Code;
(F) a Tribal nursing home operated pursuant to an
Indian health program (as defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603));
(G) a private home;
(H) a respite setting; or
(I) any other setting in which an individual
provides relevant services (as determined by the
Secretary of Health and Human Services), in the course
of the profession of such individual, to a resident of
such setting.
(27) Medicaid program.--The term ``Medicaid program''
means, with respect to a State, the State program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
(including any waiver or demonstration under such title or
under section 1115 of such Act (42 U.S.C. 1315) relating to
such title).
(28) Nurse aide.--The term ``nurse aide'' has the meaning
given such term in section 1919(b)(5) of the Social Security
Act (42 U.S.C. 1396r(b)(5)).
(29) Nursing assistant.--The term ``nursing assistant''
means an individual who provides or assists with the basic care
or support of a patient under the direction of onsite licensed
nursing staff, which may include performing duties such as--
(A) monitoring of the health status, feeding,
bathing, dressing, grooming, toileting, or ambulation
of patients or residents in a health facility or
nursing home; and
(B) medication administration and other health-
related tasks of patients in a health facility or
nursing home.
(30) Nursing home.--The term ``nursing home'' means--
(A) a nursing facility as defined in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)); or
(B) a skilled nursing facility as defined in
section 1819(a) of such Act (42 U.S.C. 1395i-3(a)).
(31) Older individual.--The term ``older individual'' has
the meaning given the term in section 102 of the Older
Americans Act of 1965 (42 U.S.C. 3002).
(32) Personal or home care aide.--
(A) In general.--The term ``personal or home care
aide'' means an individual who helps older individuals
and people with serious illness, physical disability,
cognitive impairment (including Alzheimer's disease or
other dementias, a developmental disability, or another
disability involving a mental impairment) to live in
their own home or a residential care facility (such as
a nursing home, assisted living facility, or any other
facility the Secretary of Health and Human Services
determines appropriate that is not described in
subparagraph (B)(i)) by providing personal care
services for compensation.
(B) Personal care services.--For purposes of
subparagraph (A), the term ``personal care services''
means assistance or services--
(i) provided to an individual who is not an
inpatient or resident of a hospital or
institution for mental disease; and
(ii) that enable the recipient to
accomplish activities of daily living or
instrumental activities of daily living.
(33) Secondary school.--The term ``secondary school'' has
the meaning given such term in section 8101 of the Elementary
and Secondary Education Act of 1965 (20 U.S.C. 7801).
(34) Self-directed care professional.--The term ``self-
directed care professional'' (also known as an ``independent
provider'')--
(A) means a direct care professional who is
employed by an individual who is an older individual, a
person with a disability, or a representative of such
older individual or person with a disability, and such
older individual or person with a disability has the
decision-making authority over certain supports and
services provided by the direct care professional and
takes direct responsibility to manage those supports
and services; and
(B) includes paid family caregivers.
(35) State.--The term ``State'', except as otherwise
provided in this Act, has the meaning given such term for
purposes of title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
(36) State educational agency.--The term ``State
educational agency'' has the meaning given the term in section
8101 of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801).
(37) Urban indian organization.--The term ``urban Indian
organization'' has the meaning given the term in section 4 of
the Indian Health Care Improvement Act (25 U.S.C. 1603).
(38) Workforce innovation and opportunity act terms.--The
terms ``career pathway'', ``career planning'', ``in-demand
industry sector or occupation'', ``individual with a barrier to
employment'', ``local board'', ``on-the-job training'',
``recognized postsecondary credential'', ``region'', and
``State board'' have the meanings given such terms in section 3
of the Workforce Innovation and Opportunity Act (29 U.S.C.
3102).
(39) Work-based learning.--The term ``work-based learning''
has the meaning given such term in section 3 of the Carl D.
Perkins Career and Technical Education Act of 2006 (20 U.S.C.
2302).
TITLE I--IMPROVING REIMBURSEMENT
SEC. 101. ADDITIONAL SUPPORT FOR MEDICAID LONG-TERM CARE SERVICES
PROVIDED BY DIRECT CARE PROFESSIONALS.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (kk)''; and
(2) by adding at the end the following new subsection:
``(kk) Additional Support for Long-Term Care Services Provided by
Direct Care Professionals.--
``(1) In general.--Notwithstanding subsections (b) and
(ff), in the case of a State that satisfies the conditions
described in paragraph (2), for each fiscal quarter during the
period of fiscal years 2025 through 2034, the Federal medical
assistance percentage otherwise determined for such State under
such subsection (b) or (ff) shall, after the application of any
other increase to the Federal medical assistance percentage for
the State and quarter applicable under any other provision of
law, be increased by 10 percentage points (but not to exceed 95
percent) with respect to amounts expended by the State for
medical assistance for long-term care services that are
provided by direct care professionals during such quarter.
``(2) Requirements.--As a condition for receipt of the
increase under paragraph (1) to the Federal medical assistance
percentage determined for a State, the State shall submit to
the Secretary, at such time and in such manner as specified by
the Secretary, an application that includes, in addition to
such other information as the Secretary shall require--
``(A) a description of which activities described
in paragraph (4) that a State plans to implement and a
description of how it plans to implement such
activities;
``(B) assurances that all Federal funds
attributable to the increase under paragraph (1) will
be--
``(i) expended by the State in accordance
with this subsection not later than September
30, 2036; and
``(ii) used--
``(I) to implement the activities
described in paragraph (4);
``(II) to supplement, and not
supplant, the level of State funds
expended for long-term care services
provided by direct care professionals
under the State plan (or under a waiver
of such plan) as of the date of
enactment of this subsection; and
``(III) to increase reimbursement
rates for long-term care services
provided by direct care professionals
under the State plan (or under a waiver
of such plan) to a level that will
support recruitment and retention of a
sufficient workforce to provide such
services under the State plan (or
waiver);
``(C) assurances that the State will use funds to
work to eliminate any home and community-based services
waiting lists and ensure service capacity;
``(D) assurances that the State will use at least
85 percent of the Federal funds attributable to the
increase under paragraph (1) to improve compensation,
benefits, working conditions, and training for direct
care professionals and direct care managers; and
``(E) assurances that the State will conduct
adequate oversight and ensure the validity of such data
as may be required by the Secretary.
``(3) Approval of application.--Not later than 90 days
after the date of submission of an application of a State under
paragraph (2), the Secretary shall certify if the application
is complete. Upon certification that an application of a State
is complete, the application shall be deemed to be approved for
purposes of this section.
``(4) Activities to improve the direct care professional
workforce.--
``(A) In general.--A State shall work with
community partners such as Area Agencies on Aging,
centers for independent living, as described in part C
of title VII of the Rehabilitation Act of 1973,
nonprofit long-term care services providers, and other
entities to implement some or all of the purposes
described in subparagraph (B).
``(B) Focused areas of improvement.--The purposes
described in this paragraph, with respect to a State,
are the following:
``(i) To increase rates for service
provider agencies that employ direct care
professionals (including independent providers
in a self-directed or consumer-directed model)
to provide long-term care services under the
State plan (or under a waiver of such plan),
provided that any service provider agency or
individual that receives payment under such an
increased rate increases the compensation it
pay its direct care professionals.
``(ii) To provide paid sick leave, paid
family leave, and paid medical leave for direct
care professionals.
``(iii) To provide hazard pay, overtime
pay, and shift differential pay for direct care
professionals.
``(iv) To improve stability of direct care
professional jobs, including consistent hours,
scheduling, pay, and benefit eligibility.
``(v) To provide home and community-based
services to individuals who are on waiting
lists for programs approved under sections 1115
or 1915.
``(vi) To purchase emergency supplies and
equipment, which may include items not
typically covered under the State plan (or
under a waiver of such plan), such as personal
protective equipment, necessary to enhance
access to services and to protect the health
and well-being of direct care professionals.
``(vii) To pay for the travel of direct
care professionals to conduct their job
responsibilities.
``(viii) To recruit new direct care
professionals.
``(ix) To pay for training for direct care
professionals, including apprenticeship
programs.
``(x) To pay for assistive technologies,
staffing, and training to facilitate eligible
individuals' communication, and other costs
incurred in order to facilitate community
integration and ensure an individual's person-
centered service plan is fully implemented.
``(xi) To prepare information and public
health and educational materials in accessible
formats (including formats accessible to people
with low literacy or intellectual disabilities
about prevention, treatment, recovery, and
other aspects of communicable diseases and
threats to the health of individuals who are
enrolled for medical assistance under the State
plan (or under a waiver of such plan), their
families, and the general community served by
agencies described in clause (i).
``(xii) To protect the health and safety of
direct care professionals during public health
emergencies and natural disasters.
``(xiii) To pay for interpreters to assist
in providing long-term care services to
individuals under the State plan (or under a
waiver of such plan) and to inform the general
public about communicable diseases and other
public health threats.
``(xiv) To pay for other expenses deemed
appropriate by the Secretary to enhance,
expand, or strengthen long-term care services
under the State plan (or under a waiver of such
plan).
``(5) Reporting requirements.--
``(A) State reporting requirements.--Not later than
December 31, 2027, and every 2 years thereafter until
December 31, 2039, any State with respect to which an
application is approved by the Secretary pursuant to
paragraph (3) shall submit a report to the Secretary
that contains the following information:
``(i) Activities and programs that were
funded using Federal funds attributable to the
increase to the Federal medical assistance
percentage of the State under paragraph (1).
``(ii) The number of individuals enrolled
under the State plan (or under a waiver of such
plan) who were served by such activities and
programs.
``(iii) A detailed accounting of all
spending of funds attributable to the increase
to the Federal medical assistance percentage of
the State under paragraph (1) by the State and
by any providers with whom the State entered
into contracts or agreements to fulfill the
requirements of this subsection.
``(B) Non-application of the paperwork reduction
act.--Chapter 35 of title 44, United States Code
(commonly referred to as the `Paperwork Reduction Act
of 1995'), shall not apply to the provisions of this
subsection.
``(6) Enforcement.--
``(A) In general.--If the Secretary determines that
a State with respect to which an application is
approved pursuant to paragraph (3) has failed to comply
with the requirements of this subsection (including the
requirement that all Federal funds attributable to the
increase to the Federal medical assistance percentage
of the State under paragraph (1) be spent in accordance
with paragraph (4)) for any quarter during the period
of fiscal years described in paragraph (1), the
Secretary may reduce the number of percentage points by
which the Federal medical assistance percentage for the
State and quarter would otherwise be increased under
paragraph (1) for such quarter.
``(B) Penalty based on severity of failure.--The
Secretary shall impose reductions under this paragraph
based on the degree to which a State has failed to
comply with the requirements of this subsection.
``(7) Evaluation.--Not later than 2027 and annually until
2036, the Secretary, in conjunction with the Secretary of
Labor, shall evaluate the implementation and outcomes of this
subsection on the availability of staff to cover shifts in all
long-term care settings serving, worker credentials and skills,
and worker compensation through a contract with an external
evaluator who has experience with evaluation related to people
with disabilities and older individuals.
``(8) Definitions.--In this subsection:
``(A) Direct care professional.--The term `direct
care professional' has the meaning given such term in
section 3 of the Long-Term Care Workforce Support Act.
``(B) Home and community-based services.--The term
`home and community-based services' means any of the
following:
``(i) Home health care services authorized
under paragraph (7) of subsection (a).
``(ii) Personal care services authorized
under paragraph (24) of such subsection.
``(iii) PACE services authorized under
paragraph (26) of such subsection.
``(iv) Home and community-based services
authorized under subsections (b), (c), (i),
(j), and (k) of section 1915, such services
authorized under a waiver under section 1115,
and such services through coverage authorized
under section 1937.
``(v) Case management services authorized
under subsection (a)(19) of this section and
section 1915(g).
``(vi) Rehabilitative services, including
those related to behavioral health, described
in subsection (a)(13) of this section.
``(vii) Such other services specified by
the Secretary.''.
SEC. 102. ADDITIONAL SUPPORT FOR MEDICAID LONG-TERM CARE SERVICES AND
DIRECT CARE PROFESSIONALS.
(a) In General.--Not later than 18 months after the date of
enactment of this Act, the Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall award grants
to States for the purpose of supporting and strengthening services
provided by direct care professionals across direct care settings and
improving recruitment, compensation, and retention of the direct care
professional workforce.
(b) Application.--Not later than 6 months after the date of
enactment of this Act, each State that seeks to receive a grant under
this section shall submit an application, in such form and manner as
the Secretary shall require, to the Secretary that includes--
(1) information on how the State will use grant funds to
improve long-term care services and the recruitment,
compensation, and retention of direct care professionals in a
manner that maximizes the independence of people with
disabilities and older individuals, limits unnecessary
institutionalization, and supports people living in residential
settings;
(2) specifies the proportion of grant funds that the State
plans to spend on activities to support long-term professional
care workers in nursing homes, home health settings, and home
and community-based services settings, respectively;
(3) a plan for sustaining the work at the conclusion of the
grant period; and
(4) such other information as the Secretary shall require.
(c) Grant Amounts.--The Secretary shall award each State that
submits an application to the Secretary that meets the requirements of
subsection (b) a 5-year grant in an amount that bears the same
proportion to the amount appropriated under subsection (e) as--
(1) the number of individuals who are enrolled for medical
assistance under the Medicaid program of the State involved (as
determined by the Secretary using the most recent data
available as of the date of enactment of this Act); bears to
(2) the total number of individuals who are enrolled for
medical assistance under the Medicaid programs of all States
that submit to the Secretary an application that meets the
requirements of subsection (b).
(d) Use of Grant Funds.--
(1) In general.--A State that receives a grant under this
section shall use the funds of such grant in accordance with
the requirements of this subsection.
(2) Supplement, not supplant.--A State shall use funds from
a grant awarded under this section to supplement, and not
supplant, the level of State funds expended for services in
long-term care settings through programs in effect as of
January 1, 2025.
(3) Required implementation of certain activities.--The
State shall use funds from a grant awarded under this section
to implement and evaluate, or supplement the implementation of,
activities (which shall include the activities described in
paragraph (4)) to enhance, expand, or strengthen long-term care
services and to improve compensation to the workforce that
provides such services.
(4) Activities to strengthen and expand the direct care
professional workforce.--
(A) In general.--The State strengthens and expands
the direct care professional workforce that provides
services across long-term care settings by--
(i) adopting a salary review process to
ensure that the rates payable for long-term
care services under the State Medicaid program
are sufficient to ensure access to such
services under such program;
(ii) requiring that at least 85 percent of
all payments for long-term care services that
are made under the State Medicaid program,
including base payments and supplemental
payments, are for compensation to direct care
professionals and direct care professional
managers; and
(iii) updating, developing, and adopting
qualification standards and training
opportunities for the continuum of direct care
professionals, including programs for
independent direct care professionals and
agency direct care professionals, as well as
unique programs.
(B) Payment rates.--In carrying out subparagraph
(A)(i), the State shall--
(i) address insufficient payment rates
under the State Medicaid program for delivery
of long-term care services with an emphasis on
supporting the recruitment and retention of
direct care professionals;
(ii) update payment rates under the State
Medicaid program for long-term care services,
including home and community-based services,
nursing home services, skilled nursing facility
services, and intermediate care facility
services at least every 2 years through a
transparent process involving meaningful input
from stakeholders, in which the majority of
stakeholders are recipients of such services,
families, direct care professionals, chosen
representatives of direct care workers, aging,
disability, and workforce advocates, long-term
care providers, and may also include health
plans; and
(iii) ensure that, with respect to any
increases in the payment rates under the State
Medicaid program for long-term care services--
(I) at a minimum, 85 percent of
such payment rate increases are passed
through to direct care professionals
and direct care professional managers
who provide such services and in a
manner that is determined with input
from the stakeholders described in
clause (ii);
(II) such payment rate increases
are incorporated into payment rates for
such services provided under title XIX
of the Social Security Act (42 U.S.C.
1396 et seq.) by a managed care entity
(as defined in section 1932(a)(1)(B) of
the Social Security Act (42 U.S.C.
1396u-2(a)(1)(B)) or a prepaid
inpatient health plan or prepaid
ambulatory health plan, as defined in
section 438.2 of title 42, Code of
Federal Regulations (or any successor
regulation)), under a contract with the
State;
(III) such payment rate increases
are appropriately distributed across
settings, populations, and services so
as promote independence of people with
disabilities and older individuals, not
result in increased
institutionalization, and assists in
the facilitation of rebalancing the
Medicaid program towards the least
restrictive settings appropriate for
individuals receiving services; and
(IV) such payment rate increases
are prioritized toward home and
community-based service workers in
States that have a waiting list for
HCBS waiver services and have been
determined by CMS to have inadequate
HCBS capacity.
(e) Appropriation.--There is appropriated to the Secretary for
awarding grants under this section an amount equal to $100,000,000,000.
(f) Evaluation of Impact on HCBS Waiting Lists.--The Secretary
shall evaluate the implementation and outcomes of this title on State
Medicaid program waiting lists for home and community-based services
through a contract with an external evaluator who has experience with
evaluation related to people with disabilities and older individuals.
SEC. 103. MAKING PERMANENT THE STATE OPTION TO EXTEND PROTECTION UNDER
MEDICAID FOR RECIPIENTS OF HOME AND COMMUNITY-BASED
SERVICES AGAINST SPOUSAL IMPOVERISHMENT.
(a) In General.--Section 1924(h)(1)(A) of the Social Security Act
(42 U.S.C. 1396r-5(h)(1)(A)) is amended by striking ``is described in
section 1902(a)(10)(A)(ii)(VI)'' and inserting the following: ``is
eligible for medical assistance for home and community-based services
provided under subsection (c), (d), or (i) of section 1915, under a
waiver approved under section 1115, or who is eligible for such medical
assistance by reason of being determined eligible under section
1902(a)(10)(C) or by reason of section 1902(f) or otherwise on the
basis of a reduction of income based on costs incurred for medical or
other remedial care, or who is eligible for medical assistance for home
and community-based attendant services and supports under section
1915(k)''.
(b) Conforming Amendment.--Section 2404 of the Patient Protection
and Affordable Care Act (42 U.S.C. 1396r-5 note) is amended by striking
``September 30, 2027'' and inserting ``the date of enactment of the
Long-Term Care Workforce Support Act''.
SEC. 104. PERMANENT EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING
DEMONSTRATION.
(a) In General.--Subsection (h)(1) of section 6071 of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
(1) in subparagraph (K), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (L), by striking ``through 2027.'' and
inserting ``through 2025; and''; and
(3) by adding at the end the following new subparagraph:
``(M) $500,000,000 for each fiscal year after
fiscal year 2025.''.
(b) Redistribution of Unexpended Grant Awards.--Subsection (e)(2)
of section 6071 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a
note) is amended by adding at the end the following new sentence: ``Any
portion of a State grant award for a fiscal year under this section
that is unexpended by the State at the end of the fourth succeeding
fiscal year shall be rescinded by the Secretary and added to the
appropriation for the fifth succeeding fiscal year for grants under
this section.''.
TITLE II--TRAINING, RECRUITMENT, CAREER ADVANCEMENT, AND WORKER
SUPPORTS
Subtitle A--Improving Workforce Training
CHAPTER 1--GRANTS FOR SUPPORTING THE DIRECT CARE PROFESSIONAL WORKFORCE
SEC. 201. DEFINITIONS.
In this chapter:
(1) Eligible entity.--The term ``eligible entity'' means an
entity--
(A) that is--
(i) a State;
(ii) a labor organization, joint labor-
management organization, or employer of direct
care professionals;
(iii) a nonprofit entity with experience in
aging, disability, or supporting the rights and
interests of, the training of, or educating
direct care professionals;
(iv) an Indian Tribe, Tribal organization,
or Urban Indian organization;
(v) a community or technical college or
other institution of higher education; or
(vi) a consortium of entities listed in any
of clauses (i) through (v);
(B) that agrees, as applicable with respect to the
type of grant the entity is seeking under this chapter
and the activities supported through such grant, to
include as advisors and trainers in such activities--
(i) older individuals;
(ii) people with disabilities;
(iii) direct care professionals; and
(iv) family members of such individuals,
persons, or professionals; and
(C) that agrees to consult with the State Medicaid
agency of the State (or each State) served by the grant
on the grant activities, to the extent that such agency
(or each such agency) is not the eligible entity.
(2) Project participant.--The term ``project participant''
means an individual participating in a project or activity
assisted with a grant under this chapter, including (as
applicable for the category of the grant) a direct care
professional or an individual training to be such a
professional.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(4) Supportive services.--The term ``supportive services''
means services that are necessary to enable an individual to
participate in activities assisted with a grant under this
chapter, such as transportation, child care, dependent care,
housing, workplace accommodations, employee benefits such as
paid sick leave and child care, workplace health and safety
protections, wages and overtime pay, and needs-related
payments.
SEC. 202. AUTHORITY TO AWARD GRANTS.
(a) Grants.--
(1) In general.--Not later than 12 months after the date of
enactment of this Act, the Secretary, in consultation with the
Administrator of the Centers for Medicare & Medicaid Services,
the Secretary of Labor, and the Secretary of Education, shall
award grants described in paragraph (2) to eligible entities. A
grant awarded under this section may be in more than 1 category
described in such paragraph.
(2) Categories of grants.--The categories of grants
described in this paragraph are each of the following:
(A) Direct care professionals grants.--Grants to
eligible entities to create and carry out projects for
the purposes of recruiting, retaining, or providing
advancement opportunities for direct care professionals
who are not described in subparagraph (B), (C), or (D),
including through education or training programs for
such professionals or individuals seeking to become
such professionals.
(B) Direct care professional managers grants.--
Grants to eligible entities to create and carry out
projects for the purposes of recruiting, retaining, or
providing advancement opportunities for direct care
professional managers, including through education or
training programs for such managers or individuals
seeking to become such managers.
(C) Self-directed care professionals grants.--
Grants to eligible entities to create and carry out
projects for the purposes of recruiting, retaining, or
providing advancement opportunities for self-directed
care professionals, including through education or
training programs for such professionals or individuals
seeking to become such professionals.
(D) Home and community-based services grants.--
Grants to eligible entities to create and carry out
projects to recruit, retain, or provide advancement
opportunities for home and community-based services
workers providing services and supports to older
individuals, or people with disabilities, who are
eligible for coverage under a State Medicaid program.
(3) Projects for advancement opportunities.--Not less than
30 percent of projects assisted with grants under this chapter
shall be projects to provide career pathways that offer
opportunities for professional development and advancement
opportunities to direct care professionals.
(b) Treatment of Continuation Activities.--An eligible entity that
carries out activities described in subsection (a)(2) prior to receipt
of a grant under this chapter may use such grant to continue carrying
out such activities, and, in using such grant to continue such
activities, shall be treated as an eligible entity carrying out a
project through a grant under this chapter.
SEC. 203. PROJECT PLANS.
(a) In General.--An eligible entity seeking a grant under this
chapter shall submit to the Secretary a project plan for each project
to be developed and carried out (including for activities to be
continued as described in section 202(b)) with the grant. Such project
plan shall be submitted at such time, in such manner, and containing
such information as the Secretary may require.
(b) Contents.--A project plan submitted by an eligible entity under
subsection (a) shall include a description of information determined
relevant by the Secretary for purposes of the category of the grant and
the activities to be carried out through the grant. Such information
may include (as applicable) the following:
(1) Demographic information regarding the population in the
State, city or municipality, or region to be served by the
project, including a description of the populations likely to
need services provided by direct care professionals, such as
people with disabilities and older individuals.
(2) Projections of unmet need for services provided by
direct care professionals based on enrollment waiting lists
under home and community-based waivers under section 1115 of
the Social Security Act (42 U.S.C. 1315) or section 1915(c) of
such Act (42 U.S.C. 1396n(c)) and other relevant data to the
extent practicable and feasible, such as direct care
professional workforce vacancy rates and crude separation rates
and the number of direct care professionals, including such
professionals who are managers or supervisors, in the State or
region to be served by the project.
(3) An advisory committee to advise the eligible entity on
activities to be carried out through the grant. Such advisory
committee--
(A) shall include--
(i) older individuals and people with
disabilities receiving services from the direct
care professionals targeted by the project;
(ii) organizations representing the rights
and interests of people receiving services by
the direct care professionals targeted by the
project;
(iii) individuals who are direct care
professionals targeted by the project and
organizations representing the rights and
interests of such direct care professionals;
(iv) as applicable, employers of
individuals described in clause (iii) and labor
organizations representing such individuals;
(v) representatives of the State Medicaid
agency, the State agency defined in section 102
of the Older Americans Act of 1965 (42 U.S.C.
3002), the State developmental disabilities
office, and the State mental health agency, in
the State (or each State) to be served by the
project;
(vi) parents or caregivers of children with
disabilities or chronic conditions; and
(vii) representatives reflecting diverse
racial, cultural, ethnic, geographic,
socioeconomic, and gender identity and sexual
orientation perspectives; and
(B) may include any other individuals or entities
listed in paragraph (12).
(4) Current or projected job openings for, or relevant
labor market information related to, the direct care
professionals targeted by the project in the State or region to
be served by the project, and the geographic scope of the
workforce to be served by the project.
(5) Specific efforts and strategies that the project will
undertake to reduce barriers to recruitment, retention, or
advancement of the direct care professionals targeted by the
project, including an assurance that such efforts will
include--
(A) an assessment of the wages or other
compensation or benefits necessary to recruit and
retain the direct care professionals targeted by the
project;
(B) a description of the project's projected
compensation or benefits for the direct care
professionals targeted by the project at the State or
local level, including a comparison of such projected
compensation or benefits to regional and national
compensation or benefits and a description of how wages
and benefits received by project participants will be
impacted by the participation in and completion of the
project; and
(C) a description of the projected impact of
workplace safety issues on the recruitment and
retention of direct care professionals targeted by the
project, including the availability of personal
protective equipment.
(6) In the case of a project offering an education or
training program for direct care professionals, a description
of such program (including how the core competencies identified
by the Centers for Medicare & Medicaid Services will be
incorporated, curricula, models, and standards used under the
program, and any associated recognized postsecondary
credentials for which the program provides preparation, as
applicable), which shall include an assurance that such program
will provide to each project participant in such program--
(A) relevant training regarding the rights of
recipients of long-term care services, including their
rights to--
(i) receive services in integrated settings
that provide access to the broader community;
(ii) exercise self-determination;
(iii) be free from all forms of abuse,
neglect, or exploitation; and
(iv) person-centered planning and
practices, including participation in planning
activities;
(B) relevant training to ensure that each project
participant has the necessary skills to recognize abuse
and understand their obligations with regard to
reporting and responding to abuse appropriately in
accordance with relevant Federal and State law;
(C) relevant training regarding the provision of
culturally competent and disability competent supports
to recipients of services provided by the direct care
professionals targeted by the project;
(D) an apprenticeship program, work-based learning,
or on-the-job training opportunities;
(E) supervision or mentoring; and
(F) for any on-the-job training portion of the
program, a progressively increasing, clearly defined
schedule of wages to be paid to each such participant
that--
(i) is consistent with skill gains or
attainment of a recognized postsecondary
credential received as a result of
participation in or completion of such program;
(ii) ensures the entry wage is not less
than the greater of--
(I) the minimum wage required under
section 6(a) of the Fair Labor
Standards Act of 1938 (29 U.S.C.
206(a)); or
(II) the applicable minimum wage
required by other applicable Federal or
State law, or a collective bargaining
agreement; and
(iii) does not use a certificate under
section 14(c) of the Fair Labor Standards Act
of 1938 (29 U.S.C. 214(c)).
(7) Any other innovative models or processes the eligible
entity will implement to support the retention and career
advancement of the direct care professionals targeted by the
project.
(8) The supportive services and benefits to be provided to
the project participants in order to support the employment,
retention, or career advancement of the direct care
professionals targeted by the project.
(9) How the eligible entity will make use of career
planning to support the identification of advancement
opportunities and career pathways for the direct care
professionals in the State or region to be served by the
project.
(10) How the eligible entity will collect and submit to the
Secretary direct care professional workforce data and outcomes
of the project.
(11) How the project--
(A) will--
(i) provide adequate and safe equipment and
facilities for training and supervision,
including a safe work environment free from
discrimination, which may include the provision
of personal protective equipment and other
necessary equipment to prevent the spread of
infectious disease among the direct care
professionals targeted by the project and
recipients of services provided by such
professionals;
(ii) incorporate remote training and
education opportunities or technology-supported
opportunities;
(iii) for training and education curricula,
incorporate evidence-supported practices for
adult learners and universal design for
learning and ensure recipients of services
provided by the direct care professionals
targeted by the project participate in the
development and implementation of such training
and education curricula;
(iv) use outreach, recruitment, and
retention strategies designed to reach and
retain a diverse workforce;
(v) incorporate methods to monitor
satisfaction with project activities for
project participants and individuals receiving
services from such participants; and
(vi) incorporate core competencies
identified by the Centers for Medicare &
Medicaid Services; and
(B) may incorporate continuing education programs
and specialty training, with a specific focus on--
(i) trauma-informed care;
(ii) behavioral health;
(iii) developmental disabilities or other
disabilities involving mental impairment;
(iv) co-occurring behavioral health
conditions and a disability described in clause
(iii);
(v) Alzheimer's and dementia care;
(vi) infection prevention and control
measures;
(vii) chronic disease management;
(viii) age-related conditions; and
(ix) the use of supportive or assistive
technology.
(12) How the eligible entity will consult throughout the
implementation of the project, or coordinate the project with,
each of the following:
(A) Older individuals and people with disabilities.
(B) The State Medicaid agency, the State agency
defined in section 102 of the Older Americans Act of
1965 (42 U.S.C. 3002), and the State developmental
disabilities office for the State (or each State) to be
served by the project.
(C) The local board and State board for each
region, or State, to be served by the project.
(D) In the case of a project that carries out an
education or training program, a nonprofit organization
with demonstrated experience in the development or
delivery of curricula or coursework.
(E) A nonprofit organization, including a labor
organization, that fosters the professional development
and collective engagement of the direct care
professionals targeted by the project.
(F) Organizations representing the rights and
interests of people receiving services by the direct
care professionals targeted by the project.
(G) Area agencies on aging.
(H) Centers for independent living, as described in
part C of chapter I of title VII of the Rehabilitation
Act of 1973 (29 U.S.C. 796f et seq.).
(I) The State Council on Developmental Disabilities
(as such term is used in subtitle B of title I of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (42 U.S.C. 15021 et seq.)) for the
State (or each State) to be served by the project.
(J) Aging and Disability Resource Centers.
(K) A nonprofit State provider association that
represents providers who employ the direct care
professionals targeted by the project, where such
associations exist.
(L) An entity that employs the direct care
professionals targeted by the project.
(M) University Centers for Excellence in
Developmental Disabilities Education, Research, and
Service supported under subtitle D of title I of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (42 U.S.C. 15061 et seq.).
(N) The State protection and advocacy system
described in section 143 of such Act (42 U.S.C. 15043)
of the State (or each State) to be served by the
project.
(O) Direct care professionals, and direct care
professional workforce organizations, representing
underserved communities, including communities of
color.
(P) Individuals employed or working as the direct
care professionals targeted by the project.
(Q) Representatives of such professionals.
(R) Individuals receiving services from such
professionals.
(S) The families of such professionals.
(T) The families of individuals receiving services
from such professionals.
(U) Individuals receiving education or training to
become such professionals.
(13) Outreach efforts to individuals for participation in
such project, including targeted outreach efforts to--
(A) individuals who are recipients of assistance
under a State program funded under part A of title IV
of the Social Security Act (42 U.S.C. 601 et seq.) or
individuals who are eligible for such assistance; and
(B) individuals with a barrier to employment.
(c) Considerations.--In selecting eligible entities to receive a
grant under this chapter, the Secretary shall ensure--
(1) equitable geographic and demographic diversity,
including by selecting recipients serving rural areas and
selecting recipients serving urban areas; and
(2) that selected eligible entities will serve areas where
the occupation of direct care professional, or a related
occupation, is an in-demand industry sector or occupation.
SEC. 204. USES OF FUNDS; SUPPLEMENT, NOT SUPPLANT.
(a) Uses of Funds.--
(1) In general.--Each eligible entity receiving a grant
under this chapter shall use the funds of such grant to carry
out at least 1 project described in section 202(a)(2).
(2) Administrative costs.--Each eligible entity receiving a
grant under this chapter shall not use more than 5 percent of
the funds of such grant for costs associated with the
administration of activities under this chapter.
(3) Direct support.--Each eligible entity receiving a grant
under this chapter shall use not less than 5 percent of the
funds of such grant to provide direct financial benefits or
supportive services to direct care professionals to support the
financial needs of such participants during the duration of the
project activities.
(b) Supplement, Not Supplant.--An eligible entity receiving a grant
under this chapter shall use such grant only to supplement, and not
supplant, the amount of funds that, in the absence of such grant, would
be available to address the recruitment, training and education,
retention, and advancement of direct care professionals, in the State
or region served by the eligible entity.
(c) Prohibition.--No amounts made available under this chapter may
be used for any activity that is subject to the reporting requirements
set forth in section 203(a) of the Labor-Management Reporting and
Disclosure Act of 1959 (29 U.S.C. 433(a)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated for grants under section 202, $500,000,000 for each of
fiscal years 2025 through 2029.
CHAPTER 2--OTHER WORKFORCE TRAINING GRANTS
SEC. 205. WORKFORCE INVESTMENT ACTIVITIES GRANTS FOR DOMESTIC WORKERS.
(a) Definitions.--In this section:
(1) Domestic services.--The term ``domestic services''--
(A) means services--
(i) of a household nature;
(ii) provided in interstate commerce; and
(iii) performed by an individual in or
about a private home (permanent or temporary);
and
(B) includes services performed by individuals such
as companions, housekeepers, nurses, home health aides,
or personal or home care aides.
(2) Domestic worker.--The term ``domestic worker''--
(A) means, except as provided in subparagraph (B),
an individual, including an employee, who is
compensated directly or indirectly for the performance
of domestic services; and
(B) does not include--
(i) an individual who is a family member,
friend, neighbor, or parent of a child and who
provides child care for the child in the
child's home; and
(ii) any employee described in section
13(a)(15) of the Fair Labor Standards Act of
1938 (29 U.S.C. 213(a)(15)).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Labor, in consultation with the Secretary of Education and
the Secretary of Health and Human Services.
(4) Supportive services; training services; workforce
investment activities.--The terms ``supportive services'',
``training services'', and ``workforce investment activities''
have the meanings given the terms in section 3 of the Workforce
Innovation and Opportunity Act (29 U.S.C. 3102).
(b) National Grant Program for Domestic Workers.--Every 3 years,
the Secretary shall, on a competitive basis, make grants to, or enter
into contracts with, eligible entities to carry out the activities
described in subsection (d). The Secretary shall make the grants, or
enter into the contracts, for periods of 4 years.
(c) Eligibility.--
(1) Eligible entities.--To be eligible to receive a grant
or enter into a contract under this section, an entity--
(A) shall have experience working with older
individuals or people with disabilities; and
(B) shall be--
(i)(I) a nonprofit organization that is
described in paragraph (3), (5), or (6) of
section 501(c) of the Internal Revenue Code of
1986, and exempt from taxation under section
501(a) of such Code;
(II) an organization with a board of
directors, at least one-half of the members of
which is comprised of--
(aa) domestic workers; or
(bb) representatives of an
organization of such workers, including
such workers who are direct care
professionals, which organization is
independent from all businesses,
organizations, corporations, or
individuals that would pursue any
financial interest in conflict with
that of the workers;
(III) an organization that is independent
as described in subclause (II)(bb); and
(IV) an organization that has expertise in
domestic work and the workforce of domestic
workers, including such workers who are direct
care professionals;
(ii) an eligible provider of training
services listed pursuant to section 122(d) of
the Workforce Innovation and Opportunity Act
(29 U.S.C. 3152(d)); or
(iii) an entity that carries out an
apprenticeship program.
(2) Program plan.--
(A) In general.--To be eligible to receive a grant
or enter into a contract under this section, an entity
described in paragraph (1) shall submit to the
Secretary of Labor a plan that describes a 4-year
strategy for meeting the needs of domestic workers,
including such workers who are direct care
professionals, in the area to be served by such entity.
(B) Contents.--Such plan shall--
(i) describe the domestic worker
population, which shall include domestic
workers who provide long-term care services, to
be served and identify the needs of such
population to be served for workforce
investment activities and related assistance,
which may include employment and supportive
services;
(ii) identify the manner in which career
pathways to be provided will strengthen the
ability of the domestic workers to be served to
obtain or retain employment and to improve
wages or working conditions, including improved
employment standards and opportunities in the
field of domestic work;
(iii) specifically address how the funding
provided through the grant or contract for
services under this section to domestic workers
will improve wages and skills for domestic
workers in a way that helps meet the need to
recruit workers for and retain workers in in-
demand occupations or careers; and
(iv) provide an assurance that the
workforce investment activities and related
assistance carried out under this section will
include relevant training for domestic workers
who are direct care professionals, including--
(I) training regarding the rights
of recipients of long-term care
services, including the rights of such
recipients to--
(aa) receive services in
integrated settings that
provide access to the broader
community;
(bb) exercise self-
determination;
(cc) be free from all forms
of abuse, neglect, or
exploitation; and
(dd) receive person-
centered planning and
practices, including through
the participation of such
recipients in planning
activities;
(II) training to ensure that each
participant of such training has the
necessary skills to recognize abuse and
understand their obligations with
regard to reporting and responding to
abuse appropriately in accordance with
relevant Federal and State law; and
(III) training regarding the
provision of culturally competent and
disability-competent supports to
recipients of long-term care services.
(3) Awards and administration.--The grants and contracts
under this subsection shall be awarded by the Secretary using
full and open competitive procedures and shall be administered
by the Secretary.
(d) Authorized Activities.--Funds made available under this section
shall be used to carry out workforce investment activities and provide
related assistance for domestic workers, including such workers who are
direct care professionals, which may include--
(1) outreach, employment, training services, educational
assistance, digital literacy assistance, English language and
literacy instruction, worker safety training, supportive
services, school dropout prevention and recovery activities,
individual career services, and career pathways;
(2) follow-up services for those individuals placed in
employment;
(3) development or education as needed by domestic workers,
including domestic workers who are direct care professionals;
(4) customized career and technical education in
occupations that will lead to higher wages, enhanced benefits,
and long-term employment in domestic work or another area; and
(5) the creation or maintenance of employment and training-
related placement services, including digital placement
services.
(e) Funding Allocation.--From the funds appropriated and made
available to carry out this section, the Secretary shall reserve not
more than 1 percent for discretionary purposes related to carrying out
this section, such as providing technical assistance to eligible
entities.
(f) Eligible Provider Performance Reports.--Each eligible entity
shall prepare performance reports to report on outcomes achieved by the
programs of workforce investment activities and related assistance
carried out under this section. The performance report for an eligible
entity shall include, with respect to each such program (referred to in
this subsection as a ``program of study'') of such entity--
(1) information specifying the levels of performance
achieved with respect to the primary indicators of performance
described in subclauses (I) through (V) of section
116(b)(2)(A)(i) of the Workforce Innovation and Opportunity Act
(29 U.S.C. 3141(b)(2)(A)(i)) with respect to all individuals
engaging in the program of study;
(2) the total number of individuals exiting from the
program of study;
(3) the total number of participants who received training
services through the program;
(4) the total number of participants who exited from
training services, disaggregated by the type of entity that
provided the training services, during the most recent program
year and the 3 preceding program years;
(5) the average cost per participant for the participants
who received training services, disaggregated by the type of
entity that provided the training services, during the most
recent program year and the 3 preceding program years; and
(6) information on indicators specified by the Secretary
concerning the impact of the training services on the wages,
skills, recruitment, and retention of participants.
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2025 through 2029.
SEC. 206. DIRECT CARE PROFESSIONAL CAREER ADVANCEMENT DEMONSTRATION
PROJECTS.
(a) In General.--Section 2008 of the Social Security Act (42 U.S.C.
1397g) is amended--
(1) by adding at the end the following new subsection:
``(e) Direct Care Professional Career Advancement Demonstration
Projects.--
``(1) In general.--The Secretary, in consultation with the
Secretary of Labor, shall award, from the amount appropriated
under paragraph (4), grants to eligible entities to conduct
demonstration projects that are designed to provide eligible
individuals with opportunities for education, training, and
career advancement as a direct care professional, including as
a personal or home care aide, home health aide, or nursing aide
or assistant.
``(2) Definitions.--In this subsection:
``(A) Eligible entity.--The term `eligible entity'
has the meaning given such term in subsection (a).
``(B) Eligible individual.--The term `eligible
individual' means an individual--
``(i) whose income does not exceed 200
percent of the poverty line (as defined in
section 2110(c)(5)) applicable to a family of
the size involved; and
``(ii) who is employed as a direct care
professional who--
``(I) has at least 30 percent
patient volume (as estimated in
accordance with a methodology
established by the Secretary)
attributable to individuals who are
receiving medical assistance under
title XIX; or
``(II) is employed by an agency
that is a provider of personal or home
care services that has at least 30
percent of the agency's patient volume
(as so estimated) attributable to such
individuals.
``(C) Direct care professional.--The term `direct
care professional' has the meaning given such term in
section 3 of the Long-Term Care Workforce Support Act.
``(3) Requirements.--
``(A) Prioritization of projects that support rural
areas, underserved areas, and women, individuals from
communities of color, and individuals with
disabilities.--The Secretary shall ensure that not less
than half of the demonstration projects supported by
grants awarded under this subsection support--
``(i) eligible individuals in rural areas
(as defined in section 2007(f)(5));
``(ii) eligible individuals in underserved
urban areas (including urban health
professional shortage areas (as defined in
section 332 of the Public Health Service Act);
``(iii) eligible individuals who are women,
who are from communities of color, or who
belong to other underserved and diverse
populations such as Asian, Pacific Islander,
Native American, or Alaska Native communities;
and
``(iv) eligible individuals with
disabilities.
``(B) Amount of grant.--In no case shall the
Secretary award an eligible entity a grant to conduct a
demonstration project under this subsection in an
amount that exceeds $750,000 for each year that the
entity conducts such project.
``(C) Reports.--
``(i) Interim reports.--An eligible entity
awarded a grant to conduct a demonstration
project under this subsection shall submit
interim reports to the Secretary on the
activities carried out under the project and a
final report on such activities upon the
conclusion of the entities' participation in
the project.
``(ii) Evaluation.--The Administrator of
the Health Resources and Services
Administration shall evaluate the demonstration
projects conducted under this subsection. Such
evaluation shall include identification of
successful activities for creating
opportunities for developing and sustaining,
particularly with respect to low-income
individuals and direct care professionals, a
health or human services professions workforce
that has accessible opportunities for career
advancement, that meets high standards for
education, training, certification, and
professional development, that provides
increased wages and affordable benefits,
including health care coverage, that are
responsive to the workforce's needs, and that
is responsive to the needs of diverse racial
and ethnic communities.
``(iii) Report to congress.--Not later than
1 year after the demonstration projects
conducted under this subsection conclude, the
Secretary shall submit a final report to
Congress on such demonstration projects that
includes--
``(I) the result of the evaluation
conducted under clause (ii);
``(II) recommendations for best
practices; and
``(III) such recommendations for
legislation or administrative actions
as the Secretary deems appropriate.
``(iv) Additional report.--Not later than 1
year after the demonstration projects conducted
under this subsection conclude, the Secretary
shall submit to the Committee on Health,
Education, Labor, and Pensions and the Special
Committee on Aging of the Senate and the
Committee on Education and the Workforce and
the Committee on Energy and Commerce of the
House of Representatives and make publicly
available, a report on the activities and
results of such projects. Such report shall
describe--
``(I) the number and geographic
distribution of the grants awarded
under this subsection;
``(II) the participation of
underrepresented and economically
disadvantaged participants in
demonstration projects conducted under
this subsection; and
``(III) recommendations for program
revisions to achieve the desired
program outcome.
``(4) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
to carry out this subsection $10,000,000 for each of fiscal
years 2025 through 2029.''.
(b) Incentive Payments for Long-Term Care Services Furnished by
Direct Care Professionals Who Complete Certain Training.--Section 1834
of the Social Security Act (42 U.S.C. 1395m) is amended by adding at
the end the following new subsection:
``(aa) Incentive Payments for Direct Care Services Furnished by
Direct Care Professionals Who Complete Certain Training.--In the case
of long-term care services furnished on or after October 1, 2025, by a
direct care professional who has successfully completed education or
training under a demonstration project under section 2008(e), in
addition to the amount of payment that would otherwise be made for such
services under this part, there also shall be paid an amount equal to
25 percent of the payment amount for the service under this part to be
paid to the direct care professional.''.
SEC. 207. PATHWAYS TO HEALTH CAREERS.
Effective October 1, 2024, title XX of the Social Security Act (42
U.S.C. 1397-1397n-13) is amended by adding at the end the following:
``Subtitle D--Career Pathways Through Health Profession Opportunity
Grants
``SEC. 2071. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY
GRANTS.
``(a) Application Requirements.--An eligible entity desiring a
grant under this section for a project shall submit to the Secretary an
application for the grant, that includes the following:
``(1) A description of how the applicant will use a career
pathways approach to train eligible individuals for health
professions, including direct care professionals, that will put
eligible individuals on a career path to an occupation that
pays well, under the project.
``(2) A description of the adult basic education and
literacy activities, work readiness activities, training
activities, and case management, career coaching, and mentoring
support services that the applicant will use to assist eligible
individuals to gain work experience, connection to employers,
and job placement, and a description of the plan for
recruiting, hiring, and training staff to provide the case
management, mentoring, and career coaching services, under the
project directly or through local governmental, apprenticeship,
educational, or charitable institutions.
``(3) A demonstration that the applicant has experience
working with low-income populations, or a description of the
plan of the applicant to work with a partner organization that
has the experience.
``(4) A plan for providing post-employment support and
ongoing training as part of a career pathway under the project.
``(5) A description of the support services that the
applicant will provide under the project, including a plan for
how child care and transportation support services will be
guaranteed and, if the applicant will provide a cash stipend or
wage supplement, how the stipend or supplement would be
calculated and distributed.
``(6) A certification by the applicant that the project
development included--
``(A) consultation or commitment to consult with a
local workforce development board;
``(B) consideration of registered apprenticeship
and pre-apprenticeship models;
``(C) consideration of career pathway programs in
the State in which the project is to be conducted; and
``(D) a review of the State plan under section 102
or 103 of the Workforce Innovation and Opportunity Act.
``(7) A description of the availability and relevance of
recent labor market information and other pertinent evidence of
in-demand jobs or worker shortages.
``(8) A certification that the applicant will directly
provide or contract for the training services described in the
application.
``(9) A commitment by the applicant that, if the grant is
made to the applicant, the applicant will--
``(A) during the planning period for the project,
provide the Secretary with any information needed by
the Secretary to establish adequate data reporting and
administrative structure for the project;
``(B) hire a person to direct the project not later
than the end of the planning period applicable to the
project;
``(C) accept all technical assistance offered by
the Secretary with respect to the grant;
``(D) participate in peer technical assistance
conferences as are regularly scheduled by the
Secretary; and
``(E) provide all data required by the Secretary
under subsection (g).
``(b) Additional Application Element.--In considering applications
for a grant under this section, the Secretary shall require qualified
applicants to have at least 1 of the following application elements:
``(1) Applications submitted by applicants to whom a grant
was made under this section or any predecessor to this section.
``(2) Applications submitted by applicants who have
business and community partners in each of the following
categories:
``(A) State and local government agencies and
social service providers, including a State or local
entity that administers a State program funded under
part A of this title.
``(B) Institutions of higher education,
apprenticeship programs, and local workforce
development boards.
``(C) Health care employers, home and community-
based services agencies, health care industry or sector
partnerships, labor unions, and labor-management
partnerships.
``(3) Applications that include opportunities for mentoring
or peer support, and make career coaching available, as part of
the case management plan.
``(4) Applications which describe a project that will serve
a rural area in which--
``(A) the community in which the individuals to be
enrolled in the project reside is located;
``(B) the project will be conducted; or
``(C) an employer partnership that has committed to
hiring individuals who successfully complete all
activities under the project is located.
``(5) Applications that include a commitment to providing
project participants with a cash stipend or wage supplement.
``(6) Applications submitted by applicants who are serving
or situated in communities of color and other underserved
communities.
``(7) Applications which have an emergency cash fund to
assist project participants financially in emergency
situations.
``(c) Grants.--
``(1) Competitive grants.--
``(A) Grant authority.--
``(i) In general.--The Secretary shall make
a grant in accordance with this paragraph to an
eligible entity whose application for the grant
is approved by the Secretary, to conduct a
project designed to train low-income
individuals for allied health professions,
health information technology, physician
assistants, nursing assistants, licensed
practical/vocational nurse, registered nurse,
advanced practice nurse, direct care
professionals, and other professions considered
part of a health care career pathway model.
``(ii) Guarantee of grantees in each state
and the district of columbia.--For each grant
cycle, the Secretary shall award a grant under
this paragraph to at least 2 eligible entities
in each State that is not a territory, to the
extent there are a sufficient number of
applications that have a high likelihood of
success and that are submitted by the entities
that meet the requirements applicable with
respect to such a grant. If, for a grant cycle,
there are fewer than 2 such eligible entities
in a State that have submitted applications
with a high likelihood of success, the
Secretary shall identify qualified eligible
applicants located elsewhere, that are
otherwise approved but un-funded, and issue a
Substitution of Grant and tailored technical
assistance. In the preceding sentence, the term
`issue a Substitution of Grant' means, in a
case in which an approved grantee does not
complete its full project period, or in which
there are fewer than 2 qualified grantees per
State with a high likelihood of success,
substitute an applicant located in another
State that was approved but un-funded during
the competition for the award for the award
recipient.
``(B) Guarantee of grants for indian populations.--
The Secretary shall award a grant under this paragraph
to at least 10 eligible entities that are an Indian
tribe, a tribal organization, or a tribal college or
university, to the extent there are a sufficient number
of applications submitted by the entities that meet the
requirements applicable with respect to such a grant.
``(C) Guarantee of grantees in the territories.--
The Secretary shall award a grant under this paragraph
to at least 2 eligible entities that are located in a
territory, to the extent there are a sufficient number
of applications submitted by the entities that meet the
requirements applicable with respect to such a grant.
``(2) Grant cycle.--The grant cycle under this section
shall be not less than 5 years, with a planning period of not
more than the first 12 months of the grant cycle. During the
planning period, the amount of the grant shall be in such
lesser amount as the Secretary determines appropriate.
``(d) Use of Grant.--
``(1) In general.--An entity to which a grant is made under
this section shall use the grant in accordance with the
approved application for the grant.
``(2) Support to be provided.--
``(A) Required support.--A project for which a
grant is made under this section shall include the
following:
``(i) An assessment for adult basic skill
competency, and provision of adult basic skills
education if necessary for eligible individuals
to enroll in the project and go on to enter and
complete post-secondary training, through means
including the following:
``(I) Establishing a network of
partners that offer pre-training
activities for project participants who
need to improve basic academic skills
or English language proficiency before
entering a health occupational training
career pathway program.
``(II) Offering resources to enable
project participants to continue
advancing adult basic skill proficiency
while enrolled in a career pathway
program.
``(III) Embedding adult basic skill
maintenance as part of ongoing post-
graduation career coaching and
mentoring.
``(ii) A guarantee that child care and
transportation are available and affordable
support services for project participants
through means such as the following:
``(I) Referral to, and assistance
with, enrollment in a subsidized child
care program.
``(II) Direct payment to a child
care provider if a slot in a subsidized
child care program is not available or
reasonably accessible.
``(III) Payment of co-payments or
associated fees for child care and
transportation.
``(iii) Case management plans that include
career coaching (with the option to offer
appropriate peer support and mentoring
opportunities to help develop soft skills and
social capital), which may be offered on an
ongoing basis before, during, and after initial
training as part of a career pathway model.
``(iv) A plan to provide project
participants with transportation through means
such as the following:
``(I) Referral to, and assistance
with enrollment in, a subsidized
transportation program.
``(II) If a subsidized
transportation program is not
reasonably available, direct payments
to subsidize transportation costs.
``(B) Transportation.--For purposes of this
paragraph, the term `transportation' includes public
transit, or gasoline for a personal vehicle if public
transit is not reasonably accessible or available.
``(C) Allowed support.--The goods and services
provided under a project for which a grant is made
under this section may include the following:
``(i) A cash stipend.
``(ii) A reserve fund for financial
assistance to project participants in emergency
situations.
``(iii) Tuition, certification exam fees,
and training materials such as books, software,
uniforms, shoes, connection to the internet,
hair nets, and personal protective equipment.
``(iv) In-kind resource donations such as
interview clothing and conference attendance
fees.
``(v) Assistance with accessing and
completing high school equivalency or adult
basic education courses as necessary to achieve
success in the project and make progress toward
career goals.
``(vi) Other support services as deemed
necessary for family well-being, success in the
project, and progress toward career goals.
``(3) Training.--The number of hours of training provided
to an eligible individual under a project for which a grant is
made under this section, for a recognized postsecondary
credential (including an industry-recognized credential, and a
certificate awarded by a local workforce development board),
which is awarded in recognition of attainment of measurable
technical or occupational skills necessary to gain employment
or advance within an occupation, shall be--
``(A) not less than the number of hours of training
required for certification in that level of skill by
the State in which the project is conducted; or
``(B) if there is no such requirement, such number
of hours of training as the Secretary finds is
necessary to achieve that skill level.
``(4) Inclusion of tanf recipients.--In the case of a
project for which a grant is made under this section that is
conducted in a State that has a program funded under part A of
title IV, at least 10 percent of the eligible individuals to
whom support is provided under the project shall meet the
income eligibility requirements under that State program,
without regard to whether the individuals receive benefits or
services directly under that State program.
``(5) Income limitation.--An entity to which a grant is
made under this section shall not use the grant to provide
support to a person who is not an eligible individual.
``(6) Prohibition.--An entity to which a grant is made
under this section shall not use the grant for purposes of
entertainment, except that case management and career coaching
services may include celebrations of specific career-based
milestones such as completing a semester, graduation, or job
placement.
``(e) Technical Assistance.--
``(1) In general.--The Secretary shall provide technical
assistance--
``(A) to assist eligible entities in applying for
grants under this section;
``(B) that is tailored to meet the needs of
grantees at each stage of the administration of
projects for which grants are made under this section;
``(C) that is tailored to meet the specific needs
of Indian tribes, tribal organizations, and tribal
colleges and universities;
``(D) that is tailored to meet the specific needs
of the territories;
``(E) that is tailored to meet the specific needs
of applicants, eligible entities, and grantees, in
carrying out dedicated career pathway projects pursuant
to subsection (h); and
``(F) to facilitate the exchange of information
among eligible entities regarding best practices and
promising practices used in the projects.
``(2) Continuation of peer technical assistance
conferences.--The Secretary shall continue to hold peer
technical assistance conferences for entities to which a grant
is made under this section or was made under the immediate
predecessor of this section. The preceding sentence shall not
be interpreted to require any such conference to be held in
person.
``(f) Evaluation of Dedicated Career Pathways.--
``(1) In general.--The Secretary shall, by grant, contract,
or interagency agreement, conduct rigorous and well-designed
evaluations of the dedicated career pathway projects carried
out pursuant to subsection (h).
``(2) Requirement applicable to second chance career
pathway.--In the case of a project of the type described in
subsection (i), the evaluation shall include identification of
successful activities for creating opportunities for developing
and sustaining, particularly with respect to low-income
individuals with arrest or conviction records, a health
professions workforce that has accessible entry points, that
meets high standards for education, training, certification,
and professional development, and that provides increased wages
and affordable benefits, including health care coverage, that
are responsive to the needs of the workforce.
``(g) Reports.--As a condition of funding, an eligible entity
awarded a grant to conduct a project under this section shall submit
interim reports to the Secretary on the activities carried out under
the project, and, on the conclusion of the project, a final report on
the activities.
``(h) Second Chance Career Pathway.--
``(1) Grant authority.--The Secretary shall award grants in
accordance with this subsection to eligible entities to conduct
career pathway projects for the purpose of providing education
and training for eligible individuals with arrest or conviction
records to enter and follow a career pathway in the health
professions through occupations that are expected to experience
a labor shortage or be in high demand.
``(2) Duration.--A grant awarded under this subsection
shall have the same grant cycle as is provided in subsection
(c)(2), and as a condition of funding the grantee shall comply
with all data reporting requirements associated with the grant
cycle.
``(3) Application requirements.--An entity seeking a grant
under this subsection for a project shall submit to the
Secretary an application for the grant, that includes the
following:
``(A) A demonstration that the State in which the
project is to be conducted has in effect policies or
laws that permit certain allied health and behavioral
health care credentials to be awarded to people with
certain arrest or conviction records (which policies or
laws shall include appeals processes and other
opportunities to demonstrate rehabilitation to obtain
licensure and approval to work in the proposed health
careers), and a plan described in the application which
will use a legally permitted career pathway to train
people with such a record to be trained and employed in
such a career.
``(B) A discussion of how the project or future
strategic hiring decisions will demonstrate the
experience and expertise of the project in working with
job seekers who have arrest or conviction records or
employers with experience working with people with
arrest or conviction records.
``(C) A demonstration that the applicant has
experience working with low-income populations, or a
description of the plan of the applicant to work with a
partner that has the experience.
``(D) An identification of promising innovations or
best practices that can be used to provide the
training.
``(E) A proof of concept or demonstration that the
applicant has done sufficient research on workforce
shortage or in-demand jobs for which people with
certain types of criminal records can be hired.
``(F) A plan for recruiting students who are
eligible individuals into the project.
``(G) A plan for providing post-employment support
and ongoing training as part of a career pathway under
the project.
``(4) Support to be provided.--A recipient of a grant under
this subsection for a project shall provide--
``(A) access to legal assistance for project
participants for the purpose of addressing arrest or
conviction records and associated workforce barriers;
``(B) assistance with programs and activities
deemed necessary to address arrest or conviction
records as an employment barrier; and
``(C) required supportive services described in
subsection (d)(2)(A) to participants who need the
services, and may expend funds on eligible supportive
services described in subsection (d)(2)(B).
``(i) Definitions.--In this section:
``(1) Allied health profession.--The term `allied health
profession' has the meaning given in section 799B(5) of the
Public Health Service Act.
``(2) Career pathway.--The term `career pathway' has the
meaning given that term in section 3(7) of the Workforce
Innovation and Opportunity Act.
``(3) Direct care professional.--The term `direct care
professional' has the meaning given such term in section 3 of
the Long-Term Care Workforce Support Act.
``(4) Eligible entity.--The term `eligible entity' means
any of the following entities that demonstrates in an
application submitted under this section that the entity has
the capacity to fully develop and administer the project
described in the application:
``(A) A local workforce development board
established under section 107 of the Workforce
Innovation and Opportunity Act.
``(B) A State or territory, a political subdivision
of a State or territory, or an agency of a State,
territory, or such a political subdivision, including a
State or local entity that administers a State program
funded under part A of this title.
``(C) An Indian tribe, a tribal organization, or a
tribal college or university.
``(D) An institution of higher education (as
defined in the Higher Education Act of 1965).
``(E) A hospital (as defined in section 1861(e)).
``(F) A high-quality skilled nursing facility.
``(G) A Federally qualified health center (as
defined in section 1861(aa)(4)).
``(H) A nonprofit organization described in section
501(c)(3) of the Internal Revenue Code of 1986, a labor
organization, or an entity with shared labor-management
oversight, that has a demonstrated history of providing
health profession training to eligible individuals.
``(I) An opioid treatment program (as defined in
section 1861(jjj)(2)), and other comprehensive
addiction care providers.
``(J) A home and community-based services provider
agency.
``(5) Eligible individual.--The term `eligible individual'
means an individual whose family income does not exceed 200
percent of the Federal poverty level and has not been charged
with or convicted of a violent crime or financial fraud (as
determined by the Secretary).
``(6) Federal poverty level.--The term `Federal poverty
level' means the poverty line (as defined in section 673(2) of
the Omnibus Budget Reconciliation Act of 1981, including any
revision required by such section applicable to a family of the
size involved).
``(7) Indian tribe; tribal organization.--The terms `Indian
tribe' and `tribal organization' have the meaning given the
terms in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b).
``(8) Institution of higher education.--The term
`institution of higher education' has the meaning given the
term in section 101 or 102(a)(1)(B) of the Higher Education Act
of 1965.
``(9) Territory.--The term `territory' means the
Commonwealth of Puerto Rico, the United States Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa.
``(10) Tribal college or university.--The term `tribal
college or university' has the meaning given the term in
section 316(b) of the Higher Education Act of 1965.
``(j) Evaluation.--The Secretary of Health and Human Services, in
conjunction with the Secretary of Labor, shall evaluate the
implementation and outcomes of this section on the adoption of paid
leave by long-term care services providers and the recruitment and
retention of direct care professionals through a contract with an
external evaluator who has experience with evaluation of labor
practices and people with disabilities and older individuals.
``(k) Funding.--In addition to amounts otherwise available, there
is appropriated to the Secretary--
``(1) $318,750,000 for grants under subsection (c)(1)(A)
for each of fiscal years 2025 through 2029;
``(2) $17,000,000 for grants under subsection (c)(1)(B) for
each of fiscal years 2025 through 2029;
``(3) $21,250,000 for grants under subsection (c)(1)(C) for
each of fiscal years 2025 through 2029;
``(4) $25,500,000 for projects conducted under subsection
(h) for each of fiscal years 2025 through 2029;
``(5) $25,500,000, plus all amounts referred to in
paragraphs (1) through (4) of this subsection that remain
unused after all grant awards are made for the fiscal year, for
each of fiscal years 2025 through 2029, for the provision of
technical assistance and administration; and
``(6) $17,000,000 for each of fiscal years 2025 through
2029 for studying the effects of the projects for which a grant
is made under this section, and for administration, for the
purpose of supporting the rigorous evaluation of the projects,
and supporting the continued study of the short-, medium-, and
long-term effects of all such projects, including the
effectiveness of new or added elements of the projects.''.
SEC. 208. INCREASING WORKFORCE DIVERSITY IN ALLIED HEALTH PROFESSIONALS
AND DIRECT SUPPORT PROFESSIONALS.
Title VII of the Public Health Service Act is amended--
(1) by redesignating part G (42 U.S.C. 295j et seq.) as
part H; and
(2) by inserting after part F (42 U.S.C. 295h et seq.) the
following new part:
``PART G--INCREASING WORKFORCE DIVERSITY IN ALLIED HEALTH PROFESSIONALS
AND DIRECT CARE PROFESSIONALS
``SEC. 783. SCHOLARSHIPS AND STIPENDS.
``(a) In General.--The Secretary may award grants and contracts to
eligible entities to increase educational opportunities in the
professions of physical therapy, occupational therapy, respiratory
therapy, audiology, speech-language pathology, and direct care
professionals for eligible individuals by--
``(1) providing student scholarships or stipends, including
for--
``(A) completion of an accelerated degree program;
``(B) completion of an associate's, bachelor's,
master's, or doctoral degree program; and
``(C) entry by a diploma or associate's degree
practitioner into a bridge or degree completion
program;
``(2) providing assistance for completion of prerequisite
courses or other preparation necessary for acceptance for
enrollment in the eligible entity;
``(3) carrying out activities to increase the retention of
students in 1 or more programs in the professions of physical
therapy, occupational therapy, respiratory therapy, audiology,
speech-language pathology, and direct care professionals; and
``(4) building or strengthening career pipeline programs,
including those for high school students, older workers and
retirees, veterans, and other displaced workers.
``(b) Consideration of Recommendations.--In carrying out subsection
(a), the Secretary shall take into consideration the recommendations of
national organizations representing the professions of physical
therapy, occupational therapy, respiratory therapy, audiology, speech-
language pathology, and direct care professionals, including the
American Physical Therapy Association, the American Occupational
Therapy Association, the American Speech-Language-Hearing Association,
the American Association for Respiratory Care, the American Academy of
Audiology, the Academy of Doctors of Audiology, and the National
Alliance for Direct Support Professionals.
``(c) Required Information and Conditions for Award Recipients.--
``(1) In general.--The Secretary may require recipients of
awards under this section to report to the Secretary concerning
the annual admission, retention, and graduation rates for
eligible individuals in programs of the recipient leading to a
degree in any of the professions of physical therapy,
occupational therapy, respiratory therapy, audiology, speech-
language pathology, and direct care professionals.
``(2) Falling rates.--If any of the rates reported by a
recipient under paragraph (1) fall below the average for such
recipient over the 2 years preceding the year covered by the
report, the recipient shall provide the Secretary with plans
for immediately improving such rates.
``(3) Ineligibility.--A recipient described in paragraph
(2) shall be ineligible for continued funding under this
section if the plan of the recipient fails to improve the rates
within the 1-year period beginning on the date such plan is
implemented.
``(d) Evaluation.--
``(1) In general.--In accordance with paragraph (2), the
Secretary, in conjunction with the Secretary of Labor, shall
evaluate the implementation and outcomes of this section on the
recruitment and retention in long-term care settings of
certified nursing assistants, physical therapists, occupational
therapists, audiologists, speech-language pathologists,
respiratory therapists, direct support professionals, and any
other direct care professionals determined by the Secretary.
``(2) External evaluator.--The Secretary shall conduct the
evaluation under paragraph (1) through a contract with an
external evaluator who has experience with evaluation related
to people with disabilities and older individuals.
``(e) Definitions.--In this section:
``(1) Direct care professional; disability.--The terms
`direct care professional' and `disability' have the meanings
given such terms in section 3 of the Long-Term Care Workforce
Support Act.
``(2) Eligible entity.--The term `eligible entity' means an
education program that--
``(A) is accredited by--
``(i) the Council on Academic Accreditation
in Audiology and Speech-Language Pathology or
the Accreditation Commission for Audiology
Education;
``(ii) the Commission on Accreditation in
Physical Therapy Education;
``(iii) the Accreditation Council for
Occupational Therapy Education;
``(iv) the Commission on Accreditation for
Respiratory Care; or
``(v) the National Alliance for Direct
Support Professionals Certification Program;
and
``(B) is carrying out a program for recruiting and
retaining students underrepresented in the professions
of physical therapy, occupational therapy, respiratory
therapy, audiology, speech-language pathology, and
direct care professionals (including racial or ethnic
minorities, students with disabilities, or students
from disadvantaged backgrounds).
``(3) Eligible individual.--The term `eligible individual'
means an individual who--
``(A) is a member of a class of persons who are
underrepresented in the professions of physical
therapy, occupational therapy, respiratory therapy,
audiology, speech-language pathology, and direct care
professionals, including--
``(i) individuals who are racial or ethnic
minorities; or
``(ii) individuals who are from
disadvantaged backgrounds;
``(B) has a financial need for a scholarship or
stipend; and
``(C) is enrolled (or accepted for enrollment) at a
physical therapy, occupational therapy, respiratory
therapy, audiology, speech-language pathology, or
direct care professionals program as a full-time
student at an eligible entity.
``(4) Individualized education program.--The term
`individualized education program' has the meaning given such
term in section 602 of the Individuals with Disabilities
Education Act.
``(5) Long-term care setting.--The term `long-term care
setting' has the meaning given such term in section 3 of the
Long-Term Care Workforce Support Act.
``(6) Older individual.--The term `older individual' has
the meaning given such term in section 102 of the Older
Americans Act of 1965.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2025 through 2029.''.
Subtitle B--Improving Workforce Recruitment
SEC. 211. TECHNICAL ASSISTANCE CENTER FOR BUILDING THE DIRECT CARE
PROFESSIONAL WORKFORCE.
(a) Grant Program Authorized.--
(1) In general.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall award
a grant, on a competitive basis, to an eligible partnership
described in subsection (b) to create a national technical
assistance center (referred to in this section as the
``Center'') for supporting direct care professional workforce
creation, training and education, recruitment, retention, and
advancement, including through the activities under subsection
(c).
(2) Consultation.--The Center shall carry out activities
under this section in consultation with the Secretary of Labor,
the Secretary of Education, the Secretary of Veterans Affairs,
the Administrator of the Administration for Community Living,
the Administrator of the Centers for Medicare & Medicaid
Services, the Administrator of the Health Resources and
Services Administration, and the heads of other entities as
necessary.
(b) Eligible Partnerships.--
(1) In general.--An eligible partnership described in this
subsection is a partnership of 3 or more of the following:
(A) An institution of higher education.
(B) A disability-led organization.
(C) An organization focusing on older individuals.
(D) An organization focusing on direct care
professionals.
(E) An organization that represents service
provider agencies that employ direct care
professionals.
(F) An organization, including a labor
organization, that fosters professional development.
(G) A University Center for Excellence in
Developmental Disabilities Education, Research, and
Service supported under subtitle D of title I of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (42 U.S.C. 15061 et seq.).
(H) An agency implementing a State protection and
advocacy system described in section 143 of such Act
(42 U.S.C. 15043).
(I) A State Council on Developmental Disabilities
(as such term is used in subtitle B of title I of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (42 U.S.C. 15021 et seq.)).
(J) An organization representing a center for
independent living, as described in part C of title VII
of the Rehabilitation Act of 1973 (29 U.S.C. 796f et
seq.).
(K) An organization representing veterans.
(L) An organization representing parents or
caregivers of children with disabilities or chronic
conditions.
(M) Any other entity the Secretary designates as
important to improving the direct care professional
workforce.
(2) Applications.--To be eligible for a grant under this
section, an eligible partnership described in paragraph (1)
shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary
may require.
(c) Activities.--The Center may--
(1) develop recommendations for training and education
curricula for direct care professionals, which such
recommendations may include recommendations for curricula for
higher education, postsecondary credentials, and programs with
community and technical colleges;
(2) develop learning and dissemination strategies to--
(A) engage States and other entities in activities
supported under this section and best practices for
supporting the direct care professional workforce; and
(B) distribute findings from activities supported
by the grant under this section;
(3) explore the national data gaps, workforce shortage
areas, and data collection strategies for direct care
professionals and make recommendations to the Director of the
Office of Management and Budget for an occupation category in
the Standard Occupational Classification system for direct care
professionals as a healthcare support occupation; and
(4) recommend career development and advancement
opportunities for direct care professionals, which may include
occupational frameworks, national standards, recruitment
campaigns, pre-apprenticeship and on-the-job training
opportunities, apprenticeship programs, career pathways,
specializations or certifications, educational information
about career opportunities in long-term care settings, or other
activities.
(d) Advisory Council.--
(1) In general.--The Secretary shall convene an advisory
council to provide recommendations to the Center with respect
to the duties of the Center under this section and may engage
individuals described in paragraph (2) for service on the
advisory council.
(2) Individuals.--The individuals described in this
paragraph include--
(A) older individuals and people with disabilities;
(B) organizations representing the rights and
interests of people receiving services from direct care
professionals;
(C) individuals who are direct care professionals
and organizations representing the rights and interests
of direct care professionals;
(D) as applicable, employers of individuals
described in subparagraph (C) and labor organizations
representing such individuals;
(E) representatives of State Medicaid agencies,
State agencies defined in section 102 of the Older
Americans Act of 1965 (42 U.S.C. 3002), State
developmental disabilities offices, and State mental
health agencies;
(F) representatives reflecting diverse racial,
cultural, ethnic, geographic, socioeconomic, and gender
identity and sexual orientation perspectives;
(G) representatives of local boards and State
boards;
(H) a nonprofit organization with demonstrated
experience in the development or delivery of curricula
or coursework;
(I) a nonprofit organization, including a labor
organization, that fosters the professional development
and collective engagement of direct care professionals;
(J) area agencies on aging;
(K) centers for independent living, as described in
part C of title VII of the Rehabilitation Act of 1973
(29 U.S.C. 796f et seq.);
(L) representatives of State Councils on
Developmental Disabilities (as such term is used in
subtitle B of title I of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15021 et seq.));
(M) representatives of Aging and Disability
Resource Centers;
(N) representatives of nonprofit State provider
associations that represents providers who employ
direct care professionals;
(O) representatives of entities that employ direct
care professionals;
(P) representatives of University Centers for
Excellence in Developmental Disabilities Education,
Research, and Service supported under subtitle D of
title I of the Developmental Disabilities Assistance
and Bill of Rights Act of 2000 (42 U.S.C. 15061 et
seq.);
(Q) representatives of State protection and
advocacy systems described in section 143 of such Act
(42 U.S.C. 15043); and
(R) representatives of direct care professional
organizations representing underserved communities,
including communities of color.
(e) Authorization of Appropriations.--There are authorized to be
appropriated $10,000,000 to carry out this section for each of fiscal
years 2025 through 2029.
SEC. 212. REPORT ON EFFORTS TO ENHANCE THE DIRECT CARE PROFESSIONAL
WORKFORCE.
Not later than 180 days after the date of enactment of this Act,
the Secretary of Health and Human Services shall submit to the
appropriate committees of Congress, a report that contains an
assessment of the programs and activities of the Department of Health
and Human Services related to enhancing the direct care professional
workforce, including the extent to which programs and activities
authorized under titles VII and VIII of the Public Health Service Act
(42 U.S.C. 292 et seq.; 42 U.S.C. 296 et seq.) address--
(1) increasing nursing faculty who are trained in geriatric
nursing;
(2) increasing individuals preparing for careers in or
advanced degrees in geriatric nursing or long-term care;
(3) increasing direct care professionals;
(4) the extent to which the Department coordinates with
other Federal departments regarding programs designed to
improve the direct care professional workforce; and
(5) recommendations for best practices.
SEC. 213. COMPREHENSIVE GERIATRIC EDUCATION.
Section 865 of the Public Health Service Act (42 U.S.C. 298) is
amended--
(1) in subsection (a), by striking ``the elderly'' and
inserting ``older individuals'';
(2) in subsection (b)--
(A) in paragraph (1), by striking ``the elderly''
and inserting ``older individuals'';
(B) in paragraph (2), by striking ``treatment'' and
all that follows and inserting ``health care needs of
older individuals;''; and
(C) in paragraph (5), by striking ``the elderly
population'' and inserting ``older individuals'';
(3) in subsection (d)--
(A) in the heading, by striking ``Eligible Entity''
and inserting ``Definitions'';
(B) by striking ``For purposes of this section, the
term'' and inserting ``For purposes of this section:
``(1) Eligible entity.--The term''; and
(C) by adding at the end the following:
``(2) Older individual.--The term `older individual' has
the meaning given such term in section 102 of the Older
Americans Act of 1965.''; and
(4) in subsection (e), by striking ``years'' and all that
follows and inserting ``years 2025 through 2029.''.
SEC. 214. REVIEW OF THE AVAILABILITY AND QUALITY OF APPRENTICESHIP
PROGRAMS IN LONG-TERM CARE SETTINGS.
Not later than 180 days after the date of enactment of this Act,
the Secretary of Labor, in coordination with the Secretary of Health
and Human Services, shall submit a report to the appropriate committees
of Congress that--
(1) identifies the extent of vacancies at employers that
employ direct care professionals at the State and local levels
within the direct care professional workforce, including with
respect to vacancies of direct care professionals;
(2) review existing apprenticeship programs in the direct
care professional workforce;
(3) provide recommendations on the design of apprenticeship
programs in the direct care professional workforce, including
about potential funding opportunities, potential apprenticeship
program sponsors, and a national competency-based occupational
framework; and
(4) identify opportunities for coordination with other
State and local entities, including State educational agencies,
local educational agencies, career and technical education
programs, institutions of higher education, State agencies with
responsibility for administering a State Medicaid program, and
labor management organizations, to create apprenticeship
programs and other ways to incorporate associate and bachelor's
degrees in apprenticeship programs.
SEC. 215. RURAL HEALTH WORKFORCE GRANT PROGRAM.
Part D of title VII of the Public Health Service Act (42 U.S.C. 294
et seq.) is amended by adding at the end the following:
``SEC. 760A. RURAL HEALTH WORKFORCE GRANT PROGRAM.
``(a) Definitions.--In this section:
``(1) Carl d. perkins career and technical education act
definitions.--The terms `career and technical education',
`career guidance and academic counseling', and `program of
study' have the meanings given the terms in section 3 of the
Carl D. Perkins Career and Technical Education Act of 2006.
``(2) ESEA definitions.--The terms `elementary school',
`local educational agency', and `secondary school' have the
meanings given the terms in section 8101 of the Elementary and
Secondary Education Act of 1965.
``(3) Institution of higher education.--The term
`institution of higher education' has the meaning given the
term in section 102 of the Higher Education Act of 1965.
``(4) Long-term care workforce support act.--The terms
`direct care professional' and `direct care professional
workforce' have the meanings given such terms in section 3 of
the Long-Term Care Workforce Support Act.
``(5) Workforce innovation and opportunity act
definitions.--The terms `career pathway', `industry or sector
partnership', and `local board' have the meanings given the
terms in section 3 of the Workforce Innovation and Opportunity
Act.
``(b) Authorization of Grants.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with the Secretary of
Education, shall award grants on a competitive basis to
eligible entities to develop career exploration programs
aligned to career and technical education programs of study to
bring awareness to elementary school and secondary school
students in underserved rural communities about health care
professions careers and provide children and youth underserved
rural community health care experiences related to such
careers.
``(2) Grant amount.--Each grant awarded under this section
shall be in an amount that is not more than $250,000 per year.
``(3) Grant period.--Each grant awarded under this section
shall be for a period not to exceed 5 years.
``(c) Eligible Entities.--
``(1) In general.--To be eligible to receive a grant under
this section, an entity shall meet the following requirements:
``(A) Be a consortium consisting of a local
educational agency and at least 2 of the following:
``(i) An institution of higher education
that provides a recognized postsecondary
credential in health care.
``(ii) A health care practice, facility, or
provider organization.
``(iii) A State, Indian Tribe or Tribal
organization, or a local governmental entity.
``(iv) A local board.
``(v) An industry or sector partnership.
``(vi) A nonprofit organization
representing the interests of underserved rural
communities and rural health care.
``(vii) An area health education center.
``(viii) A rural health clinic.
``(ix) Any other entity as determined
appropriate by the Secretary.
``(B) Submit an application to the Secretary at
such time, in such manner, and containing such
information that the Secretary may require, including a
plan for the long-term tracking of participants
supported by the grant under this section.
``(2) Matching funds.--In order to ensure the institutional
commitment of an entity to a program supported by a grant under
this section, to be eligible to receive such a grant, the
Secretary may require the entity seeking such grant to agree to
make available (directly or through contributions from State,
county or municipal governments, or the public or private
sector) recurring non-Federal contributions in cash or in kind
(including plant, equipment, or services) towards the costs of
operating the program in an amount that is equal to not less
than 50 percent of the total costs of operating such program.
``(d) Priority.--In awarding grants under this section, the
Secretary shall give priority to eligible entities that--
``(1) include in its consortium--
``(A) an entity that has demonstrated alignment
with a State plan or local application developed under
the Carl D. Perkins Career and Technical Education Act
of 2006;
``(B) a high-need local educational agency, as
defined in section 200 of the Higher Education Act of
1965, or a local educational agency eligible to receive
assistance under part B of title V of the Elementary
and Secondary Education Act of 1965;
``(C) an institution of higher education at which
at least 30 percent of the enrolled students are
Federal Pell Grant recipients;
``(D) a minority-serving institution of higher
education described in any of paragraphs (1) through
(7) of section 371(a) of the Higher Education Act of
1965; or
``(E) a local educational agency that serves the
greatest number of students; and
``(2) provide a plan to sustain the program funded under
the grant beyond the period of the grant.
``(e) Use of Funds; Requirements.--An eligible entity receiving a
grant under this section shall use the grant funds to establish,
improve, or expand an underserved rural community training program for
elementary school students and secondary school students that meets the
following requirements:
``(1) Carrying out program planning, including--
``(A) development and support of a coordinating
body to organize, administer, and oversee the
activities of the consortium;
``(B) conducting a needs analysis using data,
including community demographics, workforce estimates,
and capacity of training programs to direct work of the
consortium; and
``(C) developing a regional articulation plan that
benefits students with respect to reducing barriers to
program entry, reducing time to graduation, and lower
cost training options.
``(2) Carrying out age-appropriate education activities and
promotion of the program that align with section 135(b)(1) of
the Carl D. Perkins Career and Technical Education Act of 2006,
including--
``(A) engaging students in underserved rural
communities in elementary school for exposure to health
career workforce opportunities, and including direct
care professionals in educational opportunities as
practicable;
``(B) exposing secondary school students in
underserved rural communities to health career
workforce opportunities available in their communities,
including by providing career guidance and academic
counseling on such opportunities;
``(C) developing strategies to address resiliency
and mental health among elementary school and secondary
school students in underserved rural communities
interested in health care professions careers in such
communities;
``(D) providing age-appropriate mentoring, academic
enrichment, or support for elementary school and
secondary school students in underserved rural
communities, carried out by health care professionals
or peers;
``(E) enrolling secondary school students
(including those in underserved rural communities) in
health care career and technical education programs of
study or career pathways in underserved rural
communities;
``(F) developing and enrolling of secondary school
students in pre- and youth-apprenticeships or summer
programs that provide clinical or other health care
professions focused experiences in underserved rural
communities;
``(G) providing financial supplemental support for
student transportation to, and housing at, the program
site, as appropriate; and
``(H) such other activities as the Secretary
determines appropriate.
``(3) Each such program shall be carried out for a term of
not less than 5 years.
``(f) Technical Assistance.--The Administrator of the Health
Resources and Services Administration shall, directly or indirectly,
provide technical assistance to grant recipients for purposes of
carrying out the programs described in subsection (e).
``(g) Reporting.--
``(1) Annual reporting by recipients.--
``(A) In general.--An eligible entity receiving a
grant under this section shall submit an annual report
to the Secretary on the progress of the program
supported by such grant, based on criteria the
Secretary determines appropriate, including the program
selection of students who participated in the program.
``(B) Contents.--Each report required under
subparagraph (A) shall include any data requested by
the Secretary, which may include, as appropriate, the
number of participants and the demographics of such
participants served by the program supported by the
grant, including the number of participants who
enrolled in the program and withdrew prior to
completion of the program.
``(2) Reports to congress.--
``(A) Annual reports.--Not later than 2 years after
the date of enactment of this section, and annually
thereafter until all programs supported through a grant
under this section are completed, the Secretary shall
prepare and submit to Congress a report that includes
the progress of each program supported by a grant under
this section and the challenges experienced by grantees
with respect to such programs.
``(B) Grant cycle final report.--Not later than
September 30, 2030, the Administrator of the Health
Resources and Services Administration shall submit a
report to Congress on the lessons learned through the
programs supported by grants under this section and
that based on such lessons identifies best practices
for career exploration programs with a focus on
underserved rural communities and the direct care
professional workforce.
``(h) Regulations.--The Secretary shall, by regulation, define the
term `underserved rural community' for purposes of this section.
``(i) Supplement Not Supplant.--Any eligible entity receiving funds
under this section shall use such funds to supplement, not supplant,
any other Federal, State, and local funds that would otherwise be
expended by such entity to carry out the activities described in this
section.
``(j) Evaluation.--
``(1) In general.--The Secretary, in conjunction with the
Secretary of Labor, shall evaluate the implementation and
outcomes of this section on the recruitment of secondary school
students residing in underserved rural communities entering
professions of direct care professionals.
``(2) External evaluator.--The Secretary shall conduct the
evaluation under paragraph (1) through a contract with an
external evaluator who has experience with evaluation related
to workforce development and people with disabilities and older
individuals.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2025 through 2029.''.
Subtitle C--Providing Career Advancement Opportunities; Assessment of
Worker Well-being
SEC. 221. ASSESSMENT OF DIRECT CARE PROFESSIONAL WELL-BEING.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary''), in coordination
with the Director of the National Institute for Occupational Safety and
Health of the Centers for Disease Control and Prevention, the Assistant
Secretary for Mental Health and Substance Use, and the Administrator of
the Health Resources and Services Administration, shall--
(1) not later than 1 year after the date of enactment of
this Act, develop a research-based tool for assessing direct
care professional well-being, as described in subsection (b);
and
(2) not less frequently than biennially, collect data on
worker well-being using the tool developed pursuant to
paragraph (1) and make such data publicly available as
described in subsection (c).
(b) Assessment Tool.--The tool for the assessment of direct care
professional well-being developed under subsection (a)(1) shall--
(1) include the use of an anonymous, validated survey of
direct care professionals;
(2) at a minimum, assess and include the views of such
professionals on--
(A) workplace policies and culture, including
meaningful engagement of such professionals;
(B) workplace physical environment and safety;
(C) circumstances outside of work for such
professionals; and
(D) the physical and mental health status of such
professionals; and
(3) be developed with input from direct care professionals,
older individuals, people with disabilities, and family members
of older individuals and people with disabilities.
(c) Public Availability of Aggregate Data and the Assessment
Tool.--The Secretary shall--
(1) make available, through a publicly available data
repository, aggregated and de-identified data collected by the
assessment of direct care professional well-being under
subsection (a);
(2) make the assessment tool developed under subsection
(a)(1) publicly available in a format that allows employers,
researchers, and other entities to voluntarily use and
administer such assessment for purposes of using information
collected by the assessment to improve the well-being of direct
care professionals; and
(3) conduct outreach to employers, researchers, and other
relevant entities to increase awareness of the availability of
the tool for the assessment of the well-being of direct care
professionals.
(d) Burden on Participants.--In developing the assessment tool
under subsection (a)(1), the Secretary shall minimize the burden of the
data collection process on direct care professionals.
(e) Confidentiality.--The Secretary shall ensure that the
assessment tool developed under subsection (a)(1), the process of data
collection under subsection (a), and the publicly available data under
subsection (c)(1), do not involve the collection or disclosure of any
individually identifiable information regarding the direct care
professionals who are being assessed.
(f) Rule of Construction.--Nothing in this section shall be
construed to require that the assessment tool developed under
subsection (a)(1) or the data collected through such tool be used for
purposes of quality measurement or payment systems under the Medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) or a State Medicaid program.
(g) Report.--Not later than 2 years after the date of enactment of
this Act, and biennially thereafter, the Secretary shall--
(1) submit to Congress a report on the findings of the
assessment under subsection (a), including any recommendations
to address direct care professional well-being; and
(2) make such report publicly available on the website of
the Centers for Disease Control and Prevention.
(h) Definition of Well-Being.--For purposes of this section, the
term ``well-being'', with respect to a direct care professional, means
the quality of life with respect to the health and work-related
environment of such professional as related to organizational and
psychosocial factors.
(i) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary to carry out this section $6,000,000 for
each of fiscal years 2025 through 2030.
SEC. 222. NATIONAL DIRECT CARE PROFESSIONAL TRAINING STANDARDS
COMMISSION.
(a) Establishment.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish the National Direct Care Professional
Training Standards Commission (referred to in this section as
the ``Commission'') to advise the Secretary on--
(A) developing national direct care professional
training standards described in paragraph (2) to
recommend to States to implement; and
(B) providing support for States in implementing
such standards.
(2) Standards.--The standards under this subsection shall
be--
(A) competency-based;
(B) industry-recognized; and
(C) portable across settings and States.
(3) Membership.--The Commission shall include
representatives from the following:
(A) An organization representing older individuals.
(B) An organization led by people with
disabilities.
(C) An organization representing the rights and
interests of people receiving services from direct care
professionals.
(D) An organization (other than a labor
organization) representing direct care professionals.
(E) Labor organizations representing direct care
professionals.
(F) An organization representing State Medicaid
agencies, State agencies defined in section 102 of the
Older Americans Act of 1965 (42 U.S.C. 3002), State
developmental disabilities offices, and State mental
health agencies.
(G) An organization representing local boards and
State boards.
(H) An organization representing area agencies on
aging.
(I) An organization representing centers for
independent living, as described in part C of title VII
of the Rehabilitation Act of 1973 (29 U.S.C. 796f et
seq.).
(J) An organization representing State Councils on
Developmental Disabilities (as such term is used in
subtitle B of title I of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15021 et seq.)).
(K) An organization representing Aging and
Disability Resource Centers.
(L) An organization representing nonprofit State
provider associations.
(M) An organization representing entities that
employ direct care professionals.
(N) An organization representing University Centers
for Excellence in Developmental Disabilities Education,
Research, and Service supported under subtitle D of
title I of the Developmental Disabilities Assistance
and Bill of Rights Act of 2000 (42 U.S.C. 15061 et
seq.).
(O) An organization representing State protection
and advocacy systems described in section 143 of such
Act (42 U.S.C. 15043).
(P) Representatives of direct care professional
organizations representing underserved communities,
including communities of color.
(Q) Representatives reflecting diverse racial,
cultural, ethnic, geographic, socioeconomic, and gender
identity and sexual orientation perspectives.
(4) Period of appointment; vacancies.--
(A) In general.--A member of the Commission shall
be appointed for the life of the Commission.
(B) Vacancies.--A vacancy in the Commission--
(i) shall not affect the powers of the
Commission; and
(ii) shall be filled in the same manner as
the original appointment.
(5) Meetings.--
(A) Initial meeting.--Not later than 180 days after
the date on which all members of the Commission have
been appointed, the Commission shall hold the first
meeting of the Commission.
(B) Frequency.--The Commission shall meet at the
call of the Chairperson.
(C) Quorum.--A majority of the members of the
Commission shall constitute a quorum, but a lesser
number of members may hold hearings.
(6) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among the
members of the Commission.
(b) Duties.--
(1) Study.--The Commission shall conduct a thorough study
of all matters relating to direct care professional training
standards.
(2) Recommendations.--The Commission shall develop
recommendations on--
(A) national training standards for direct care
professionals that meet the requirements under
subsection (a)(2); and
(B) methods for supporting States in implementing
such standards.
(3) Report.--Not later than 3 years after the date of
enactment of this Act, the Commission shall submit to the
Secretary and the appropriate committees of Congress a report
that contains a detailed statement of the findings and
conclusions of the Commission, together with the
recommendations of the Commission for such legislation and
administrative actions as the Commission considers appropriate.
(c) Powers of Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable to
carry out this section.
(2) Information from federal agencies.--
(A) In general.--The Commission may secure directly
from a Federal department or agency such information as
the Commission considers necessary to carry out this
section.
(B) Furnishing information.--On request of the
Chairperson of the Commission, the head of the
department or agency shall furnish the information to
the Commission.
(3) Postal services.--The Commission may use the United
States mails in the same manner and under the same conditions
as other departments and agencies of the Federal Government.
(4) Gifts.--The Commission may accept, use, and dispose of
gifts or donations of services or property.
(d) Commission Personnel Matters.--
(1) Compensation of members.--A member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which the
member is engaged in the performance of the duties of the
Commission.
(2) Travel expenses.--A member of the Commission shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission
may, without regard to the civil service laws
(including regulations), appoint and terminate an
executive director and such other additional personnel
as may be necessary to enable the Commission to perform
its duties, except that the employment of an executive
director shall be subject to confirmation by the
Commission.
(B) Compensation.--The Chairperson of the
Commission may fix the compensation of the executive
director and other personnel without regard to chapter
51 and subchapter III of chapter 53 of title 5, United
States Code, relating to classification of positions
and General Schedule pay rates, except that the rate of
pay for the executive director and other personnel may
not exceed the rate payable for level V of the
Executive Schedule under section 5316 of that title.
(4) Detail of government employees.--A Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code, at rates for individuals that do not exceed the
daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of that
title.
(e) Termination of Commission.--The Commission shall terminate 90
days after the date on which the Commission submits the report required
under subsection (b)(3).
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $500,000 for fiscal year 2025,
to remain available, without fiscal year limitation, until expended.
Subtitle D--Increasing Supports for the Existing Direct Care
Professional Workforce
SEC. 231. MENTAL HEALTH SERVICES.
(a) Programs To Promote Mental Health Among Direct Care
Professionals.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall award
grants, contracts, or cooperative agreements to eligible
entities to establish or enhance evidence-based or evidence-
informed programs dedicated to improving mental health and
resiliency for direct care professionals.
(2) Eligibility.--To be eligible to receive an award under
this subsection, an entity shall be--
(A) a State;
(B) a labor organization, joint labor management
organization, or employer of direct care professionals;
(C) a nonprofit entity with experience in aging,
disability, or supporting the rights and interests of,
the training of, or educating direct care
professionals; or
(D) an Indian Tribe, Tribal organization, or Urban
Indian organization.
(3) Use of funds.--A recipient of an award under this
subsection shall use funds received through the award to
implement and evaluate a new program or enhance an existing
program to promote mental health among direct care
professionals, which may include--
(A) improving awareness among direct care
professionals about risk factors for, and signs of,
suicide and mental health or substance use disorders,
in accordance with evidence-based or evidence-informed
practices;
(B) establishing new, or enhancing existing,
evidence-based or evidence-informed programs for
preventing suicide and improving mental health and
resiliency among direct care professionals;
(C) establishing new, or enhancing existing, peer-
support programs for direct care professionals; or
(D) providing--
(i) mental health care;
(ii) follow-up services or care by a
licensed or certified mental health
professional (including by means of
telehealth); or
(iii) a referral for such services or care
by such a professional, as appropriate.
(4) Priority.--In awarding grants, contracts, and
cooperative agreements under this subsection, the Secretary
shall give priority to an eligible entity in--
(A) a rural area; or
(B) an area where the number of direct care
professional vacancies, in the year of the application,
is greater than 30 percent of the total number of
direct care professional positions in the area.
(b) Training Grants.--
(1) In general.--The Secretary may establish a program to
award grants to eligible entities to support the inclusion, in
direct care professional preparation programs and in training,
continuing education, or professional development programs for
direct care professionals, of evidence-based or evidence-
informed strategies--
(A) to address mental and substance use disorders
of direct care professionals; and
(B) to improve mental health and resiliency among
direct care professionals.
(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity shall be--
(A) an institution of higher education;
(B) a State or local government;
(C) an Indian Tribe or Tribal organization;
(D) a public or private nonprofit entity determined
appropriate by the Secretary; or
(E) a consortia of entities described in any of
subparagraphs (A) through (D), including such entities
promoting multidisciplinary approaches.
(c) Grant Terms.--A grant, contract, or cooperative agreement
awarded under subsection (a) or (b) shall be for a period of 3 years.
(d) Application Submission.--An entity seeking an award under
subsection (a) or (b) shall submit an application to the Secretary at
such time, in such manner, and accompanied by such information as the
Secretary may require.
(e) Annual Report.--An entity receiving an award under subsection
(a) or (b) shall submit to the Secretary an annual report evaluating
the activities supported by the award.
(f) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $20,000,000 for each of fiscal
years 2025 through 2029.
SEC. 232. DISSEMINATION OF BEST PRACTICES WITH RESPECT TO MENTAL HEALTH
OF DIRECT CARE PROFESSIONALS.
Not later than 2 years after the date of enactment of this Act, the
Secretary of Health and Human Services shall--
(1) identify evidence-based or evidence-informed best
practices--
(A) for preventing suicide and improving mental
health and resiliency among direct care professionals;
and
(B) for training direct care professionals in
appropriate strategies to promote their mental health;
and
(2) disseminate those best practices to the appropriate
committees of Congress.
SEC. 233. EDUCATION AND AWARENESS INITIATIVE ENCOURAGING USE OF MENTAL
HEALTH AND SUBSTANCE USE DISORDER SERVICES BY DIRECT CARE
PROFESSIONALS.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary''), in consultation
with relevant stakeholders, including medical professional
associations, shall establish a national evidence-based or evidence-
informed education and awareness initiative--
(1) with the goal of preventing suicide, mental health
conditions, and substance use disorders of direct care
professionals, to--
(A) encourage direct care professionals to seek
support and care for their mental health or substance
use concerns;
(B) help such professionals identify risk factors
associated with suicide and mental health conditions;
and
(C) help such professionals learn how best to
respond to such risk factors; and
(2) to address stigma associated with seeking mental health
and substance use disorder services.
(b) Reporting.--Not later than 2 years after the date of enactment
of this Act, the Secretary shall provide to the appropriate committees
of Congress an update on the activities and outcomes of the initiative
under subsection (a), including a description of quantitative and
qualitative metrics used to evaluate such activities and outcomes.
SEC. 234. DIRECT CARE PROFESSIONAL TRAINING GRANTS.
Section 2041 of the Social Security Act (42 U.S.C. 1397m) is
amended to read as follows:
``SEC. 2041. DIRECT CARE PROFESSIONAL TRAINING GRANTS.
``(a) In General.--
``(1) State entitlement.--
``(A) In general.--Each State shall be entitled to
receive from the Secretary for each fiscal year
specified in subsection (e) a grant in an amount equal
to the amount allotted to the State under subparagraph
(B).
``(B) State allotments.--
``(i) In general.--Subject to clauses (ii),
(iii), and (iv) the amount allotted to a State
under this subparagraph for a fiscal year shall
be equal to the product of--
``(I) the available amount for the
fiscal year; and
``(II) the ratio of--
``(aa) the number of State
residents who have attained 60
years of age or are under a
disability (as defined in
section 216(i)(1)), as
determined by the Secretary
using the most recent version
of the American Community
Survey published by the Bureau
of the Census or a successor
data set; divided by
``(bb) the total number of
such residents of all States.
``(ii) Limitation.--The amount allotted to
a State under this subparagraph for a fiscal
year shall be not less than 0.25 percent of the
available amount for the fiscal year.
``(iii) Adjustment of state allotments.--
Subject to clause (ii), the Secretary shall
proportionately increase or decrease the
amounts allotted under this subparagraph for a
fiscal year as necessary to ensure that the
available amount for the fiscal year is
allotted among the States.
``(iv) Redeterminations.--
``(I) Frequency.--The Secretary
shall make the determination referred
to in clause (i)(II)(aa) every 5 years.
``(II) Limitation.--Subject to
clause (ii), the amount allotted to a
State under this subparagraph, on the
basis of such a determination, for a
fiscal year after fiscal year 2029
shall be--
``(aa) not less than 90
percent of the amount of the
grant made to the State under
this subparagraph for the
preceding fiscal year; and
``(bb) not more than 110
percent of the amount referred
to in item (aa).
``(2) Grants to indian tribes and tribal organizations.--
``(A) In general.--The Secretary, in consultation
with the Secretary of the Interior, shall make grants
in accordance with this section to Indian tribes and
tribal organizations who operate at least 1 eligible
setting.
``(B) Grant formula.--The Secretary, in
consultation with the Secretary of the Interior, shall
devise a formula for distributing among Indian tribes
and tribal organizations the amount required to be
reserved by subsection (e) for each fiscal year.
``(3) Sub-grants.--A State, Indian tribe, or tribal
organization to which an amount is paid under this section may
use the amount to make sub-grants to local organizations,
including community organizations, local non-profits, elder
rights and justice groups, and workforce development boards for
any purpose described in paragraph (1) or (2) of subsection
(b).
``(b) Use of Funds.--
``(1) Required uses.--A State, Indian tribe, or tribal
organization to which an amount is paid under this section
shall use the amount to--
``(A) provide wage subsidies to eligible
individuals;
``(B) provide student loan repayment or tuition
assistance to eligible individuals for a degree or
certification in a field relevant to their position
referred to in subsection (f)(2)(A);
``(C) guarantee affordable and accessible child
care for eligible individuals, including help with
referrals, co-pays, or other direct assistance; and
``(D) provide assistance where necessary with
obtaining appropriate transportation, including public
transportation if available, or gas money if public
transportation is unavailable or impractical based on
work hours or location.
``(2) Authorized uses.--A State, Indian tribe, or tribal
organization to which an amount is paid under this section may
use the amount to--
``(A) establish a reserve fund for financial
assistance to eligible individuals in emergency
situations;
``(B) provide in-kind resource donations, such as
interview clothing and conference attendance fees;
``(C) provide assistance with programs and
activities, including legal assistance, deemed
necessary to address arrest or conviction records that
are an employment barrier;
``(D) support employers operating an eligible
setting in the State, Indian tribe, or tribal
organization in providing employees with not less than
2 weeks of paid leave per year; or
``(E) provide other support services the Secretary
deems necessary to allow for successful recruitment and
retention of workers.
``(3) Provision of funds only for the benefit of eligible
individuals in eligible settings.--A State, Indian tribe, or
tribal organization to which an amount is paid under this
section may provide the amount to only an eligible individual
or a partner organization serving an eligible individual.
``(4) Nonsupplantation.--A State, Indian tribe, or tribal
organization to which an amount is paid under this section
shall not use the amount to supplant the expenditure of any
State or tribal funds for recruiting or retaining employees in
an eligible setting.
``(5) Obligation deadline.--A State, Indian tribe, or
tribal organization shall remit to the Secretary for
reallotment under this section any amount paid under this
section for a fiscal year that is not obligated within 2 years
after the end of the fiscal year.
``(c) Administration.--A State, Indian tribe, or tribal
organization to which a grant is made under this section shall reserve
not more than 10 percent of the grant to--
``(1) administer subgrants in accordance with this section;
``(2) provide technical assistance and support for applying
for and accessing such a subgrant opportunity;
``(3) publicize the availability of the subgrants;
``(4) carry out activities to increase the supply of
eligible individuals; and
``(5) provide technical assistance to help subgrantees find
and train individuals to provide the services for which they
are contracted.
``(d) Reports.--
``(1) State reports.--Not less frequently than annually,
each State, Indian tribe, or tribal organization to which a
grant has been made under this section shall transmit to the
Secretary a written report describing the activities undertaken
by the State pursuant to this section during the period covered
by the report, which shall include--
``(A) the total amount expended in the State for
each type of use described in paragraph (1) or (2) of
subsection (b);
``(B) the total number of non-State organizations
in the State to which grant funds were provided, and
the amount so provided to each such organization;
``(C) the change in the number of individuals
working in each job category described in subsection
(f)(2)(A) in an eligible setting in the State;
``(D) the average duration of employment for each
such job category;
``(E) the average annual wage of workers in each
job category described in subsection (f)(2)(A) in an
eligible setting in the State;
``(F) the average amount of paid time off to which
a worker in each job category described in subsection
(f)(2)(A) in an eligible setting in the State is
entitled by their contract; and
``(G) such other data elements as the Secretary
deems relevant.
``(2) Report to congress.--Not later than 3 years after the
date of the enactment of this section, and every 4 years
thereafter, the Secretary shall submit to the Committee on
Health, Education, Labor, and Pensions and the Special
Committee on Aging of the Senate and the Committee on Energy
and Commerce and the Committee on Education and the Workforce
of the House of Representatives a written report outlining how
the grant recipients have used the grants made under this
section during the period covered by the report, which shall
include--
``(A) the total amount expended by each State,
Indian tribe, or tribal organization for each type of
use described in paragraph (1) or (2) of subsection
(b);
``(B) the total number of non-State or non-tribal
organizations in each State, Indian tribe, or tribal
organization to which grant funds were provided, and
the amount so provided to each such non-State or non-
tribal organization;
``(C) the change in the number of individuals
working in each job category described in subsection
(f)(2)(A) in an eligible setting;
``(D) the average duration of employment for each
such job category, by State, Indian tribe, or tribal
organization;
``(E) the average annual wage of workers in each
job category described in subsection (f)(2)(A) in an
eligible setting;
``(F) the average amount of paid time off to which
a worker in each job category described in subsection
(f)(2)(A) in an eligible setting is entitled by their
contract; and
``(G) such other data elements as the Secretary
deems relevant.
``(e) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the Secretary
$400,000,000 for each of fiscal years 2025 through 2029 to carry out
this section, of which 2 percent shall be reserved for grants to Indian
tribes and tribal organizations.
``(f) Definitions.--In this section:
``(1) Available amount.--The term `available amount' means,
with respect to a fiscal year, the amount specified in
subsection (e) that remains after the reservation required by
such subsection for the fiscal year, plus all amounts remitted
to the Secretary under subsection (b)(5) that have not been
reallotted under subsection (a)(1)(B)(iii).
``(2) Eligible individual.--The term `eligible individual'
means an individual who--
``(A)(i) is a qualified home health aide, as
defined in section 484.80(a) of title 42, Code of
Federal Regulations;
``(ii) is a nurse aide approved by the State as
meeting the requirements of sections 483.150 through
483.154 of such title, and is listed in good standing
on the State nurse aide registry;
``(iii) is a personal care aide approved by the
State, and furnishes personal care services, as defined
in section 440.167 of such title;
``(iv) is a qualified hospice aide, as defined in
section 418.76 of such title;
``(v) is a licensed practical nurse or a licensed
or certified social worker;
``(vi) is receiving training to be certified or
licensed as such an aide, nurse, or social worker; or
``(vii) is any other direct care professional; and
``(B) provides (or, in the case of a trainee,
intends to provide) services as such an aide, nurse, or
social worker in an eligible setting.
``(3) Eligible setting.--The term `eligible setting'
means--
``(A) a skilled nursing facility, as defined in
section 1819;
``(B) a nursing facility, as defined in section
1919;
``(C) a home health agency, as defined in section
1891;
``(D) a setting approved to deliver home or
community-based services authorized under State options
described in subsection (c) or (i) of section 1915 or,
as relevant, demonstration projects authorized under
section 1115;
``(E) a hospice, as defined in section 1814;
``(F) another long-term care setting; or
``(G) a tribal assisted living facility.
``(4) Tribal organization.--The term `tribal organization'
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act.''.
SEC. 235. CREDIT FOR CERTAIN HEALTH CARE PROFESSIONALS.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 is amended by inserting after
section 36 the following new section:
``SEC. 36A. CREDIT FOR CERTAIN HEALTH CARE PROFESSIONALS.
``(a) Allowance of Credit.--In the case of an individual who is a
health care professional described in subsection (b) with respect to
the taxable year, there shall be allowed a credit of $5,000 against the
tax imposed by this subtitle for such taxable year.
``(b) Health Care Professionals Described.--A health care
professional described in this subsection, with respect to any taxable
year, is any individual who, at any time during such taxable year, is--
``(1) a practitioner, as defined in section 1842(b)(18)(C)
of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)),
providing services for compensation as such practitioner in a
long-term care setting,
``(2) a certified nursing assistant providing services for
compensation as such assistant in a long-term care setting,
``(3) a licensed practical nurse, or registered
professional nurse, providing services for compensation as such
a nurse in a long-term care setting,
``(4) a home health aide providing services for
compensation as such aide in a long-term care setting,
``(5) a personal or home care aide providing services for
compensation as such aide in a long-term care setting, or
``(6) a direct care professional, who is not otherwise
described in any of paragraphs (1) through (5), providing
services for compensation as such professional in a long-term
care setting.
``(c) Definitions.--For purposes of this section, the terms `direct
care professional', `long-term care setting', and `personal or home
care aide' have the meanings given such terms in section 3 of the Long-
Term Care Workforce Support Act.''.
(b) Conforming Amendments.--
(1) Section 6211(b)(4)(A) of the Internal Revenue Code of
1986 is amended by inserting ``, 36A'' after ``36''.
(2) The table of section for subpart C of part IV of
subchapter A of chapter 1 such Code is amended by amending by
inserting after the item relating to section 36 the following
new item:
``Sec. 36A. Credit for certain health care professionals.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2023.
SEC. 236. DIRECT CARE PROFESSIONAL WORKFORCE EQUITY TECHNICAL
ASSISTANCE CENTER.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary''), in consultation
with the Secretary of Labor, the Administrator of the Centers for
Medicare & Medicaid Services, and the heads of other entities as
necessary, shall establish a national technical assistance center to--
(1) address inequities and disparities facing the direct
care professional workforce; and
(2) ensure that long-term care settings are meeting the
unique demographic, cultural, and linguistic needs of the
community in which such settings are situated and the community
of workers within such settings.
(b) Activities.--The Center may--
(1) maintain a centralized online hub of equity-focused
direct care professional workforce resources;
(2) conduct studies and develop trainings and resources on
the inequities facing direct care professionals and enhancing
diversity, equity, inclusion, and accessibility among long-term
care settings;
(3) develop equity-specific tools and resources to support
State and local governments in building an equitable direct
care professional workforce;
(4) design and inform interventions in the direct care
professional workforce that reduce disparities and promote
equity within the direct care professional workforce;
(5) convene experts in the direct care professional
workforce, including direct care professionals, to develop
equity-based resources; and
(6) collaborate with organizations representing people with
disabilities, older individuals, people of color, women,
immigrants, and LGBT communities, and others as determined by
the Secretary.
(c) Reporting.--Not later than 2 years after the date of enactment
of this Act, the Secretary shall provide to the appropriate committees
of Congress an update on the activities and outcomes of the initiative
under subsection (a)
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated to the Secretary $10,000,000
for each of fiscal years 2025 through 2029.
TITLE III--WORKFORCE LABOR PROTECTIONS
Subtitle A--Long-term Care Workforce Wage Theft Prevention and Wage
Recovery Act
SEC. 301. DEFINITIONS.
In this subtitle:
(1) Administrator.--The term the ``Administrator'' means
the Administrator of the Wage and Hour Division of the
Department of Labor.
(2) Community partner.--The term ``community partner''
means any stakeholder with a commitment to enforcing wage and
hour laws and preventing abuses of such laws, including any--
(A) State department of labor;
(B) attorney general of a State or other similar
authorized official of a political subdivision thereof;
(C) law enforcement agency;
(D) consulate;
(E) employee or advocate of employees, including a
labor organization, community- and faith-based
organization, business association, disability
organization, older individual organization, or
nonprofit legal aid organization;
(F) academic institution that plans, coordinates,
and implements programs and activities to prevent wage
and hour violations and recover unpaid wages, damages,
and penalties; or
(G) any municipal agency responsible for the
enforcement of local wage and hour laws.
(3) Community partnership.--The term ``community
partnership'' means a partnership between--
(A) a working group consisting of community
partners; and
(B) the Department of Labor.
(4) Covered employee.--The term ``covered employee'' means
a direct care professional working in a long-term care setting.
(5) Covered employer.--The term ``covered employer'' means
an employer who employs covered employees to work in or provide
services in a long-term care setting.
(6) Eligible entity.--The term ``eligible entity'' means an
entity that is any of the following:
(A) A nonprofit organization, including such an
organization that is a community-based organization,
faith-based organization, disability organization,
older individuals organization, or labor organization,
that provides services and support to employees,
including assisting such employees in recovering unpaid
wages.
(B) An employer.
(C) A business association.
(D) An institution of higher education, as defined
by section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(E) A partnership between any of the entities
described in subparagraphs (A) through (D).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(8) Strategic enforcement.--The term ``strategic
enforcement'' means the process by which the Secretary--
(A) targets highly noncompliant industries, as
identified by the Secretary, using industry-specific
structures to influence, and ultimately reform,
networks of interconnected employers;
(B) analyzes regulatory regimes under which
specific industries operate; and
(C) modifies the enforcement approach of such
regulatory regimes in order to ensure the greatest
impact.
(9) Wage and hour law.--The term ``wage and hour law''
means any Federal law enforced by the Wage and Hour Division of
the Department of Labor, including any provision of this Act
enforced by such division.
(10) Wage and hour violation.--The term ``wage and hour
violation'' refers to any violation of a Federal law enforced
by the Wage and Hour Division of the Department of Labor,
including any provision of this Act enforced by such division.
SEC. 302. DIRECT CARE PROFESSIONAL WORKFORCE WAGE THEFT PREVENTION AND
WAGE RECOVERY GRANT PROGRAM.
(a) In General.--The Secretary, acting through the Administrator,
shall provide grants to eligible entities to assist such entities in
enhancing the enforcement of wage and hour laws, in accordance with
this section and consistent with the purposes of this Act.
(b) Grants.--A grant provided under this section shall be designed
to--
(1) support an eligible entity in establishing and
supporting the activities described in subsection (c)(1); and
(2) develop community partnerships to expand and improve
cooperative efforts between enforcement agencies and members of
the community to--
(A) prevent and reduce wage and hour violations;
and
(B) assist covered employees in recovering back pay
for any such violations.
(c) Use of Funds.--
(1) Permissible activities.--The grants described in this
section shall assist eligible entities in establishing and
supporting activities that include--
(A) disseminating information and conducting
outreach and training to educate covered employees
about their rights under wage and hour laws;
(B) conducting educational training for covered
employers about their obligations under wage and hour
laws;
(C) conducting orientations and trainings jointly
with officials of the Wage and Hour Division of the
Department of Labor;
(D) providing assistance to covered employees in
filing claims of wage and hour violations;
(E) assisting enforcement agencies in conducting
investigations, including in the collection of evidence
and recovering back pay;
(F) monitoring compliance with wage and hour laws;
(G) performing joint visitations to worksites that
violate wage and hour laws with officials from the Wage
and Hour Division of the Department of Labor;
(H) establishing networks for education,
communication, and participation in the workplace and
community;
(I) evaluating the effectiveness of programs
designed to prevent wage and hour violations and
enforce wage and hour laws;
(J) recruiting and hiring of staff and volunteers;
(K) production and dissemination of outreach and
training materials;
(L) creation of a phone, short message service,
web, or other technology-based communication for
reporting covered employee emergencies, wage theft, or
labor violations, seeking emergency services, or
seeking support or guidance in lieu of emergency
services; and
(M) any other activities as the Secretary may
reasonably prescribe through notice and comment
rulemaking.
(2) Prohibited activities.--Notwithstanding paragraph (1),
an eligible entity receiving a grant under this section may not
use the grant funds for any purpose reasonably prohibited by
the Secretary through notice and comment rulemaking.
(d) Term of Grants.--Each grant made under this section shall be
available for expenditure for a period that is not to exceed 3 years.
(e) Applications.--
(1) In general.--An eligible entity seeking a grant under
this section shall submit an application for such grant to the
Secretary in accordance with this subsection.
(2) Partnerships.--In the case of an eligible entity that
is a partnership described in section 301(4)(E), the eligible
entity may submit a joint application that designates a single
entity as the lead entity for purposes of receiving and
disbursing funds.
(3) Contents.--An application under this subsection shall
include--
(A) a description of a plan for the program that
the eligible entity proposes to carry out with a grant
under this section, including a long-term strategy and
detailed implementation plan that reflects expected
participation of, and partnership with, community
partners;
(B) information on the prevalence of wage and hour
violations in each community or State of the eligible
entity;
(C) information on any industry or geographic area
targeted by the plan for such program;
(D) information on the type of outreach and
relationship building that will be conducted under such
program;
(E) information on the training and education that
will be provided to covered employees and covered
employers under such program; and
(F) the method by which the eligible entity will
measure results of such program.
(f) Selection.--
(1) Competitive basis.--In accordance with this subsection,
the Secretary shall, on a competitive basis, select grant
recipients from among eligible entities that have submitted an
application under subsection (e).
(2) Priority.--In selecting grant recipients under
paragraph (1), the Secretary shall give priority to eligible
entities that--
(A) serve covered employees in the long-term care
industry or geographic area that is most highly at risk
for noncompliance with wage and hour violations, as
identified by the Secretary; and
(B) demonstrate past and ongoing work to prevent
wage and hour violations or to recover unpaid wages.
(3) Other considerations.--In selecting grant recipients
under paragraph (1), the Secretary shall also consider--
(A) the prevalence of ongoing community support for
each eligible entity, including financial and other
contributions; and
(B) the eligible entity's past and ongoing
partnerships with other organizations.
(g) Memoranda of Understanding.--
(1) In general.--Not later than 60 days after receiving a
grant under this section, the grant recipient shall negotiate
and finalize with the Secretary a memorandum of understanding
that sets forth specific goals, objectives, strategies, and
activities that will be carried out under the grant by such
recipient through a community partnership.
(2) Signatures.--A representative of the grant recipient
(or, in the case of a grant recipient that is an eligible
entity described in section 301(4)(E), a representative of each
entity that composes the grant recipient) and the Secretary
shall sign the memorandum of understanding under this
subsection.
(3) Revisions.--The memorandum of understanding under this
subsection shall be reviewed and revised by the grant recipient
and the Secretary each year of the duration of the grant.
(h) Performance Evaluations.--
(1) In general.--Each grant recipient under this section
shall develop procedures for reporting, monitoring, measuring,
and evaluating the activities of each program or project funded
under this section.
(2) Guidelines.--The procedures required under paragraph
(1) shall be in accordance with guidelines established by the
Secretary.
(i) Revocation or Suspension of Funding.--If the Secretary
determines that a recipient of a grant under this section is not in
compliance with the terms and requirements of the memorandum of
understanding under subsection (g), the Secretary may revoke or suspend
(in whole or in part) the funding of the grant.
(j) Use of Components.--
(1) In general.--In addition to the Wage and Hour Division,
the Secretary (acting through the Administrator) may use any
division or agency of the Department of Labor in carrying out
this subtitle.
(2) Consultation with hhs.--The Secretary may consult with
the Secretary of Health and Human Services (acting through the
Administrator for Community Living) to carry out this subtitle.
(k) Evaluation.--The Secretary of Health and Human Services, in
conjunction with the Secretary of Labor, shall evaluate the
implementation and outcomes of this section on the occurrence of wage
and hour violations through a contract with an external evaluator who
has experience with evaluation of labor regulations and long-term care
services.
(l) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this subtitle $50,000,000 for each of fiscal
years 2025 through 2029, to remain available until expended.
Subtitle B--Direct Care Professional Rights
SEC. 311. DEFINITIONS.
(a) Fair Labor Standards Act Definitions.--In this subtitle--
(1) the terms ``enterprise'', ``enterprise engaged in
commerce or in the production of goods for commerce'', and
``person'' have the meanings given such terms in section 3 of
the Fair Labor Standards Act of 1938 (29 U.S.C. 203); and
(2) the term ``regular rate'' has the meaning given such
term in section 7(e) of such Act (29 U.S.C. 207(e)).
(b) Other Definitions.--In this subtitle:
(1) Child.--The term ``child''--
(A) means an individual who is under 18 years of
age; and
(B) includes an individual described in
subparagraph (A) who is--
(i) a biological, foster, or adopted child;
(ii) a stepchild;
(iii) a child of a domestic partner;
(iv) a legal ward; or
(v) a child of a person standing in loco
parentis.
(2) Covered entity.--The term ``covered entity''--
(A) means any person or agency who provides
compensation directly or indirectly to a direct care
professional for the performance of long-term care
services; and
(B) includes--
(i) a person acting directly or indirectly
in the interest of the entity in relation to a
direct care professional;
(ii) an employer of a direct care
professional; and
(iii) an agency that contracts with an
agency to provide direct care professionals.
(3) Medicaid hcbs-eligible older individual.--The term
``Medicaid HCBS-eligible older individual'' means an individual
who--
(A) is 60 years of age or older; and
(B) is eligible for and enrolled for medical
assistance for any of the following services (whether
provided on a fee-for-service, risk, or other basis)
under a State Medicaid program, and includes an
individual who becomes eligible for medical assistance
under a State Medicaid program when removed from a
waiting list:
(i) Home health care services authorized
under paragraph (7) of section 1905(a) of the
Social Security Act (42 U.S.C. 1396d(a)).
(ii) Personal care services authorized
under paragraph (24) of such section.
(iii) PACE services authorized under
paragraph (26) of such section.
(iv) Home and community-based services
authorized under subsections (b), (c), (i),
(j), and (k) of section 1915 of such Act (42
U.S.C. 1396n), such services authorized under a
waiver under section 1115 of such Act (42
U.S.C. 1315), and such services provided
through coverage authorized under section 1937
of such Act (42 U.S.C. 1396u-7).
(v) Case management services authorized
under section 1905(a)(19) of the Social
Security Act (42 U.S.C. 1396d(a)(19)) and
section 1915(g) of such Act (42 U.S.C.
1396n(g)).
(vi) Rehabilitative services, including
those related to behavioral health, described
in section 1905(a)(13) of such Act (42 U.S.C.
1396d(a)(13)).
(vii) Such other services specified by the
Secretary of Health and Human Services.
(4) On-call shift.--The term ``on-call shift'' means any
time a covered entity expects a direct care professional to--
(A) be available to work; and
(B) wait to contact, or be contacted by, the
covered entity, or a designee of the entity, to
determine whether the direct care professional shall
report to work during such time.
(5) Parent.--The term ``parent'', with respect to a direct
care professional, means--
(A) a biological, foster, or adoptive parent of a
direct care professional;
(B) a stepparent of a direct care professional;
(C) parent-in-law of a direct care professional;
(D) parent of a domestic partner of a direct care
professional; or
(E) a legal guardian or other person who stood in
loco parentis to the direct care professional when the
worker was a child.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(7) Shared living arrangement.--The term ``shared living
arrangement'' means a living arrangement involving--
(A) not more than 2 individuals who are a person
with a disability or a Medicaid HCBS-eligible older
individual, except if 1 or more of the individuals are
related to each other (by blood or a close association
that is equivalent to a family relationship);
(B) an individual providing services for
compensation and living in the private home of the
recipient of such services;
(C) an individual receiving funding through a State
Medicaid program or another publicly funded program;
(D) a stipend or room and board as the primary form
of payment for the individual providing such services;
and
(E) the individual receiving such services having
the final decision regarding who is the provider of
such services living with the individual, through a
consumer-driven matching process that includes
relationship building, person-centered planning as
defined by the Administrator of the Centers for
Medicare & Medicaid Services, and an assessment of
individual compatibility.
(8) Spouse.--The term ``spouse'' has the meaning given such
term by the marriage laws of the State in which the marriage
was celebrated.
SEC. 312. WRITTEN AGREEMENTS.
(a) Covered Direct Care Professional.--In this section, the term
``covered direct care professional'' means any direct care professional
to whom the covered entity expects to provide compensation for the
performance of long-term care services by the covered direct care
professional for not less than 8 hours per week.
(b) Requirement.--Each covered entity shall provide a written
agreement in accordance with this section to each covered direct care
professional who is provided compensation, directly or indirectly, by
the covered entity for the performance of long-term care services.
(c) Written Agreement Requirements.--
(1) In general.--A written agreement required under this
section shall--
(A) be signed and dated by the covered direct care
professional and the covered entity;
(B) be written in a language easily and fully
understood by the covered direct care professional and
the covered entity, which may be in multiple languages
if the covered direct care professional and the entity
do not easily and fully understand the same language;
and
(C) include the contents described in subsection
(d).
(2) Copy.--A copy of the written agreement required under
this section shall be provided to the covered direct care
professional not later than 5 calendar days after the date on
which the covered direct care professional is hired by the
covered entity.
(d) Contents of the Written Agreement.--
(1) In general.--The contents described in this subsection
shall include each of the following:
(A) The full name, address, and contact information
of the covered entity, including, as appropriate, any
``doing business as'' name of the entity and the name
of each individual of the entity who will be doing
business with the covered direct care professional.
(B) The address for the location where the covered
direct care professional will be providing long-term
care services for the covered entity.
(C) All responsibilities to be performed by the
covered direct care professional for the covered
entity, and the regularity in which such
responsibilities are to be performed.
(D) The regular rate of pay of the covered direct
care professional for any work week, including any
overtime compensation due.
(E) The day of the week when the covered direct
care professional will be paid.
(F) The required working hours for any work week,
including--
(i) the time of day and day of week the
work of the covered direct care professional
begins;
(ii) meal and rest breaks described in
section 316;
(iii) time off;
(iv) the work schedule of the covered
direct care professional at the time of hire,
including--
(I) the time of day and the days of
the week the covered direct care
professional will be expected to work
each week for the covered entity; or
(II) if the time of day or the days
of the week that the covered direct
care professional will be expected to
work for the covered entity will vary
from week to week, information
regarding a good faith estimate of the
days and hours for which the covered
direct care professional will be
expected to work for the entity each
week, including, at minimum--
(aa) the average number of
hours the covered direct care
professional will be expected
to work for the entity each
week during a typical 90-day
period;
(bb) whether the covered
direct care professional can
expect to work any on-call
shifts for the entity;
(cc) a subset of days the
covered direct care
professional can typically
expect to work (or to be
scheduled as off from work) for
the entity; and
(dd) the amount of notice
that the entity will provide to
the covered direct care
professional in advance of
scheduled work hours (as
defined in section 313(a)),
which shall not be less than 72
hours before such scheduled
work hours are to begin (except
during a period described in
subparagraph (A) of section
313(e)(1), in a case described
in subparagraph (B) of such
section, or in the case of a
shared living arrangement), and
the manner in which such notice
shall be provided;
(v) the reporting time pay policy described
in section 313(c); and
(vi) the right to request and receive a
change to scheduled work hours due to personal
events as described in section 314.
(G) If applicable, any policies of the covered
entity with respect to the covered direct care
professional for paying for or providing reimbursement
for--
(i) health insurance;
(ii) transportation, meals, or lodging; and
(iii) any fees or costs associated with the
long-term care services provided by the covered
direct care professional for the entity.
(H) If applicable, any policies of the covered
entity with respect to the covered direct care
professional for--
(i) annual or other pay increases;
(ii) severance pay; and
(iii) providing materials or equipment
related to the performance of long-term care
services by the covered direct care
professional, including (if applicable) any
cleaning supplies provided by the entity.
(I) Information about policies, procedures, and
equipment related to safety and emergencies.
(J) The policy of the covered entity pertaining to
notice of termination of the covered direct care
professional by the entity.
(K) In the case of a covered direct care
professional who resides in the household of the person
for whom the covered direct care professional provides
long-term care services--
(i) the circumstances under which the
covered entity may enter the designated living
space of the covered direct care professional;
(ii) the circumstances under which the
covered direct care professional, in a shared
living arrangement, may enter the designated
living space of the covered entity; and
(iii) a description of certain
circumstances the covered entity determines as
cause for--
(I) immediate termination of the
covered direct care professional; and
(II) removal of the covered direct
care professional from the household of
the person for whom the covered direct
care professional provides long-term
care services not later than 48 hours
after notice of the termination.
(L) Any additional benefits afforded to the covered
direct care professional by the covered entity.
(M) The process for the covered direct care
professional to raise or address grievances with
respect to, or breaches of, the written agreement.
(N) The process used by the covered entity to
change any policy described in subparagraphs (A)
through (M), including addressing additional
compensation if responsibilities are added to those
described in subparagraph (C), after the date on which
the written agreement is provided to the covered direct
care professional.
(2) Prohibitions.--A written agreement required under this
section may not--
(A) contain--
(i) a mandatory pre-dispute arbitration
agreement for claims made by a covered direct
care professional against a covered entity
regarding the legal rights of the covered
direct care professional; or
(ii) a non-disclosure agreement, non-
compete agreement, or non-disparagement
agreement, limiting the ability of the covered
direct care professional to seek compensation
for performing long-term care services after
the covered direct care professional ceases to
receive compensation from the covered entity
for the performance of long-term care services;
and
(B) be construed to waive the rights or protections
of a covered direct care professional under Federal,
State, or local law.
(e) Timing.--
(1) Initial agreement.--A covered entity shall provide a
written agreement required under this section--
(A) to each covered direct care professional hired
after the date of enactment of this Act, prior to the
first day the covered direct care professional performs
long-term care services for the entity; and
(B) to each covered direct care professional hired
on or prior to the date of enactment of this Act, 90
days after such date of enactment.
(2) Subsequent agreements.--Not later than 30 calendar days
after the date on which a covered entity makes a change to a
written agreement provided to a covered direct care
professional under this section, the entity shall provide the
covered direct care professional with an updated agreement in
accordance with this section.
(f) Records.--A covered entity that is required to provide a
written agreement under this section to a covered direct care
professional shall retain such agreement for a period of not less than
3 years from the date on which the covered direct care professional is
no longer working for the entity.
(g) Model Written Agreements.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary shall establish and make
available templates for model written agreements under this
section.
(2) Requirements.--A model written agreement required under
paragraph (1) shall--
(A) be available in multiple languages commonly
understood by covered direct care professionals,
including all languages in which the Secretary, acting
through the Administrator of the Wage and Hour
Division, translates the basic information fact sheet
published by the Administrator; and
(B) not include any agreement described in
subsection (d)(2)(A).
SEC. 313. FAIR SCHEDULING PRACTICES.
(a) Definitions.--In this section:
(1) Covered direct care professional.--The term ``covered
direct care professional'' has the meaning given the term in
section 312(a).
(2) Scheduled work hours.--The term ``scheduled work
hours'' means the hours on a specified day during which a
direct care professional is, through a written agreement or
schedule, required by a covered entity to perform long-term
care services for the entity and for which the direct care
professional will receive compensation for such services.
(b) Requirement for Notice of Covered Direct Care Professional.--In
the case of a covered direct care professional, the covered entity
shall provide the covered direct care professional notice of the
scheduled work hours of such covered direct care professional through--
(1) a written agreement described in subclause (I) of
section 312(d)(1)(F)(iv) regarding a schedule of the time of
day and the days of the week the covered direct care
professional is expected to work for the covered entity each
week; or
(2) a schedule agreed upon by the covered entity and the
covered direct care professional provided in the amount of time
specified in accordance with a written agreement described in
subclause (II) of such section, regarding a good faith estimate
of the time of day and the days of the week that the covered
direct care professional is expected to work for the entity.
(c) Requirements for Changes to Scheduled Work Hours and Reporting
Time Pay.--A covered entity shall--
(1) communicate in writing (which may be in an electronic
form) any change to the scheduled work hours of a direct care
professional, including any on-call shifts, not less than 72
hours before the direct care professional is scheduled to begin
work; and
(2) pay a direct care professional--
(A) the regular rate of pay of the direct care
professional for any scheduled work hours the direct
care professional does not work due to the covered
entity canceling or reducing the scheduled work hours
of the direct care professional after the direct care
professional arrives to work for the scheduled work
hours; or
(B) at a rate of \1/2\ of the regular rate of pay
of the direct care professional for any scheduled work
hours the direct care professional does not work due to
the covered entity canceling or reducing the scheduled
work hours of the direct care professional at a time
that is less than 72 hours prior to the commencement of
such scheduled work hours, unless the entity--
(i) is an individual with a disability
relying on the direct care professional for
disability supports and services (or an entity
supporting an individual with a disability);
and
(ii) requests the direct care professional
to consent to work alternative, equivalent
scheduled work hours within a 7-day period and
the direct care professional consents to work
such alternative, equivalent hours.
(d) Right To Decline Schedule Changes.--
(1) In general.--In the case of a covered direct care
professional, if a covered entity wishes to include work hours
in the scheduled work hours of such covered direct care
professional that are identified as hours in which the covered
direct care professional can typically expect to be scheduled
as off from work in accordance with the written agreement under
section 312(d)(1)(F)(iv)(I) or are identified as hours outside
of the good faith estimate under section
312(d)(1)(F)(iv)(II)(cc), the hiring entity shall obtain the
written consent of the worker to work such hours prior to the
commencement of such work.
(2) Consent.--The consent required under paragraph (1) may
be transmitted electronically to the covered entity.
(e) Exceptions.--
(1) In general.--Notwithstanding any provision in this
section, the requirements under subsection (c) shall not
apply--
(A) during any period in which the operations of
the covered entity cannot begin or continue due to--
(i) a fire, flood, or other natural
disaster;
(ii) a major disaster or emergency declared
by the President under section 401 or 501,
respectively, of the Robert T. Stafford
Disaster Relief and Emergency Assistance Act
(42 U.S.C. 5170, 5191) or a state of emergency
declared by a Governor of a State or chief
official of a unit of local government; or
(iii) a severe weather condition that poses
a threat to worker safety; or
(B) in a case in which--
(i) the direct care professional
voluntarily requested in writing a change to
the scheduled work hours of the direct care
professional; or
(ii) the covered entity changes the
scheduled work hours of a direct care
professional due to--
(I) a medical emergency requiring
emergency medical treatment or
hospitalization; or
(II) the risk of contagion or a
quarantine requirement related to a
public health emergency declared by the
Secretary of Health and Human Services
under section 319 of the Public Health
Service Act (42 U.S.C. 247d).
(2) Shared living arrangement.--Notwithstanding any
provision in this section, the requirements under this section
shall not apply to a shared living arrangement.
(f) Effective Date.--This section shall take effect on the date
that is 2 years after the date of enactment of this Act.
SEC. 314. RIGHT TO REQUEST AND RECEIVE TEMPORARY CHANGES TO SCHEDULED
WORK HOURS DUE TO PERSONAL EVENTS.
(a) Definitions.--In this section:
(1) Covered direct care professional.--The term ``covered
direct care professional'' has the meaning given the term in
section 312(a).
(2) Domestic violence.--The term ``domestic violence'' has
the meaning given the term in section 331.
(3) Personal event.--The term ``personal event'', with
respect to a covered direct care professional, means--
(A) an event resulting in the need of the covered
direct care professional to serve as a caregiver for an
individual related to the covered direct care
professional by blood or affinity or whose close
association with the covered direct care professional
is the equivalent of a family relationship;
(B) an event resulting from the obligation of a
covered direct care professional to attend a legal
proceeding or hearing for subsistence benefits,
including benefits under the supplemental nutrition
assistance program established under the Food and
Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) or under
a State program for temporary assistance for needy
families established under part A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.), to which
the covered direct care professional, or an individual
related to the covered direct care professional as
described in subparagraph (A), is a party or witness;
or
(C) any circumstance that would constitute a basis
for permissible use of safe time, or family, medical,
or sick leave, as determined based on the policy of the
covered entity.
(4) Safe time.--The term ``safe time'', with respect to a
covered direct care professional, means an absence from work of
the covered direct care professional resulting from domestic
violence, sexual assault, or stalking, if the absence is to--
(A) seek medical attention for the covered direct
care professional or a child, parent, spouse, or
domestic partner of the covered direct care
professional, or any other individual related to the
covered direct care professional by blood or affinity
whose close association with the covered direct care
professional is the equivalent of a family
relationship, in order to recover from physical or
psychological injury or disability caused by domestic
violence, sexual assault, or stalking;
(B) obtain, or assist a child, parent, spouse,
domestic partner, or other individual described in
subparagraph (A) in obtaining, services from a victim
services organization;
(C) obtain, or assist a child, parent, spouse,
domestic partner, or other individual described in
subparagraph (A) in obtaining, psychological or other
counseling;
(D) seek relocation for the covered direct care
professional or a child, parent, spouse, domestic
partner, or other individual described in subparagraph
(A); or
(E) take legal action, including preparing for or
participating in any civil or criminal legal proceeding
related to or resulting from domestic violence, sexual
assault, or stalking, of the covered direct care
professional or a child, parent, spouse, domestic
partner, or other individual described in subparagraph
(A).
(5) Scheduled work hours.--The term ``scheduled work
hours'' has the meaning given such term in section 313(a),
except that references in such section to the term ``direct
care professional'' shall be deemed to be a reference to the
term ``covered direct care professional''.
(6) Sexual assault; stalking.--The terms ``sexual assault''
and ``stalking'' have the meanings given such terms in section
331.
(7) Temporary change.--The term ``temporary change'', with
respect to a change in the scheduled work hours of a covered
direct care professional, means a limited alteration in the
hours or dates that, or locations where, a covered direct care
professional is scheduled to work, including through using paid
time off, trading or shifting work hours, or using short-term
unpaid leave.
(b) Request.--
(1) In general.--In accordance with this subsection, for
each calendar year, a covered entity shall, upon request of a
covered direct care professional, grant to the covered direct
care professional not less than--
(A) 2 requests for a temporary change, covering not
more than 1 business day per request, to the scheduled
work hours of the covered direct care professional due
to a personal event; or
(B) 1 request for a temporary change, covering not
more than 2 business days, to the scheduled work hours
of the covered direct care professional due to a
personal event.
(2) Notification of request.--
(A) In general.--A covered direct care professional
who requests a temporary change to the scheduled work
hours of the covered direct care professional due to a
personal event under this subsection shall--
(i) notify the covered entity, or direct
supervisor, of such covered direct care
professional, as soon as the covered direct
care professional becomes aware of the need for
the temporary change and inform the entity or
supervisor that the change is due to a personal
event;
(ii) make a proposal for the temporary
change to the scheduled work hours of the
covered direct care professional, unless the
covered direct care professional seeks leave
without pay; and
(iii) subject to subparagraph (B), not be
required to initially submit the request in
writing.
(B) Written record.--
(i) In general.--A covered direct care
professional that requests a temporary change
to the scheduled work hours of the covered
direct care professional under this subsection
and does not initially submit a request for
such change in writing shall, as soon as
practicable and not later than 2 business days
after date on which the covered direct care
professional returns to work following the
conclusion of the temporary change to the
scheduled work hours, submit a written record
of such request indicating--
(I) the date for which the change
was requested; and
(II) that the request was made due
to a personal event.
(ii) Electronic means.--A covered entity
may require that a record under this
subparagraph be submitted in electronic form if
covered direct care professionals of the entity
commonly use an electronic form to request and
manage leave and schedule changes.
(c) Response.--A covered entity who receives a request under
subsection (b) for a temporary change to the scheduled work hours of a
covered direct care professional due to a personal event shall respond
as soon as practicable. Such entity shall not be initially required to
respond to such request in writing. If such entity does not initially
respond to the requested schedule change in writing, the entity shall,
as soon as practicable and not later than 1 week after the requested
schedule change, provide the direct care professional with a written
record of the response to the requested schedule change.
(d) Effective Date.--This section shall take effect on the date
that is 2 years after the date of enactment of this Act.
SEC. 315. PRIVACY.
(a) In General.--A covered entity shall not--
(1) monitor or record a direct care professional while such
direct care professional is--
(A) using restroom or bathing facilities;
(B) in the private living quarters of the direct
care professional; or
(C) engaging in any activities associated with the
dressing, undressing, or changing of clothes of the
direct care professional;
(2) subject to subsection (b), restrict or interfere with,
or monitor, the private communications of such direct care
professional; or
(3) take possession of any documents or other personal
effects of such direct care professional.
(b) Private Communications.--A covered entity may--
(1) restrict, interfere with, or monitor the private
communications of a direct care professional if the entity has
a reasonable belief that such communications significantly
interfere with the direct care professional's performance of
expected duties; and
(2) establish reasonable restrictions on the private
communications of a direct care professional while such direct
care professional is performing work for the entity.
(c) Relation to Other Laws.--This section shall not preclude
liability under any other law.
(d) Definition of Private Communications.--In this section, the
term ``private communications'' means any communication through
telephone or internet services, including sending and receiving
communications by text message, social media, electronic mail, and
telephone, with an entity or individual other than the covered entity.
SEC. 316. BREAKS FOR MEALS AND REST.
(a) Meal Breaks.--
(1) In general.--Except as provided in subsection (c), a
covered entity shall not require a direct care professional to
work more than 5 hours for such hiring entity without an
uninterrupted meal break of not less than 30 minutes. The
number of hours worked by a direct care professional for
purposes of this paragraph shall be calculated without regard
to any rest break the direct care professional takes and to
which the direct care professional has a right under subsection
(b).
(2) Rate of pay.--A covered entity shall pay a direct care
professional for a meal break under paragraph (1) at the
regular rate of pay of the direct care professional, unless the
direct care professional is relieved of all duty for not less
than 30 minutes during the meal break and is permitted to leave
the work site during such break.
(3) Paid meal break.--Except as provided in subsection (c),
for any paid meal break required under paragraph (2), a covered
entity--
(A) shall provide a reasonable opportunity for a
direct care professional to take such break for a
period of uninterrupted time that is not less than 30
minutes; and
(B) shall not impede or discourage a direct care
professional from taking such meal break.
(b) Rest Breaks.--
(1) In general.--Except as provided in subsection (c), for
every 4 hours of work that a direct care professional is
scheduled to perform for a covered entity, the entity shall
allow the direct care professional a rest break of not less
than 10 uninterrupted minutes in which the direct care
professional is relieved of all duties related to providing
long-term care services to the entity. The entity shall allow
such rest break to occur during the first 3 hours of
consecutive work performed by the direct care professional for
the entity.
(2) Rate of pay.--A covered entity shall pay a direct care
professional for the times spent by the direct care
professional for a rest break under paragraph (1) at the
regular rate of pay of the direct care professional. The hiring
entity shall not impede or discourage a direct care
professional from taking such break.
(c) Exceptions.--
(1) In general.--Subject to paragraph (2), a direct care
professional may not have the right to a meal break under
subsection (a), or a rest break under subsection (b), in a case
in which the safety of an individual under the care of the
direct care professional prevents the direct care professional
from taking such break.
(2) On-duty breaks.--
(A) Definition of on-duty.--In this subsection, the
term ``on-duty'', with respect to a meal break under
subsection (a) or a rest break under subsection (b),
means such a break in which the direct care
professional--
(i) is not relieved of all duties of the
direct care professional for the covered
entity; and
(ii) may, to the extent possible given the
duties of the direct care professional for the
covered entity, engage in personal activities,
such as resting, eating a meal, drinking a
beverage, making a personal telephone call, or
making other personal choices.
(B) Authorization.--
(i) In general.--In a case described in
paragraph (1), the direct care professional may
still take an on-duty meal or rest break under
subsection (a) or (b), respectively, if--
(I) the nature of the work prevents
a direct care professional from being
relieved of all duties required of the
direct care professional for the
covered entity; and
(II) the direct care professional
and the covered entity agree to such an
on-duty meal or rest break in a written
agreement described in clause (ii).
(ii) Written agreement.--The written
agreement under clause (i)(II) shall include a
provision allowing the direct care professional
to, in writing, revoke the agreement at any
time.
(C) Rate of pay.--A covered entity shall compensate
a direct care professional for the time of an on-duty
meal or rest break under this paragraph at the regular
rate of pay of the direct care professional for the
entity.
(3) Shared living arrangement.--The requirements under this
section shall not apply in the case of a shared living
arrangement.
SEC. 317. PROHIBITED ACTS.
(a) Interference With Rights.--It shall be unlawful for any person
to interfere with, restrain, or deny the exercise of, or the attempt to
exercise, any right provided under this subtitle, including--
(1) discharging or in any manner discriminating against
(including retaliating against) any direct care professional
for--
(A) exercising, or attempting to exercise, any
right provided under this subtitle; or
(B) engaging in concerted activities for the
purpose of collective bargaining or mutual aid or
protection, regardless of whether such activities are
with direct care professionals of different employers
or direct care professionals at different worksites;
and
(2) discriminating against any direct care professional by
using the exercise of a right provided under this subtitle as a
negative factor in an employment action, such as an action
involving hiring, promotion, or changing work hours or number
of shifts, or a disciplinary action.
(b) Retaliation Protection.--It shall be unlawful for any covered
entity to discharge, demote, suspend, reduce the work hours of, take
any other adverse employment action against, threaten to take an
adverse employment action against, or in any other manner discriminate
against a direct care professional with respect to compensation, terms,
conditions, or privileges of employment because the direct care
professional (or any person acting pursuant to the request of the
direct care professional), whether at the initiative of the direct care
professional or in the ordinary course of the direct care
professional's duties--
(1) opposes any practice made unlawful under this subtitle;
(2) asserts any claim or right under this subtitle;
(3) assists a direct care professional in asserting such
claim or right;
(4) informs any direct care professional about this
subtitle;
(5) requests a change to the written agreement described in
section 312;
(6) requests a change in scheduled work hours described in
section 314, or any other schedule change, without regard to
the eligibility of such direct care professional to receive any
such change;
(7)(A) files an action, or institutes or causes to be
instituted any proceeding, under or related to this subtitle;
(B) gives, or is about to give, any information in
connection with any inquiry or proceeding relating to any right
provided under this subtitle; or
(C) testifies, or is about to testify, in any inquiry or
proceeding relating to any right provided under this subtitle;
and
(8) engages in concerted activities for the purpose of
collective bargaining or mutual aid or protection, regardless
of whether such activities are with direct care professionals
of different employers or direct care professionals at
different worksites.
(c) Immigration-Related Actions as Discrimination.--For purposes of
subsections (a) and (b), discrimination with respect to compensation,
terms, conditions, or privileges of employment occurs if a person
undertakes any of the following activities (unless such activity is
legal conduct undertaken at the express and specific direction or
request of the Federal Government):
(1) Reporting, or threatening to report, the citizenship or
immigration status of a direct care professional, or the
suspected citizenship or immigration status of a family member
of such an individual, to a Federal, State, or local agency.
(2) Requesting more or different documents than those
required under section 274A(b) of the Immigration and
Nationality Act (8 U.S.C. 1324a(b)), or refusing to honor
documents that on their face appear to be genuine.
(3) Using the Federal E-Verify system to check employment
status in a manner not required under section 274A(b) of the
Immigration and Nationality Act (8 U.S.C. 1324a(b)) or any
memorandum governing use of the E-Verify system.
(4) Filing, or threatening to file, a false police report
relating to the immigration status of a direct care
professional, or a family member of a direct care professional.
(5) Contacting, or threatening to contact, immigration
authorities relating to the immigration status of a direct care
professional, or a family member of a direct care professional.
(d) Presumption of Retaliation.--
(1) In general.--For the purposes of subsections (a) and
(b), proof that a person discharged an individual, or
discriminated against an individual with respect to
compensation, terms, conditions, or privileges of employment,
within 90 days of the individual involved asserting any claim
or right under this subtitle, or assisting any other individual
in asserting such a claim or right, shall raise a presumption
that the discharge or discrimination was in retaliation as
prohibited under subsection (a) or (b), as the case may be.
(2) Rebuttal.--The presumption under paragraph (1) may be
rebutted by clear and convincing evidence that such discharge
or discrimination was taken for another permissible reason.
SEC. 318. ENFORCEMENT AUTHORITY.
(a) In General.--
(1) Application.--In this subsection--
(A) the term ``covered entity'' means a covered
entity described in subsection (e)(1)(A); and
(B) the term ``direct care professional'' means a
direct care professional described in subsection
(e)(4)(A).
(2) Investigative authority.--
(A) In general.--To ensure compliance with the
provisions of this subtitle, or any regulation or order
issued under this subtitle, the Secretary shall have
the investigative authority provided under section
11(a) of the Fair Labor Standards Act of 1938 (29
U.S.C. 211(a)), with respect to covered entities,
direct care professionals, and other individuals
affected.
(B) Obligation to keep and preserve records.--A
covered entity shall make, keep, and preserve records
pertaining to compliance with this subtitle in
accordance with section 11(c) of the Fair Labor
Standards Act of 1938 (29 U.S.C. 211(c)) and in
accordance with regulations prescribed by the
Secretary.
(C) Required submissions generally limited to an
annual basis.--The Secretary shall not require under
this paragraph a covered entity to submit to the
Secretary any books or records more than once during
any 12-month period, unless the Secretary--
(i) has reasonable cause to believe there
may exist a violation of this subtitle,
including any regulation or order issued under
this subtitle; or
(ii) is investigating a charge under
paragraph (4).
(D) Subpoena authority.--For the purposes of any
investigation under this paragraph, the Secretary shall
have the subpoena authority provided under section 9 of
the Fair Labor Standards Act of 1938 (29 U.S.C. 209).
(3) Civil action by direct care professionals.--
(A) Right of action.--An action to recover the
damages or equitable relief prescribed in subparagraph
(B) may be maintained against a covered entity by one
or more direct care professionals, or a representative
for and on behalf of the direct care professionals and
any other direct care professionals that may be
similarly situated.
(B) Liability.--A covered entity that violates this
subtitle shall be liable to a direct care professional
aggrieved by the violation, except as provided in
subparagraphs (C) and (D), for--
(i) damages equal to--
(I) the amount of--
(aa) any wages, salary,
employment benefits, or other
compensation denied or lost by
reason of the violation; or
(bb) in a case in which
wages, salary, employment
benefits, or other compensation
have not been denied or lost,
any actual monetary losses
sustained, or the costs
reasonably related to damage to
or loss of property, or any
other injury to the person,
reputation, character, or
feelings, sustained by a direct
care professional as a direct
result of the violation, or any
injury to another person
sustained as a direct result of
the violation, by the covered
entity;
(II) the interest on the amount
described in subclause (I) calculated
at the prevailing rate;
(III) an additional amount as
liquidated damages; and
(IV) such other legal relief as may
be appropriate;
(ii) such equitable relief as may be
appropriate, including employment,
reinstatement, and promotion; and
(iii) a reasonable attorney's fee,
reasonable expert witness fees, and other costs
of the action.
(C) Meal and rest breaks.--In the case of a
violation of section 316, the covered entity involved
shall be liable under subparagraph (B)--
(i) for the amount of damages described in
subclauses (I), (II), and (III) of subparagraph
(B)(i); and
(ii) under subparagraph (B)(i)(IV), for
each such violation, for an amount equal to 1
hour of pay at the direct care professional's
regular rate of compensation (but not more than
2 hours of such pay for each workday for which
the covered entity is in violation of such
section).
(D) Written agreements.--In the case of a violation
of section 312, the covered entity involved shall be
liable, under subparagraph (B)(i)(I), for an amount
equal to $5,000.
(E) Venue.--An action under this paragraph may be
maintained in any Federal or State court of competent
jurisdiction.
(4) Action by the secretary.--
(A) Administrative action.--
(i) In general.--Subject to clause (ii),
and subparagraphs (C) and (D) of paragraph (3),
the Secretary shall receive, investigate, and
attempt to resolve complaints of violations of
this subtitle in the same manner that the
Secretary receives, investigates, and attempts
to resolve complaints of violations of sections
6, 7, and 15(a)(3) of the Fair Labor Standards
Act of 1938 (29 U.S.C. 206, 207, and
215(a)(3)), including the Secretary's authority
to supervise payment of wages and compensation
under section 16(c) of the Fair Labor Standards
Act of 1938 (29 U.S.C. 216(c)).
(ii) Violations generally.--The Secretary
may assess a civil penalty against a covered
entity that violates any section of this
subtitle--
(I) of not more than $15,000 for
any first violation of any such section
by such covered entity; and
(II) of not more than $25,000 for
any subsequent violation of any such
section by such covered entity.
(B) Administrative review.--Any aggrieved direct
care professional who takes exception to an order
issued by the Secretary under subparagraph (A) may
request review of and a decision regarding such order
by an administrative law judge. In reviewing the order,
the administrative law judge may hold an administrative
hearing concerning the order, in accordance with the
requirements of sections 554, 556, and 557 of title 5,
United States Code. Such hearing shall be conducted
expeditiously. If no aggrieved direct care professional
requests such review within 60 days after the order is
issued under subparagraph (A), the order shall be
considered to be a final order that is not subject to
judicial review.
(C) Civil action.--The Secretary may bring an
action in any court of competent jurisdiction to
recover amounts described in paragraph (3)(B) on behalf
of a direct care professional aggrieved by a violation
of this subtitle.
(D) Sums recovered.--
(i) In general.--Any sums recovered by the
Secretary under subparagraph (C) shall be held
in a special deposit account and shall be paid,
on order of the Secretary, directly to each
direct care professional aggrieved by the
violation for which the action was brought. Any
such sums not paid to a direct care
professional because of inability to do so
within a period of 3 years shall be deposited
into the Treasury of the United States as a
miscellaneous receipt.
(ii) Civil penalty.--Any sums recovered by
the Secretary under subparagraph (A)(ii) shall
be deposited into the general fund of the
Treasury of the United States as a
miscellaneous receipt.
(5) Limitation.--
(A) In general.--Except as provided in subparagraph
(B), an action may be brought under paragraph (3), (4),
or (6) not later than 2 years after the date of the
last event constituting the alleged violation for which
the action is brought.
(B) Willful violation.--In the case of an action
brought for a willful violation of this subtitle, such
action may be brought not later than 3 years after the
date of the last event constituting the alleged
violation for which such action is brought.
(C) Commencement.--An action shall be considered
commenced under paragraph (3), (4), or (6) for the
purposes of this paragraph on the date on which the
complaint is filed under such paragraph (3), (4), or
(6).
(6) Action for injunction.--The district courts of the
United States together with the District Court of the Virgin
Islands and the District Court of Guam shall have jurisdiction,
for cause shown, in an action brought by a direct care
professional or the Secretary--
(A) to restrain violations of this subtitle,
including the withholding of a written agreement from a
direct care professional as required under section 312,
or of any withholding of payment of wages, salary,
employment benefits, or other compensation, plus
interest, found by the court to be due to a direct care
professional under this subtitle; or
(B) to award such other equitable relief as may be
appropriate, including employment, reinstatement, and
promotion, for a violation of this subtitle.
(7) Solicitor of labor.--The Solicitor of Labor may appear
for and represent the Secretary on any litigation brought under
paragraph (4) or (6).
(8) Government accountability office and library of
congress.--Notwithstanding any other provision of this
subsection, in the case of the Government Accountability Office
and the Library of Congress, the authority of the Secretary of
Labor under this subsection shall be exercised respectively by
the Comptroller General of the United States and the Librarian
of Congress.
(b) Employees Covered by Congressional Accountability Act of
1995.--The powers, remedies, and procedures provided in the
Congressional Accountability Act of 1995 (2 U.S.C. 1301 et seq.) to the
Board (as defined in section 101 of that Act (2 U.S.C. 1301)), or any
person, alleging a violation of section 202(a)(1) of that Act (2 U.S.C.
1312(a)(1)) shall be the powers, remedies, and procedures this Act
provides to that Board, or any person, alleging an unlawful employment
practice in violation of this subtitle against a direct care
professional described in subsection (e)(4)(B).
(c) Employees Covered by Chapter 5 of Title 3, United States
Code.--The powers, remedies, and procedures provided in chapter 5 of
title 3, United States Code, to the President, the Merit Systems
Protection Board, or any person, alleging a violation of section
412(a)(1) of that title, shall be the powers, remedies, and procedures
this Act provides to the President, that Board, or any person,
respectively, alleging an unlawful employment practice in violation of
this subtitle against a direct care professional described in
subsection (e)(4)(C).
(d) Employees Covered by Chapter 63 of Title 5, United States
Code.--The powers, remedies, and procedures provided in title 5, United
States Code, to an employing agency, provided in chapter 12 of that
title to the Merit Systems Protection Board, or provided in that title
to any person, alleging a violation of chapter 63 of that title, shall
be the powers, remedies, and procedures this Act provides to that
agency, that Board, or any person, respectively, alleging an unlawful
employment practice in violation of this subtitle against a direct care
professional described in subsection (e)(4)(D).
(e) Definition.--In section 317 and this section, except as
otherwise provided in this subsection:
(1) Covered entity.--Notwithstanding section 311, the term
``covered entity'' means a covered entity--
(A) as defined in section 311(b) except that a
reference in that section to a person or an employer
shall be considered to be a reference to an employer
described in clause (i) or (ii) of subparagraph (A),
and subparagraph (B), of paragraph (2);
(B) as defined in section 311(b) except that a
reference in that section to a person or an employer
shall be considered to be a reference to an employer
described in subparagraphs (A)(iii) and (B) of
paragraph (2);
(C) as defined in section 311(b) except that a
reference in that section to a person or an employer
shall be considered to be a reference to an employer
described in subparagraphs (A)(iv) and (B) of paragraph
(2); and
(D) as defined in section 311(b) except that a
reference in that section to a person or an employer
shall be considered to be a reference to an employer
described in subparagraphs (A)(v) and (B) of paragraph
(2).
(2) Employer.--Notwithstanding section 311, for purposes of
paragraph (1), the term ``employer'' means a person who is--
(A)(i) any person who is not covered under another
clause of this subparagraph;
(ii) an entity employing a State employee described
in section 304(a) of the Government Employee Rights Act
of 1991;
(iii) an employing office, as defined in section
101 of the Congressional Accountability Act of 1995;
(iv) an employing office, as defined in section
411(c) of title 3, United States Code; or
(v) an employing agency covered under subchapter V
of chapter 63 of title 5, United States Code; and
(B) engaged in commerce or the production of goods
for commerce or is an enterprise engaged in commerce or
in the production of goods for commerce.
(3) Employment.--Notwithstanding section 3, the term
``employment'' includes work as a direct care professional.
(4) Direct care professional.--Notwithstanding section 3,
the term ``direct care professional'' means--
(A) direct care professional (as defined in such
section) who is compensated for the performance of
long-term care services by an entity described in
paragraph (1)(A);
(B) direct care professional (as defined in such
section) who is compensated for the performance of
long-term care services by an entity described in
paragraph (1)(B);
(C) direct care professional (as defined in such
section) who is compensated for the performance of
long-term care services by an entity described in
paragraph (1)(C); and
(D) direct care professional (as defined in such
section) who is compensated for the performance of
long-term care services by an entity described in
paragraph (1)(D).
SEC. 319. EFFECT ON EXISTING EMPLOYMENT BENEFITS AND OTHER LAWS.
(a) In General.--Nothing in this subtitle shall--
(1) supersede a provision in a collective bargaining
agreement;
(2) be construed to diminish the obligation of a covered
entity to comply with any contract, collective bargaining
agreement, or employment benefit program or plan that provides
greater rights or benefits to direct care professionals than
the rights established under this subtitle; or
(3) be construed to discourage or prevent a covered entity
from adopting a contract, collective bargaining agreement, or
employment benefit program or plan that provides greater rights
or benefits to direct care professionals than the rights
established under this subtitle.
(b) Other Laws.--Nothing in this subtitle shall--
(1) affect the obligation of a covered entity to provide a
reasonable accommodation in the form of a change to the work
schedule of a direct care professional required under any other
law, or to otherwise comply with any other law;
(2) preempt, limit, or otherwise affect the applicability
of any State or local law that provides comparable or superior
benefits for direct care professionals to the requirements
under this subtitle; or
(3) diminish the rights, privileges, or remedies of any
direct care professional under any Federal or State law or
under any collective bargaining agreement.
(c) No Waivers.--The rights and remedies in this subtitle may not
be waived by a direct care professional through any agreement, policy,
or form, or as a condition of employment.
Subtitle C--Workplace Violence Prevention for Health Care and Social
Services Workers Act
SEC. 321. WORKPLACE VIOLENCE PREVENTION STANDARD.
(a) Interim Final Standard.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Labor shall issue an
interim final standard on workplace violence prevention--
(A) to require certain employers in the health care
and social service sectors, and certain employers in
sectors that conduct activities similar to the
activities in the health care and social service
sectors, to develop and implement a comprehensive
workplace violence prevention plan and carry out other
activities or requirements described in section 323 to
protect health care workers, social service workers,
and other personnel from workplace violence;
(B) that shall, at a minimum, be based on the
Guidelines for Preventing Workplace Violence for
Healthcare and Social Service Workers published by the
Occupational Safety and Health Administration of the
Department of Labor in 2015 and adhere to the
requirements of this subtitle; and
(C) that provides for a period determined
appropriate by the Secretary, not to exceed 1 year,
during which the Secretary shall prioritize technical
assistance and advice consistent with section 21(d) of
the Occupational Safety and Health Act of 1970 (29
U.S.C. 670(d)) to employers subject to the standard
with respect to compliance with the standard.
(2) Inapplicable provisions of law and executive order.--
The following provisions of law and Executive orders shall not
apply to the issuance of the interim final standard under this
subsection:
(A) The requirements applicable to occupational
safety and health standards under section 6(b) of the
Occupational Safety and Health Act of 1970 (29 U.S.C.
655(b)).
(B) The requirements of chapters 5 and 6 of title
5, United States Code.
(C) Subchapter I of chapter 35 of title 44, United
States Code (commonly referred to as the ``Paperwork
Reduction Act'').
(D) Executive Order No. 12866 (58 Fed. Reg. 51735;
relating to regulatory planning and review), as
amended.
(3) Notice and comment.--Notwithstanding paragraph (2)(B),
the Secretary shall, prior to issuing the interim final
standard under this subsection, provide notice in the Federal
Register of the interim final standard and a 30-day period for
public comment.
(4) Effective date of interim standard.--The interim final
standard shall--
(A) take effect on a date that is not later than 30
days after issuance, except that such interim final
standard may include a reasonable phase-in period for
the implementation of required engineering controls
that take effect after such date;
(B) be enforced in the same manner and to the same
extent as any standard promulgated under section 6(b)
of the Occupational Safety and Health Act of 1970 (29
U.S.C. 655(b)); and
(C) be in effect until the final standard described
in subsection (b) becomes effective and enforceable.
(5) Failure to promulgate.--If an interim final standard
described in paragraph (1) is not issued not later than 1 year
of the date of enactment of this Act, the provisions of section
323 shall be in effect and enforced in the same manner and to
the same extent as any standard promulgated under section 6(b)
of the Occupational Safety and Health Act of 1970 (29 U.S.C.
655(b)) until such provisions are superseded in whole by an
interim final standard issued by the Secretary that meets the
requirements of paragraph (1).
(b) Final Standard.--
(1) Proposed standard.--Not later than 2 years after the
date of enactment of this Act, the Secretary of Labor shall,
pursuant to section 6 of the Occupational Safety and Health Act
of 1970 (29 U.S.C. 655), promulgate a proposed standard on
workplace violence prevention--
(A) for the purposes described in subsection
(a)(1)(A); and
(B) that shall include, at a minimum, requirements
contained in the interim final standard required under
subsection (a).
(2) Final standard.--Not later than 42 months after the
date of enactment of this Act, the Secretary shall issue a
final standard on such proposed standard that shall--
(A) provide no less protection than any workplace
violence standard adopted by a State plan that has been
approved by the Secretary under section 18 of the
Occupational Safety and Health Act of 1970 (29 U.S.C.
667), provided the Secretary finds that the final
standard is feasible on the basis of the best available
evidence; and
(B) be effective and enforceable in the same manner
and to the same extent as any standard promulgated
under section 6(b) of the Occupational Safety and
Health Act of 1970 (29 U.S.C. 655(b)).
SEC. 322. SCOPE AND APPLICATION.
In this subtitle:
(1) Covered facility.--
(A) In general.--The term ``covered facility''
means the following:
(i) Any hospital, including any specialty
hospital, in-patient or outpatient setting, or
clinic operating within a hospital license, or
any setting that provides outpatient services.
(ii) Any residential treatment facility,
including any nursing home, skilled nursing
facility, hospice facility, Alzheimer's and
dementia care facility, or other long-term care
facility.
(iii) Any nonresidential treatment or
service setting.
(iv) Any medical treatment or social
service setting or clinic at a correctional or
detention facility.
(v) Any community care setting, including a
community-based residential facility, group
home, and mental health clinic.
(vi) Any psychiatric treatment facility.
(vii) Any drug abuse or substance use
disorder treatment center.
(viii) Any independent freestanding
emergency center.
(ix) Any assisted living facility.
(x) Any provider of home and community-
based services.
(xi) Any facility described in clauses (i)
through (x) operated by a Federal Government
agency and required to comply with occupational
safety and health standards pursuant to part
1960 of title 29, Code of Federal Regulations
(as such part is in effect on the date of
enactment of this Act).
(xii) Any other facility the Secretary
determines should be covered under the
standards promulgated under section 321.
(B) Exclusion.--The term ``covered facility'' does
not include an office of a physician, dentist,
podiatrist, or any other health practitioner that is
not physically located within a covered facility
described in clauses (i) through (xi) of subparagraph
(A).
(2) Covered services.--
(A) In general.--The term ``covered service'' means
the following services and operations:
(i) Any services and operations provided in
any field work setting, including home health
care, home-based hospice, and home-based social
work.
(ii) Any emergency services and transport,
including such services provided by
firefighters and emergency responders.
(iii) Any services described in clauses (i)
and (ii) performed by a Federal Government
agency and required to comply with occupational
safety and health standards pursuant to part
1960 of title 29, Code of Federal Regulations
(as such part is in effect on the date of
enactment of this Act).
(iv) Any other services and operations the
Secretary determines should be covered under
the standards promulgated under section 321.
(B) Exclusion.--The term ``covered service'' does
not include child day care services.
(3) Covered employer.--
(A) In general.--The term ``covered employer''
includes a person (including a contractor, a
subcontractor, a temporary service firm, or an employee
leasing entity) that employs an individual to work at a
covered facility or to perform covered services.
(B) Exclusion.--The term ``covered employer'' does
not include an individual who privately employs, in the
individual's residence, a person to perform covered
services for the individual or a family member of the
individual or an individual who receives home and
community-based services through a self-directed or
participant-directed Medicaid waiver.
(4) Covered employee.--The term ``covered employee''
includes an individual employed by a covered employer to work
at a covered facility or to perform covered services.
SEC. 323. REQUIREMENTS FOR WORKPLACE VIOLENCE PREVENTION STANDARD.
Each standard described in section 321 shall include, at a minimum,
the following:
(1) Workplace violence prevention plan.--Not later than 6
months after the date of promulgation of the interim final
standard under section 321(a), or 18 months after the date of
enactment of this Act in a case described in section 321(a)(5),
a covered employer shall develop, implement, and maintain an
effective written workplace violence prevention plan (in this
section referred to as the ``Plan'') for covered employees at
each covered facility and for covered employees performing a
covered service on behalf of such employer, which meets the
following:
(A) Plan development.--Each Plan--
(i) shall be developed and implemented with
the meaningful participation of direct care
professionals, other employees, and employee
representatives, for all aspects of the Plan;
(ii) shall be tailored and specific to
conditions and hazards for the covered facility
or the covered service, including patient-
specific risk factors and risk factors specific
to each work area or unit;
(iii) shall be suitable for the size,
complexity, and type of operations at the
covered facility or for the covered service,
and remain in effect at all times; and
(iv) may be in consultation with
stakeholders or experts who specialize in
workplace violence prevention, emergency
response, or other related areas of expertise
for all relevant aspects of the Plan.
(B) Plan content.--Each Plan shall include
procedures and methods for the following:
(i) Identification of the individual
(including the individual's role with respect
to the covered employer) responsible for
implementation of the Plan.
(ii) With respect to each work area and
unit at the covered facility or while covered
employees are performing the covered service,
risk assessment and identification of workplace
violence risks and hazards to employees exposed
to such risks and hazards (including
environmental risk factors and patient-specific
risk factors), which shall be--
(I) informed by past violent
incidents specific to such covered
facility or such covered service; and
(II) conducted with, at a minimum--
(aa) direct care
professionals;
(bb) where applicable, the
representatives of such
workers; and
(cc) the employer.
(iii) Hazard prevention, engineering
controls, or work practice controls to correct
hazards, in a timely manner, applying
industrial hygiene principles of the hierarchy
of controls, which--
(I) may include security and alarm
systems, adequate exit routes,
monitoring systems, barrier protection,
established areas for patients and
clients, lighting, entry procedures,
staffing and working in teams, and
systems to identify and flag clients
with a history of violence; and
(II) shall ensure that employers
correct, in a timely manner, hazards
identified in any violent incident
investigation described in paragraph
(2) and any annual report described in
paragraph (5).
(iv) Reporting, incident response, and
post-incident investigation procedures,
including procedures--
(I) for employees to report
workplace violence risks, hazards, and
incidents;
(II) for employers to respond to
reports of workplace violence;
(III) for employers to perform a
post-incident investigation and
debriefing of all reports of workplace
violence with the participation of
employees and their representatives;
(IV) to provide medical care or
first aid to affected employees; and
(V) to provide employees with
information about available trauma and
related counseling.
(v) Procedures for emergency response,
including procedures for threats of mass
casualties and procedures for incidents
involving a firearm or a dangerous weapon.
(vi) Procedures for communicating with and
training the covered employees on workplace
violence hazards, threats, and work practice
controls, the employer's plan, and procedures
for confronting, responding to, and reporting
workplace violence threats, incidents, and
concerns, and employee rights.
(vii) Procedures for--
(I) ensuring the coordination of
risk assessment efforts, Plan
development, and implementation of the
Plan with other employers who have
employees who work at the covered
facility or who are performing the
covered service; and
(II) determining which covered
employer or covered employers shall be
responsible for implementing and
complying with the provisions of the
standard applicable to the working
conditions over which such employers
have control.
(viii) Procedures for conducting the annual
evaluation under paragraph (6).
(C) Availability of plan.--Each Plan shall be made
available at all times to the covered employees who are
covered under such Plan.
(2) Violent incident investigation.--
(A) In general.--As soon as practicable after a
workplace violence incident, risk, or hazard of which a
covered employer has knowledge, the employer shall
conduct an investigation of such incident, risk, or
hazard under which the employer shall--
(i) review the circumstances of the
incident, risk, or hazard, and whether any
controls or measures implemented pursuant to
the Plan of the employer were effective; and
(ii) solicit input from involved employees,
their representatives, and supervisors about
the cause of the incident, risk, or hazard, and
whether further corrective measures (including
system-level factors) could have prevented the
incident, risk, or hazard.
(B) Documentation.--A covered employer shall
document the findings, recommendations, and corrective
measures taken for each investigation conducted under
this paragraph.
(3) Training and education.--With respect to the covered
employees covered under a Plan of a covered employer, the
employer shall provide training and education to such employees
who may be exposed to workplace violence hazards and risks,
which meet the following requirements:
(A) Annual training and education shall include
information on the Plan, including identified workplace
violence hazards, work practice control measures,
reporting procedures, recordkeeping requirements,
response procedures, anti-retaliation policies, and
employee rights.
(B) Additional hazard recognition training shall be
provided for supervisors and managers to ensure they--
(i) can recognize high-risk situations; and
(ii) do not assign employees to situations
that predictably compromise the safety of such
employees.
(C) Additional training shall be provided for each
such covered employee whose job circumstances have
changed, within a reasonable timeframe after such
change.
(D) Additional training shall be provided for each
such covered employee whose job circumstances require
working with victims of torture, trafficking, or
domestic violence.
(E) Applicable training shall be provided under
this paragraph for each new covered employee prior to
the employee's job assignment.
(F) All training shall provide such employees
opportunities to ask questions, give feedback on
training, and request additional instruction,
clarification, or other follow-up.
(G) All training shall be provided in-person and by
an individual with knowledge of workplace violence
prevention and of the Plan, except that any annual
training described in subparagraph (A) provided to an
employee after the first year such training is provided
to such employee may be conducted by live video if in-
person training is impracticable.
(H) All training shall be appropriate in content
and vocabulary to the language, educational level, and
literacy of such covered employees.
(4) Recordkeeping and access to plan records.--
(A) In general.--Each covered employer shall--
(i) maintain for not less than 5 years--
(I) records related to each Plan of
the employer, including workplace
violence risk and hazard assessments,
and identification, evaluation,
correction, and training procedures;
(II) a violent incident log
described in subparagraph (B) for
recording all workplace violence
incidents; and
(III) records of all incident
investigations as required under
paragraph (2)(B); and
(ii)(I) make such records and logs
available, upon request, to covered employees
and their representatives for examination and
copying in accordance with section 1910.1020 of
title 29, Code of Federal Regulations (as such
section is in effect on the date of enactment
of this Act), and in a manner consistent with
HIPAA privacy regulations (defined in section
1180(b)(3) of the Social Security Act (42
U.S.C. 1320d-9(b)(3))) and part 2 of title 42,
Code of Federal Regulations (as such part is in
effect on the date of enactment of this Act);
and
(II) ensure that any such records and logs
that may be copied, transmitted electronically,
or otherwise removed from the employer's
control for purposes of this clause omit any
element of personal identifying information
sufficient to allow identification of any
patient, resident, client, or other individual
alleged to have committed a violent incident
(including the individual's name, address,
electronic mail address, telephone number, or
social security number, or other information
that, alone or in combination with other
publicly available information, reveals such
individual's identity).
(B) Violent incident log description.--Each violent
incident log shall--
(i) be maintained by a covered employer for
each covered facility controlled by the
employer and for each covered service being
performed by a covered employee on behalf of
such employer;
(ii) be based on a template developed by
the Secretary not later than 1 year after the
date of enactment of this Act;
(iii) include, at a minimum, a description
of--
(I) the violent incident (including
environmental risk factors present at
the time of the incident);
(II) the date, time, and location
of the incident, and the names and job
titles of involved employees;
(III) the nature and extent of
injuries to covered employees;
(IV) a classification of the
perpetrator who committed the violence,
including whether the perpetrator was--
(aa) a patient, client,
resident, or customer of a
covered employer;
(bb) a family or friend of
a patient, client, resident, or
customer of a covered employer;
(cc) a stranger;
(dd) a coworker,
supervisor, or manager of a
covered employee;
(ee) a partner, spouse,
parent, or relative of a
covered employee; or
(ff) any other appropriate
classification;
(V) the type of violent incident
(such as type 1 violence, type 2
violence, type 3 violence, or type 4
violence); and
(VI) how the incident was abated;
(iv) not later than 7 days after the
employer learns of such incident, contain a
record of each violent incident, which is
updated to ensure completeness of such record;
(v) be maintained for not less than 5
years; and
(vi) in the case of a violent incident
involving a privacy concern case, protect the
identity of employees in a manner consistent
with section 1904.29(b) of title 29, Code of
Federal Regulations (as such section is in
effect on the date of enactment of this Act).
(C) Annual summary.--
(i) Covered employers.--Each covered
employer shall prepare and submit to the
Secretary an annual summary of each violent
incident log for the preceding calendar year
that shall--
(I) with respect to each covered
facility, and each covered service, for
which such a log has been maintained,
include--
(aa) the total number of
violent incidents;
(bb) the number of
recordable injuries related to
such incidents; and
(cc) the total number of
hours worked by the covered
employees for such preceding
year;
(II) be completed on a form
provided by the Secretary;
(III) be posted for 90 days
beginning February 1 of each year in a
manner consistent with the requirements
of part 1904 of title 29, Code of
Federal Regulations (as such part is in
effect on the date of enactment of this
Act), relating to the posting of
summaries of injury and illness logs;
(IV) be located in a conspicuous
place or places where notices to
employees are customarily posted; and
(V) not be altered, defaced, or
covered by other material.
(ii) Secretary.--Not later than 1 year
after the promulgation of the interim final
standard under section 321(a), or 2 years after
the date of enactment of this Act in a case
described in section 321(a)(5), the Secretary
shall make available a platform for the
electronic submission of annual summaries
required under this subparagraph.
(5) Annual report.--
(A) Report to secretary.--Not later than February
15 of each year, each covered employer shall report to
the Secretary, on a form provided by the Secretary, the
frequency, quantity, and severity of workplace
violence, and any incident response and post-incident
investigation (including abatement measures) for the
incidents set forth in the annual summary of the
violent incident log described in paragraph (4)(C).
(B) Report to congress.--Not later than 180 days
after February 15 of each year, the Secretary shall
submit to Congress a summary of the reports received
under subparagraph (A). The contents of the summary of
the Secretary to Congress shall not disclose any
confidential information.
(6) Annual evaluation.--Each covered employer shall conduct
an annual written evaluation, conducted with the full, active
participation of covered employees and employee
representatives, of--
(A) the implementation and effectiveness of the
Plan, including a review of the violent incident log;
and
(B) compliance with training required by each
standard described in section 321, and specified in the
Plan.
(7) Plan updates.--Each covered employer shall incorporate
changes to the Plan, in a manner consistent with paragraph
(1)(A)(i) and based on findings from the most recent annual
evaluation conducted under paragraph (6), as appropriate.
(8) Anti-retaliation.--
(A) Policy.--Each covered employer shall adopt a
policy prohibiting any person (including an agent of
the employer) from the discrimination or retaliation
described in subparagraph (B).
(B) Prohibition.--No covered employer shall
discriminate or retaliate against any employee for--
(i) reporting a workplace violence
incident, threat, or concern to, or seeking
assistance or intervention with respect to such
incident, threat, or concern from, the
employer, law enforcement, local emergency
services, or a local, State, or Federal
government agency; or
(ii) exercising any other rights under this
section.
(C) Enforcement.--This paragraph shall be enforced
in the same manner and to the same extent as any
standard promulgated under section 6(b) of the
Occupational Safety and Health Act of 1970 (29 U.S.C.
655(b)).
SEC. 324. RULES OF CONSTRUCTION.
Notwithstanding section 18 of the Occupational Safety and Health
Act of 1970 (29 U.S.C. 667)--
(1) nothing in this subtitle shall be construed to curtail
or limit authority of the Secretary under any other provision
of the law;
(2) the rights, privileges, or remedies of covered
employees shall be in addition to the rights, privileges, or
remedies provided under any Federal or State law, or any
collective bargaining agreement;
(3) nothing in this subtitle shall be construed to limit or
prevent health care workers, social service workers, and other
personnel from reporting violent incidents to appropriate law
enforcement; and
(4) nothing in this Act shall be construed to limit or
diminish any protections in relevant Federal, State, or local
law related to--
(A) domestic violence;
(B) stalking;
(C) dating violence; or
(D) sexual assault.
SEC. 325. DEFINITIONS.
In this subtitle:
(1) Alarm.--The term ``alarm'' means a mechanical,
electrical, or electronic device that does not rely upon an
employee's vocalization in order to alert others.
(2) Dangerous weapon.--The term ``dangerous weapon'' means
an instrument capable of inflicting death or serious bodily
injury, without regard to whether such instrument was designed
for that purpose.
(3) Engineering controls.--
(A) In general.--The term ``engineering controls''
means an aspect of the built space or a device that
removes a hazard from the workplace or creates a
barrier between a covered employee and the hazard.
(B) Inclusions.--For purposes of reducing workplace
violence hazards, the term ``engineering controls''
includes electronic access controls to employee
occupied areas, weapon detectors (installed or
handheld), enclosed workstations with shatter-resistant
glass, deep service counters, separate rooms or areas
for high-risk patients, locks on doors, removing access
to or securing items that could be used as weapons,
furniture affixed to the floor, opaque glass in patient
rooms (which protects privacy, but allows the health
care provider to see where the patient is before
entering the room), closed-circuit television
monitoring and video recording, sight-aids, and
personal alarm devices.
(4) Environmental risk factors.--
(A) In general.--The term ``environmental risk
factors'' means factors in the covered facility or area
in which a covered service is performed that may
contribute to the likelihood or severity of a workplace
violence incident.
(B) Clarification.--Environmental risk factors may
be associated with the specific task being performed or
the work area, such as working in an isolated area,
poor illumination or blocked visibility, and lack of
physical barriers between individuals and persons at
risk of committing workplace violence.
(5) Patient-specific risk factors.--The term ``patient-
specific risk factors'' means factors specific to a patient
that may increase the likelihood or severity of a workplace
violence incident, including--
(A) a patient's treatment and medication status,
and history of violence and use of drugs or alcohol;
and
(B) any conditions or disease processes of the
patient that may cause the patient to experience
confusion or disorientation, be nonresponsive to
instruction, behave unpredictably, or engage in
disruptive, threatening, or violent behavior.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(7) Threat of violence.--The term ``threat of violence''
means a statement or conduct that--
(A) causes an individual to fear for such
individual's safety because there is a reasonable
possibility the individual might be physically injured;
and
(B) serves no legitimate purpose.
(8) Type 1 violence.--The term ``type 1 violence''--
(A) means workplace violence directed at a covered
employee at a covered facility or while performing a
covered service by an individual who has no legitimate
business at the covered facility or with respect to
such covered service; and
(B) includes violent acts by any individual who
enters the covered facility or worksite where a covered
service is being performed with the intent to commit a
crime.
(9) Type 2 violence.--The term ``type 2 violence'' means
workplace violence directed at a covered employee by customers,
clients, patients, students, inmates, or any individual for
whom a covered facility provides services or for whom the
employee performs covered services.
(10) Type 3 violence.--The term ``type 3 violence'' means
workplace violence directed at a covered employee by a present
or former employee, supervisor, or manager.
(11) Type 4 violence.--The term ``type 4 violence'' means
workplace violence directed at a covered employee by an
individual who is not an employee, but has or is known to have
had a personal relationship with such employee, or with a
customer, client, patient, student, inmate, or any individual
for whom a covered facility provides services or for whom the
employee performs covered services.
(12) Work practice controls.--
(A) In general.--The term ``work practice
controls'' means procedures and rules that are used to
effectively reduce workplace violence hazards.
(B) Inclusions.--The term ``work practice
controls'' includes--
(i) assigning and placing sufficient
numbers of staff to reduce patient-specific
type 2 violence hazards;
(ii) provision of dedicated and available
safety personnel such as security guards;
(iii) employee training on workplace
violence prevention methods and techniques to
de-escalate and minimize violent behavior; and
(iv) employee training on procedures for
response in the event of a workplace violence
incident and for post-incident response.
(13) Workplace violence.--
(A) In general.--The term ``workplace violence''
means any act of violence or threat of violence,
without regard to intent, that occurs at a covered
facility or while a covered employee performs a covered
service.
(B) Exclusions.--The term ``workplace violence''
does not include lawful acts of self-defense or lawful
acts of defense of others.
(C) Inclusions.--The term ``workplace violence''
includes--
(i) the threat or use of physical force
against a covered employee that results in or
has a high likelihood of resulting in injury,
psychological trauma, or stress, without regard
to whether the covered employee sustains an
injury, psychological trauma, or stress; and
(ii) an incident involving the threat or
use of a firearm or a dangerous weapon,
including the use of common objects as weapons,
without regard to whether the employee sustains
an injury, psychological trauma, or stress.
SEC. 326. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION STANDARD TO
CERTAIN FACILITIES RECEIVING MEDICARE FUNDS.
(a) In General.--Section 1866 of the Social Security Act (42 U.S.C.
1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y), by striking the period at
the end and inserting ``, and''; and
(C) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) in the case of hospitals that are not
otherwise subject to the Occupational Safety and Health
Act of 1970 (or a State occupational safety and health
plan that is approved under section 18(b) of such Act)
and skilled nursing facilities that are not otherwise
subject to such Act (or such a State occupational
safety and health plan), to comply with the Workplace
Violence Prevention Standard (as promulgated under
section 321 of the Long-Term Care Workforce Support
Act).''; and
(2) in subsection (b)(4)--
(A) in subparagraph (A), by inserting ``and a
hospital or skilled nursing facility that fails to
comply with the requirement of subsection (a)(1)(Z)
(relating to the Workplace Violence Prevention
Standard)'' after ``Bloodborne Pathogens standard)'';
and
(B) in subparagraph (B)--
(i) by striking ``(a)(1)(U)'' and inserting
``(a)(1)(V)''; and
(ii) by inserting ``(or, in the case of a
failure to comply with the requirement of
subsection (a)(1)(Z), for a violation of the
Workplace Violence Prevention standard referred
to in such subsection by a hospital or skilled
nursing facility, as applicable, that is
subject to the provisions of such Act)'' before
the period at the end.
(b) Effective Date.--The amendments made by subsection (a) shall
apply beginning on the date that is 1 year after the date of issuance
of the interim final standard on workplace violence prevention required
under section 321.
Subtitle D--Improving Access to Job Benefits
SEC. 331. DEFINITIONS.
In this subtitle:
(1) Child.--The term ``child'' means a biological, foster,
or adopted child, a stepchild, a child of a domestic partner, a
legal ward, or a child of a person standing in loco parentis.
(2) Commerce; industry or activity affecting commerce.--The
terms ``commerce'' and ``industry or activity affecting
commerce'' mean any activity, business, or industry in commerce
or in which a labor dispute would hinder or obstruct commerce
or the free flow of commerce, and include ``commerce'' and any
``industry affecting commerce'', as defined in paragraphs (1)
and (3) of section 501 of the Labor Management Relations Act,
1947 (29 U.S.C. 142 (1) and (3)).
(3) Covered direct care professional.--The term ``covered
direct care professional'' means an employee who is employed as
a direct care professional by an employer.
(4) Domestic violence.--The term ``domestic violence'' has
the meaning given the term in section 40002(a) of the Violence
Against Women Act of 1994 (34 U.S.C. 12291(a)), except that the
reference in such section to the term ``jurisdiction receiving
grant funding'' shall be deemed to mean the jurisdiction in
which the victim lives or the jurisdiction in which the
employer involved is located. Such term also includes dating
violence, as that term is defined in such section.
(5) Employee.--The term ``employee'' means an individual
who is an employee, as defined in section 3(e) of the Fair
Labor Standards Act of 1938 (29 U.S.C. 203(e)), except that a
reference in such section to an employer shall be considered to
be a reference to an employer described in paragraph (6).
(6) Employer.--
(A) In general.--The term ``employer''--
(i) means a person who is engaged in
commerce or in any industry or activity
affecting commerce who employs 1 or more
employees;
(ii) includes--
(I) any person who acts, directly
or indirectly, in the interest of an
employer to any of the employees of
such employer; and
(II) any successor in interest of
such an employer; and
(iii) does not include any public agency.
(B) Definitions.--For purposes of this
subparagraph:
(i) Employee.--The term ``employee'' has
the meaning given such term in section 3 of the
Fair Labor Standards Act of 1938 (29 U.S.C.
203).
(ii) Person.--The term ``person'' has the
meaning given such term in section 3 of the
Fair Labor Standards Act of 1938 (29 U.S.C.
203).
(iii) Public agency.--The term ``public
agency'' has the meaning given such term in
section 3 of the Fair Labor Standards Act of
1938 (29 U.S.C. 203).
(C) Predecessors.--Any reference in this paragraph
to an employer shall include a reference to any
predecessor of such employer.
(7) Employment benefits.--The term ``employment benefits''
means all benefits provided or made available to employees by
an employer, including group life insurance, health insurance,
disability insurance, sick leave, annual leave, educational
benefits, and pensions, regardless of whether such benefits are
provided by a practice or written policy of an employer or
through an ``employee benefit plan'', as defined in section
3(3) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1002(3)).
(8) Health care provider.--The term ``health care
provider'' means a provider who--
(A)(i) is a doctor of medicine or osteopathy who is
authorized to practice medicine or surgery (as
appropriate) by the State in which the doctor
practices; or
(ii) is any other person determined by the
Secretary to be capable of providing health care
services; and
(B) is not employed by an employer for whom the
provider issues certification under this subtitle.
(9) Paid sick time.--The term ``paid sick time'' means an
increment of compensated leave that--
(A) can be--
(i) earned by an employee for use during an
absence from employment for a reason described
in any paragraph of section 332(b); or
(ii) provided by an employer during a
public health emergency for use during an
absence from employment for a reason described
in any paragraph of section 332(b); and
(B) is compensated at a rate that is not less than
the greatest of--
(i) the employee's regular rate of pay;
(ii) the wage rate described in section
6(a)(1) of the Fair Labor Standards Act of 1938
(29 U.S.C. 206(a)(1)); or
(iii) the minimum wage rate provided for in
the applicable State or local law for the State
or locality in which the employee is employed.
(10) Parent.--The term ``parent'' means a biological,
foster, or adoptive parent of an employee, a stepparent of an
employee, parent-in-law, parent of a domestic partner, or a
legal guardian or other person who stood in loco parentis to an
employee when the employee was a child.
(11) Public health emergency.--The term ``public health
emergency'' means a public health emergency declared by the
Secretary of Health and Human Services for a jurisdiction, or
by a State public health official with authority to declare
such an emergency for the State or jurisdiction within the
State.
(12) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(13) Sexual assault.--The term ``sexual assault'' has the
meaning given the term in section 40002(a) of the Violence
Against Women Act of 1994 (34 U.S.C. 12291(a)).
(14) Spouse.--The term ``spouse'', with respect to an
employee, has the meaning given such term by the marriage laws
of the State in which the marriage was celebrated.
(15) Stalking.--The term ``stalking'' has the meaning given
the term in section 40002(a) of the Violence Against Women Act
of 1994 (34 U.S.C. 12291(a)).
(16) Victim services organization.--The term ``victim
services organization'' means a nonprofit, nongovernmental
organization that provides assistance to victims of domestic
violence, sexual assault, or stalking or advocates for such
victims, including a rape crisis center, an organization
carrying out a domestic violence, sexual assault, or stalking
prevention or treatment program, an organization operating a
shelter or providing counseling services, or a legal services
organization or other organization providing assistance through
the legal process.
SEC. 332. PAID SICK TIME.
(a) Earning of Paid Sick Time.--
(1) In general.--Subject to subsection (c), an employer
shall provide each covered direct care professional employed by
the employer not less than 1 hour of earned paid sick time for
every 30 hours worked, to be used as described in subsection
(b). An employer shall not be required to permit a covered
direct care professional to earn, under this subsection, more
than 56 hours of paid sick time in a year, unless the employer
chooses to set a higher limit.
(2) Exempt covered direct care professionals.--
(A) In general.--Except as provided in subparagraph
(B), for purposes of this subsection, a covered direct
care professional who is exempt from overtime
requirements under section 13(a)(1) of the Fair Labor
Standards Act of 1938 (29 U.S.C. 213(a)(1)) shall be
deemed to work 40 hours in each workweek.
(B) Shorter normal workweek.--If the normal
workweek of such a covered direct care professional is
less than 40 hours, the covered direct care
professional shall earn paid sick time under this
subsection based upon that normal workweek.
(3) Dates for beginning to earn paid sick time and use.--
(A) In general.--Except as provided in subparagraph
(B) and the second sentence of paragraph (8), covered
direct care professionals shall begin to earn paid sick
time under this section at the commencement of their
employment. Except as provided in such subparagraph and
such sentence, a covered direct care professional shall
be entitled to use the earned paid sick time beginning
on the 60th calendar day following commencement of the
covered direct care professional's employment. After
that 60th calendar day, the covered direct care
professional may use the paid sick time as the time is
earned. An employer may, at the discretion of the
employer, loan paid sick time to a covered direct care
professional for use by such covered direct care
professional in advance of the covered direct care
professional earning such sick time as provided in this
section and may permit use before the 60th day of
employment.
(B) Public health emergency.--Subparagraph (A)
shall not apply with respect to additional paid sick
time provided under subsection (c). In the event of a
public health emergency, a covered direct care
professional may immediately use the additional or
accrued paid sick time described in subsection (c),
regardless of how long the covered direct care
professional has been employed by an employer.
(4) Carryover.--
(A) In general.--Except as provided in subparagraph
(B), paid sick time earned under this section shall
carry over from 1 year to the next.
(B) Construction.--Except as provided in subsection
(c), this subtitle shall not be construed to require an
employer to permit a covered direct care professional
to earn more than 56 hours of earned paid sick time at
a given time.
(5) Employers with existing policies.--Any employer with a
paid leave policy who makes available an amount of paid leave
that is sufficient to meet the requirements of this section and
that may be used for the same purposes and under the same
conditions as the purposes and conditions described in this
section shall not be required to permit a covered direct care
professional to earn additional paid sick time under this
section.
(6) Construction.--Nothing in this section shall be
construed as requiring financial or other reimbursement to a
covered direct care professional from an employer upon the
covered direct care professional's termination, resignation,
retirement, or other separation from employment for earned paid
sick time that has not been used.
(7) Reinstatement.--If a covered direct care professional
is separated from employment with an employer and is rehired,
within 12 months after that separation, by the same employer,
the employer shall reinstate the covered direct care
professional's previously earned paid sick time. The covered
direct care professional shall be entitled to use the earned
paid sick time and earn additional paid sick time at the
recommencement of employment with the employer.
(8) Prohibition.--An employer may not require, as a
condition of providing paid sick time under this subtitle, that
the covered direct care professional involved search for or
find a replacement to cover the hours during which the covered
direct care professional is using paid sick time.
(b) Uses.--Paid sick time earned under this section may be used by
a covered direct care professional for any of the following:
(1) An absence resulting from a physical or mental illness,
injury, or medical condition of the covered direct care
professional.
(2) An absence resulting from obtaining professional
medical diagnosis or care, or preventive medical care, for the
covered direct care professional.
(3) An absence resulting from the closure of a covered
direct care professional's place of employment by order of a
Federal or State public official with jurisdiction, or at the
employer's discretion, due to a public health emergency.
(4) An absence because a Federal or State public official
with jurisdiction or a health care provider has determined that
the covered direct care professional's presence in the
community may jeopardize the health of others because of the
covered direct care professional's exposure to a communicable
disease during a public health emergency, regardless of whether
the covered direct care professional has actually contracted
the communicable disease.
(5) An absence for the purpose of caring for a child, a
parent, a spouse, a domestic partner, or any other individual
related by blood or affinity whose close association with the
covered direct care professional is the equivalent of a family
relationship--
(A) who is a child, if the child's school or place
of care has been closed by order of a Federal or State
public official with jurisdiction or at the discretion
of the school or place of care due to a public health
emergency, including if a school or entity operating
the place of care is physically closed but is providing
education or care to the child remotely; or
(B) because a Federal or State public official with
jurisdiction or a health care provider has determined
that the presence in the community of the person
receiving care may jeopardize the health of others
because of the person's exposure to a communicable
disease during a public health emergency, regardless of
whether the person has actually contracted the
communicable disease.
(6) An absence for the purpose of caring for a child, a
parent, a spouse, a domestic partner, or any other individual
related by blood or affinity whose close association with the
covered direct care professional is the equivalent of a family
relationship--
(A) who has any of the conditions or needs for
diagnosis or care described in paragraph (1) or (2);
(B) who is a child, if the covered direct care
professional is required to attend a school meeting or
a meeting at a place where the child is receiving care
necessitated by the child's health condition or
disability; or
(C) who is otherwise in need of care.
(7) An absence resulting from domestic violence, sexual
assault, or stalking, if the time is to--
(A) seek medical attention for the covered direct
care professional or the covered direct care
professional's child, parent, spouse, domestic partner,
or an individual related to the covered direct care
professional as described in paragraph (6), to recover
from physical or psychological injury or disability
caused by domestic violence, sexual assault, or
stalking;
(B) obtain or assist a related person described in
paragraph (6) in obtaining services from a victim
services organization;
(C) obtain or assist a related person described in
paragraph (6) in obtaining psychological or other
counseling;
(D) seek relocation; or
(E) take legal action, including preparing for or
participating in any civil or criminal legal proceeding
related to or resulting from domestic violence, sexual
assault, or stalking.
(c) Additional Paid Sick Time for Public Health Emergency.--
(1) Additional paid sick time.--On the date of a
declaration of a public health emergency by the Secretary of
Health and Human Services under section 319 of the Public
Health Service Act (42 U.S.C. 247d) or a major disaster or
emergency declared by the President under section 401 or 501,
respectively, of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act (42 U.S.C. 5170, 5191), an employer in
the jurisdiction involved shall provide each covered direct
care professional of the employer in that jurisdiction with
additional paid sick time, in addition to any amount of paid
sick time accrued by the covered direct care professional under
subsection (a) (including paid leave referred to in subsection
(a)(4)).
(2) Amount of paid sick time.--In receiving additional paid
sick time under paragraph (1), the covered direct care
professional shall receive--
(A) for a full-time salaried covered direct care
professional, a specified amount of paid sick time that
is sufficient to provide the covered direct care
professional with 14 continuous days away from work
without a reduction in pay; and
(B) for a part-time or hourly covered direct care
professional, a specified amount of paid sick time
equal to the number of hours that the covered direct
care professional was scheduled to work or, if not so
scheduled, regularly works in a 14-day period.
(3) Use of leave.--The additional sick time and accrued
sick time described in this subsection shall be available for
immediate use by the covered direct care professional for the
purposes described in any paragraph of subsection (b) beginning
on the date a public health emergency is declared, regardless
of how long the covered direct care professional has been
employed by an employer.
(4) Sequencing.--During the public health emergency, a
covered direct care professional may first use the additional
sick time for those purposes. The covered direct care
professional may then use the accrued sick time during the
public health emergency, or retain the accrued sick time for
use after the public health emergency. An employer may not
require a covered direct care professional to use the accrued
sick time, or any other paid leave provided by the employer to
the covered direct care professional, before using the
additional sick time.
(5) Periods.--A covered direct care professional may take
the additional sick time on the schedule that meets the covered
direct care professional's needs, consistent with subsection
(b), including taking the additional sick time intermittently
or on a reduced leave schedule, and an employer may not require
a covered direct care professional to take the additional sick
time in a single period or on any other schedule specified by
the employer.
(d) Scheduling.--A covered direct care professional shall make a
reasonable effort to schedule a period of paid sick time under
subsection (a) in a manner that does not unduly disrupt the operations
of the employer.
(e) Procedures.--
(1) In general.--Paid sick time shall be provided upon the
oral or written request of a covered direct care professional.
Such request shall--
(A) include the expected duration of the period of
such time; and
(B)(i) in a case in which the need for such period
of time is foreseeable at least 7 days in advance of
such period, be provided at least 7 days in advance of
such period; and
(ii) otherwise, be provided as soon as practicable
after the covered direct care professional is aware of
the need for such period.
(2) Certification in general.--
(A) Provision.--
(i) In general.--Subject to subparagraphs
(C) and (D), an employer may require that a
request for paid sick time under this section
for a purpose described in paragraph (1), (2),
or (6) of subsection (b) be supported by a
certification issued by the health care
provider of the covered direct care
professional or of an individual described in
subsection (b)(6), as appropriate, if the
period of such time covers more than 3
consecutive workdays.
(ii) Timeliness.--The covered direct care
professional shall provide a copy of such
certification to the employer in a timely
manner, not later than 30 days after the first
day of the period of time. The employer shall
not delay the commencement of the period of
time on the basis that the employer has not yet
received the certification.
(B) Sufficient certification.--
(i) In general.--A certification provided
under subparagraph (A) shall be sufficient if
it states--
(I) the date on which the period of
time will be needed;
(II) the probable duration of the
period of time;
(III) the appropriate medical facts
within the knowledge of the health care
provider regarding the condition
involved, subject to clause (ii); and
(IV)(aa) for purposes of paid sick
time under subsection (b)(1), a
statement that absence from work is
medically necessary;
(bb) for purposes of such time
under subsection (b)(2), the dates on
which testing for a medical diagnosis
or care is expected to be given and the
duration of such testing or care; and
(cc) for purposes of such time
under subsection (b)(6), in the case of
time to care for someone who is not a
child, a statement that care is needed
for an individual described in such
subsection, and an estimate of the
amount of time that such care is needed
for such individual.
(ii) Limitation.--In issuing a
certification under subparagraph (A), a health
care provider shall make reasonable efforts to
limit the medical facts described in clause
(i)(III) that are disclosed in the
certification to the minimum necessary to
establish a need for the covered direct care
professional to use paid sick time.
(C) Public health emergencies.--No certification or
other documentation may be required under this subtitle
by an employer during any public health emergency.
(D) Regulations.--Regulations prescribed under
section 339 shall specify the manner in which a covered
direct care professional who does not have health
insurance shall provide a certification for purposes of
this paragraph.
(E) Confidentiality and nondisclosure.--
(i) Protected health information.--Nothing
in this subtitle shall be construed to require
a health care provider to disclose information
in violation of section 1177 of the Social
Security Act (42 U.S.C. 1320d-6) or the
regulations promulgated pursuant to section
264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2
note).
(ii) Health information records.--If an
employer possesses health information about a
covered direct care professional, a covered
direct care professional's child, parent,
spouse, domestic partner, or an individual
related to the covered direct care professional
as described in subsection (b)(6), such
information shall--
(I) be maintained on a separate
form and in a separate file from other
personnel information;
(II) be treated as a confidential
medical record; and
(III) not be disclosed except to
the affected covered direct care
professional or with the permission of
the affected covered direct care
professional.
(3) Certification in the case of domestic violence, sexual
assault, or stalking.--
(A) In general.--An employer may require that a
request for paid sick time under this section for a
purpose described in subsection (b)(7) be supported by
any one of the following:
(i) A police report indicating that the
covered direct care professional, or a member
of the covered direct care professional's
family described in subsection (b)(7), was a
victim of domestic violence, sexual assault, or
stalking.
(ii) A court order protecting or separating
the covered direct care professional or a
member of the covered direct care
professional's family described in subsection
(b)(7) from the perpetrator of an act of
domestic violence, sexual assault, or stalking,
or other evidence from the court or prosecuting
attorney that the covered direct care
professional or a member of the covered direct
care professional's family described in
subsection (b)(7) has appeared in court or is
scheduled to appear in court in a proceeding
related to domestic violence, sexual assault,
or stalking.
(iii) Other documentation signed by a
covered direct care professional or volunteer
working for a victim services organization, an
attorney, a police officer, a medical
professional, a social worker, an antiviolence
counselor, or a member of the clergy, affirming
that the covered direct care professional or a
member of the covered direct care
professional's family described in subsection
(b)(7) is a victim of domestic violence, sexual
assault, or stalking.
(B) Requirements.--The requirements of paragraph
(2) shall apply to certifications under this paragraph,
except that--
(i) subclauses (III) and (IV) of
subparagraph (B)(i) and subparagraph (B)(ii) of
such paragraph shall not apply;
(ii) the certification shall state the
reason that the leave is required with the
facts to be disclosed limited to the minimum
necessary to establish a need for the covered
direct care professional to be absent from
work, and the covered direct care professional
shall not be required to explain the details of
the domestic violence, sexual assault, or
stalking involved; and
(iii) with respect to confidentiality under
subparagraph (E) of such paragraph, any
information provided to the employer under this
paragraph shall be confidential, except to the
extent that any disclosure of such information
is--
(I) requested or consented to in
writing by the covered direct care
professional; or
(II) otherwise required by
applicable Federal or State law.
(C) Specification of documentation.--An employer
may not specify which of the forms of documentation
described in clause (i), (ii), or (iii) of subparagraph
(A) is required to be provided in order to satisfy the
requirement under such subparagraph.
SEC. 333. NOTICE REQUIREMENT.
(a) In General.--Each employer shall notify each covered direct
care professional employed by the employer and include in any employee
handbook the information--
(1) describing paid sick time available to covered direct
care professionals under this subtitle;
(2) pertaining to the filing of an action under this
subtitle;
(3) on the details of the notice requirement for a
foreseeable period of time under section 332(e)(1)(B)(i); and
(4) that describes--
(A) the protections that a covered direct care
professional has in exercising rights under this
subtitle; and
(B) how the covered direct care professional can
contact the Secretary if any of the rights are
violated.
(b) Posting of Notice.--Each employer shall post and keep posted a
notice, to be prepared or approved in accordance with procedures
specified in regulations prescribed under section 339, setting forth
excerpts from, or summaries of, the pertinent provisions of this
subtitle including the information described in paragraphs (1) through
(4) of subsection (a).
(c) Location.--The notice described under subsection (b) shall be
posted--
(1) in conspicuous places on the premises of the employer,
where notices to employees (including applicants) are
customarily posted; or
(2) in employee handbooks.
(d) Violation; Penalty.--Any employer who willfully violates the
posting requirements of this section shall be subject to a civil fine
in an amount not to exceed $100 for each separate offense.
SEC. 334. PROHIBITED ACTS.
(a) Interference With Rights.--
(1) Exercise of rights.--It shall be unlawful for any
employer to interfere with, restrain, or deny the exercise of,
or the attempt to exercise, any right provided under this
subtitle, including--
(A) discharging or discriminating against
(including retaliating against) any individual,
including a job applicant, for exercising, or
attempting to exercise, any right provided under this
subtitle;
(B) using the taking of paid sick time under this
subtitle as a negative factor in an employment action,
such as hiring, promotion, reducing hours or number of
shifts, or a disciplinary action; or
(C) counting the paid sick time under a no-fault
attendance policy or any other absence-control policy.
(2) Discrimination.--It shall be unlawful for any employer
to discharge or in any other manner discriminate against
(including retaliating against) any individual, including a job
applicant, for opposing any practice made unlawful by this
subtitle.
(b) Interference With Proceedings or Inquiries.--It shall be
unlawful for any person to discharge or in any other manner
discriminate against (including retaliating against) any individual,
including a job applicant, because such individual--
(1) has filed an action, or has instituted or caused to be
instituted any proceeding, under or related to this subtitle;
(2) has given, or is about to give, any information in
connection with any inquiry or proceeding relating to any right
provided under this subtitle; or
(3) has testified, or is about to testify, in any inquiry
or proceeding relating to any right provided under this
subtitle.
(c) Construction.--Nothing in this section shall be construed to
state or imply that the scope of the activities prohibited by section
105 of the Family and Medical Leave Act of 1993 (29 U.S.C. 2615) is
less than the scope of the activities prohibited by this section.
SEC. 335. ENFORCEMENT AUTHORITY.
(a) Investigative Authority.--
(1) In general.--To ensure compliance with the provisions
of this subtitle, or any regulation or order issued under this
subtitle, the Secretary shall have, subject to paragraph (3),
the investigative authority provided under section 11(a) of the
Fair Labor Standards Act of 1938 (29 U.S.C. 211(a)), with
respect to employers, covered direct care professionals, and
other individuals affected by an employer.
(2) Obligation to keep and preserve records.--An employer
shall make, keep, and preserve records pertaining to compliance
with this subtitle in accordance with section 11(c) of the Fair
Labor Standards Act of 1938 (29 U.S.C. 211(c)) and in
accordance with regulations prescribed by the Secretary.
(3) Required submissions generally limited to an annual
basis.--The Secretary shall not require, under the authority of
this subsection, an employer to submit to the Secretary any
books or records more than once during any 12-month period,
unless the Secretary has reasonable cause to believe there may
exist a violation of this subtitle or any regulation or order
issued pursuant to this subtitle, or is investigating a charge
pursuant to subsection (c).
(4) Subpoena authority.--For the purposes of any
investigation provided for in this subsection, the Secretary
shall have the subpoena authority provided for under section 9
of the Fair Labor Standards Act of 1938 (29 U.S.C. 209).
(b) Civil Action by Covered Direct Care Professionals or
Individuals.--
(1) Right of action.--An action to recover the damages or
equitable relief prescribed in paragraph (1) may be maintained
against any employer in any Federal or State court of competent
jurisdiction by a covered direct care professional or
individual or a representative for and on behalf of--
(A) the covered direct care professional or
individual; or
(B) the covered direct care professional or
individual and others similarly situated.
(2) Liability.--Any employer who violates section 334
(including a violation relating to rights provided under
section 332) shall be liable to any covered direct care
professional or individual affected--
(A) for damages equal to--
(i) the amount of--
(I) any wages, salary, employment
benefits, or other compensation denied
or lost by reason of the violation; or
(II) in a case in which wages,
salary, employment benefits, or other
compensation have not been denied or
lost, any actual monetary losses
sustained as a direct result of the
violation up to a sum equal to 56 hours
of wages or salary for the covered
direct care professional or individual,
or the specified period described in
section 332(c)(3), or a combination of
those hours and that period, as the
case may be;
(ii) the interest on the amount described
in clause (i) calculated at the prevailing
rate; and
(iii) an additional amount as liquidated
damages; and
(B) for such equitable relief as may be
appropriate, including employment, reinstatement, and
promotion.
(3) Fees and costs.--The court in an action under this
subsection shall, in addition to any judgment awarded to the
plaintiff, allow a reasonable attorney's fee, reasonable expert
witness fees, and other costs of the action to be paid by the
defendant.
(c) Action by the Secretary.--
(1) Administrative action.--The Secretary shall receive,
investigate, and attempt to resolve complaints of violations of
section 334 (including a violation relating to rights provided
under section 332) in the same manner that the Secretary
receives, investigates, and attempts to resolve complaints of
violations of sections 6 and 7 of the Fair Labor Standards Act
of 1938 (29 U.S.C. 206 and 207).
(2) Civil action.--The Secretary may bring an action in any
court of competent jurisdiction to recover the damages
described in subsection (b)(2)(A).
(3) Sums recovered.--Any sums recovered by the Secretary
pursuant to paragraph (2) shall be held in a special deposit
account and shall be paid, on order of the Secretary, directly
to each covered direct care professional or individual
affected. Any such sums not paid to a covered direct care
professional or individual affected because of inability to do
so within a period of 3 years shall be deposited into the
Treasury of the United States as miscellaneous receipts.
(d) Limitation.--
(1) In general.--Except as provided in paragraph (2), an
action may be brought under subsection (b), (c), or (e) not
later than 2 years after the date of the last event
constituting the alleged violation for which the action is
brought.
(2) Willful violation.--In the case of an action brought
for a willful violation of section 334 (including a willful
violation relating to rights provided under section 332), such
action may be brought not later than 3 years after the last
event constituting the alleged violation for which such action
is brought.
(3) Commencement.--In determining when an action is
commenced under subsection (b), (c), or (e) for the purposes of
this subsection, it shall be considered to be commenced on the
date when the complaint is filed.
(e) Action for Injunction by Secretary.--The district courts of the
United States shall have jurisdiction, for cause shown, in an action
brought by the Secretary--
(1) to restrain violations of section 334 (including a
violation relating to rights provided under section 332),
including the restraint of any withholding of payment of wages,
salary, employment benefits, or other compensation, plus
interest, found by the court to be due to covered direct care
professionals or individuals eligible under this subtitle; or
(2) to award such other equitable relief as may be
appropriate, including employment, reinstatement, and
promotion.
(f) Solicitor of Labor.--The Solicitor of Labor may appear for and
represent the Secretary on any litigation brought under subsection (c)
or (e).
SEC. 336. EDUCATION AND OUTREACH.
(a) In General.--The Secretary may conduct a public awareness
campaign to educate and inform the public of the requirements for paid
sick time required by this subtitle.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary $20,000,000 to carry out such campaign.
SEC. 337. EFFECT ON EXISTING EMPLOYMENT BENEFITS.
(a) More Protective.--Nothing in this subtitle shall be construed
to diminish the obligation of an employer to comply with any contract,
collective bargaining agreement, or any employment benefit program or
plan that provides greater paid sick leave or other leave rights to
covered direct care professionals or individuals than the rights
established under this subtitle.
(b) Less Protective.--The rights established for covered direct
care professionals under this subtitle shall not be diminished by any
contract, collective bargaining agreement, or any employment benefit
program or plan.
SEC. 338. ENCOURAGEMENT OF MORE GENEROUS LEAVE POLICIES.
Nothing in this subtitle shall be construed--
(1) to discourage employers from adopting or retaining
leave policies more generous than policies that comply with the
requirements of this subtitle; or
(2) to discourage or prevent an employer from adopting a
contract, collective bargaining agreement, or employment
benefit program or plan that provides greater right or benefits
to covered direct care professionals than the rights
established under this subtitle.
SEC. 339. REGULATIONS.
(a) In General.--Subject to subsection (b), not later than 180 days
after the date of enactment of this Act, the Secretary shall prescribe
such regulations as are necessary to carry out this subtitle.
(b) Immediate Compliance.--The rights and responsibilities
specified in this subtitle shall take effect on the date of enactment
of this Act and employers and other persons subject to those
responsibilities shall comply immediately, without regard whether
regulations have been prescribed under this section.
SEC. 339A. EFFECTIVE DATE.
If a public health emergency was declared before and remains in
effect on the date of enactment of this Act, for purposes of this
subtitle, including section 332(c), the public health emergency shall
be considered to have been declared on the date of enactment of this
Act.
SEC. 339B. COLLECTION OF DATA AND FURTHER STUDY.
(a) Compilation of Information.--The Commissioner of the Bureau of
Labor Statistics shall--
(1) collect data on--
(A) the amount of paid and unpaid sick time
available to covered direct care professionals by
occupation and type of employment establishment; and
(B) an estimate of the average sick time used by
covered direct care professionals according to
occupation and the type of covered direct care
professional; and
(2) annually report that data to the Comptroller General of
the United States.
(b) GAO Study.--The Comptroller General of the United States
shall--
(1) conduct a study to evaluate the implementation of this
subtitle--
(A) that includes an estimation of the access of
covered direct care professionals to paid sick time,
the awareness of covered direct care professionals of
rights under this Act, and the experiences of employers
in complying with this subtitle; and
(B) that takes into account access, awareness, and
experiences of covered direct care professionals by
race, ethnicity, gender, disability, occupation, and
any other characteristic determined by the Secretary;
and
(2) not later than 5 years after the date of enactment of
this Act, submit the report to the Committee on Health,
Education, Labor, and Pensions and the Special Committee on
Aging of the Senate and the Committee on Education and the
Workforce of the House of Representatives.
TITLE IV--NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY
SEC. 401. DEFINITIONS.
In this title:
(1) Advisory council.--The term ``Advisory Council'' means
the National Direct Care Professional Compensation Advisory
Council convened under section 403.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(3) Strategy.--The term ``Strategy'' means the National
Direct Care Professional Compensation Strategy set forth under
section 402.
SEC. 402. NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY.
(a) In General.--The Secretary, in consultation with the heads of
other appropriate Federal agencies, shall develop jointly with the
Advisory Council and submit to the appropriate committees of Congress,
and the State agencies responsible for carrying out direct care
professional programs, and make publicly available on the internet
website of the Department of Health and Human Services, a National
Direct Care Professional Compensation Strategy.
(b) Contents.--
(1) In general.--The Strategy shall identify recommended
actions that the Federal Government (under existing Federal
programs), State and local governments, communities, health
care providers, including direct care professionals and others,
are taking, or may take, to provide direct care professionals a
livable wage, including recommendations on--
(A) how to calculate the fair cost of labor
provided by direct care professionals;
(B) how State Medicaid agencies, managed care
organizations, and other public payers should establish
policies and procedures to ensure the direct care
professional workforce is compensated at the full cost
of their labor;
(C) how to set clear expectations for employers of
direct care professionals with respect to compensation
for such professionals; and
(D) how to ensure additional training and
certification is tied to increased compensation for
such professionals.
(2) Considerations.--The recommendations under paragraph
(1) shall take into account--
(A) the particular challenges of the direct care
professional workforce, including--
(i) the largely part-time nature of the
work;
(ii) the mobile or transient nature of
positions in the direct care professional
workforce;
(iii) precarity due to race, ethnicity,
sexual orientation, gender identity, and
immigration status; and
(iv) any decrease in public benefits that
direct care professionals may experience
following an increase in wages; and
(B) strategies for wage enhancement for direct care
professionals.
(c) Duties of the Secretary.--The Secretary, in carrying out
subsection (a), shall oversee the following:
(1) Collecting and making publicly available information
submitted by the Advisory Council under section 403(e) to the
appropriate committees of Congress, and the State agencies
responsible for carrying out direct care professional programs,
including evidence-based or promising practices and innovative
models (both domestic and foreign) regarding compensation for
direct care professionals.
(2) Coordinating and assessing existing Federal Government
programs and activities to compensate direct care professionals
while ensuring maximum effectiveness and avoiding unnecessary
duplication.
(3) Providing technical assistance, as appropriate, such as
disseminating identified best practices and information sharing
based on reports provided under section 403(e), to State or
local efforts to compensate direct care professionals.
(d) Initial Strategy; Updates.--The Secretary shall--
(1) not later than 18 months after the date of enactment of
this Act, develop, publish, and submit to the appropriate
committees of Congress, and the State agencies responsible for
carrying out direct care professional programs, an initial
Strategy incorporating the items addressed in the Advisory
Council's initial report under section 403(e) and other
relevant information, including best practices, for
compensating direct care professionals; and
(2) biennially update, republish, and submit to the
appropriate committees of Congress and the State agencies
responsible for carrying out direct care professional programs
the Strategy, taking into account the most recent annual report
submitted under section 403(e)(1)--
(A) to reflect new developments, challenges,
opportunities, and solutions; and
(B) to review progress based on recommendations for
compensating direct care professionals in the Strategy
and, based on the results of such review, recommend
priority actions for improving the implementation of
such recommendations, as appropriate.
(e) Process for Public Input.--The Secretary shall establish a
process for public input to inform the development of, and updates to,
the Strategy, including a process for the public to submit
recommendations to the Advisory Council and an opportunity for public
comment on the proposed Strategy.
(f) No Preemption.--Nothing in this title preempts any authority of
a State or local government to compensate direct care professionals.
(g) Rule of Construction.--Nothing in this title shall be construed
to permit the Secretary (through regulation, guidance, grant criteria,
or otherwise) to--
(1) mandate, direct, or control the allocation of State or
local resources;
(2) mandate the use of any of the best practices identified
in the reports required under this title; or
(3) otherwise expand the authority of the Secretary beyond
that expressly provided to the Secretary in this title.
(h) Authorization of Appropriations.--There is authorized to be
appropriated for the advisory committee $100,000 for each of years 2025
through 2029.
SEC. 403. NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION ADVISORY
COUNCIL.
(a) Convening.--The Secretary shall convene a National Direct Care
Professional Compensation Advisory Council to advise and provide
recommendations, including identified best practices, to the Secretary
on compensating direct care professionals.
(b) Membership.--
(1) In general.--The members of the Advisory Council shall
consist of--
(A) the appointed members under paragraph (2); and
(B) the Federal members under paragraph (3).
(2) Appointed members.--In addition to the Federal members
under paragraph (3), the Secretary shall appoint not more than
15 voting members of the Advisory Council who are not
representatives of Federal departments or agencies and who
shall include at least 1 representative of each of the
following:
(A) Direct care professionals.
(B) Older individuals eligible for long-term care
services under a State Medicaid program.
(C) People with disabilities.
(D) Health care and social service providers.
(E) Employers of direct care professionals.
(F) State and local officials responsible for
direct care professional policies in their
jurisdictions.
(G) Accreditation bodies responsible for
accrediting direct care professionals.
(H) Veterans who are older individuals or people
with disabilities.
(I) Organizations representing workers, including
labor organizations.
(J) As appropriate, other experts in direct care
and advocacy organizations for the direct care
professional workforce.
(3) Federal members.--The Federal members of the Advisory
Council, who shall be nonvoting members, shall consist of the
following:
(A) The Administrator of the Centers for Medicare &
Medicaid Services (or the Administrator's designee).
(B) The Administrator of the Administration for
Community Living (or the Administrator's designee who
has experience in both aging and disability).
(C) The Secretary of Veterans Affairs (or the
Secretary's designee).
(D) The Secretary of Labor (or the Secretary's
designee).
(E) The Administrator of the Health Resources and
Services Administration (or the Administrator's
designee).
(F) The heads of other Federal departments or
agencies (or their designees), including relevant
departments or agencies that oversee labor and
workforce, economic, government financial policies,
community service, and other impacted populations, as
appointed by the Secretary or the Chair of the Advisory
Council.
(4) Diverse representation.--The Secretary shall ensure
that the membership of the Advisory Council reflects the
diversity of direct care professionals and individuals eligible
for long-term care services under a State Medicaid program.
(c) Meetings.--The Advisory Council shall meet quarterly during the
1-year period beginning on the date of enactment of this Act and at
least 3 times during each year thereafter. Meetings of the Advisory
Council shall be open to the public.
(d) Non-Federal Member Compensation.--
(1) Compensation of members.--A member of the Advisory
Council who is not an officer or employee of the Federal
Government shall be compensated at a rate equal to the daily
equivalent of the annual rate of basic pay prescribed for level
IV of the Executive Schedule under section 5315 of title 5,
United States Code, for each day (including travel time) during
which the member is engaged in the performance of the duties of
the Commission.
(2) Travel expenses.--A member of the Advisory Council who
is not an officer or employee of the Federal Government shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Commission.
(3) Child care.--A member of the Advisory Council who is
not an officer or employee of the Federal Government shall be
permitted expenses for child care during the period for which
they are required to meet with the Advisory Council or travel
to and from meetings of the Advisory Council.
(4) Technology support.--A member of the Advisory Council
who is not an officer or employee of the Federal Government
shall be permitted expenses for technology necessary to
participate in activities of the Advisory Council.
(e) Advisory Council Annual Reports.--
(1) In general.--Not later than 12 months after the date of
enactment of this Act, and annually thereafter, the Advisory
Council shall submit to the Secretary, the appropriate
committees of Congress, and the State agencies responsible for
carrying out direct care professional programs, and make
publicly available on the internet website of the Department of
Health and Human Services, a report concerning the development,
maintenance, and updating of the Strategy, including a
description of the outcomes of the recommendations and any
priorities included in the initial report pursuant to paragraph
(2), as appropriate.
(2) Initial report.--The Advisory Council's initial report
under paragraph (1) shall include--
(A) an inventory and assessment of all federally
funded efforts to compensate direct care professionals
and the outcomes of such efforts, including analyses of
the extent to which federally funded efforts are
reaching direct care professionals and gaps in such
efforts;
(B) recommendations--
(i) to improve and better coordinate
Federal programs and activities to compensate
direct care professionals, as well as
opportunities to improve the coordination of
such Federal programs and activities with State
programs; and
(ii) to effectively deliver services based
on the performance, mission, and purpose of a
program while eliminating redundancies,
avoiding unnecessary duplication and overlap,
and ensuring the needs of direct care
professionals are met;
(C) the identification of challenges faced by
direct care professionals, including financial, health,
and other challenges, and existing approaches to
address such challenges; and
(D) an evaluation of how the status of the direct
care professional workforce affects the Medicare
program, the Medicaid program, and other Federal
programs.
(f) Nonapplicability of Federal Advisory Committee Act.--Chapter 10
of title 5, United States Code, shall not apply to the Advisory
Council.
SEC. 404. SUNSET PROVISION.
The authority and obligations established by this title shall
terminate on the date that is 10 years after the date of enactment of
this Act.
TITLE V--IMPROVING OVERSIGHT AND ACCOUNTABILITY
SEC. 501. EVALUATION OF IMPLEMENTATION AND OUTCOMES.
(a) In General.--The Secretary of Health and Human Services, in
conjunction with the Secretary of Labor, shall evaluate the
implementation and outcomes of this Act in the aggregate through a
contract with an external evaluator who has experience in evaluating--
(1) home and community-based services;
(2) disability programs;
(3) programs for older individuals;
(4) nursing homes and intermediate care facilities; and
(5) health care workforce programs, including direct care
professional workforce programs.
(b) Evaluation Criteria.--The external evaluator shall document and
evaluate the implementation and outcomes of this Act, and the
amendments made by this Act, including outcomes based on--
(1) the impact on workforce creation, training, education,
recruitment, retention, professional development, and
advancement of the direct care professional workforce,
including direct care professionals from low-income families;
(2) the economic effects, including the impact on
compensation and benefits, on the direct care professional
workforce;
(3) the impact on working conditions, including scheduling
flexibility and stability, for direct care professionals;
(4) the impact of workforce investment activities,
including supportive services, on recruitment, wages, benefits,
and advancement of direct care professionals;
(5) the impact on burnout, attrition, and stability of the
direct care professional workforce;
(6) the impact on vacancy rates and crude separation rates
of the direct care professional workforce;
(7) the economic effects on--
(A) individuals enrolled for medical assistance
under a State Medicaid program;
(B) people with disabilities and older individuals
receiving long-term care services, including home and
community-based services; and
(C) the families of any such individuals or persons
described in subparagraph (A) or (B);
(8) the impact on the capacity of States to ensure the
delivery of long-term care services and on the costs to the
Medicare and Medicaid programs;
(9) the capacity of the direct care professional workforce
to provide services for individuals needing long-term care
services or changes in access, availability, and quality of
long-term care services;
(10) the impact on State waiting lists for home and
community-based services;
(11) the impact on mental health outcomes, including
substance use disorders and suicidality, among direct care
professionals;
(12) promising practices identified by activities
authorized or conducted pursuant to this Act, or the amendments
made by this Act; and
(13) any other factor as determined appropriate by the
Secretary of Health and Human Services.
(c) Fiscal Analysis.--The Secretary of Health and Human Services,
in conjunction with the Secretary of Labor, shall contract with an
independent external evaluator to track spending by States and
providers of funding provided to States under sections 101 and 102
(including the amendments made by such sections). The evaluator shall--
(1) collect spending data from each State receiving funds
under such sections;
(2) analyze the data to determine what percentage of
funding under such sections was expended to improve wages and
benefits of direct care professionals, disaggregated by
subcategories of direct care professionals described in section
3(11);
(3) beginning 2 years after the date of enactment of this
Act, and every year thereafter through fiscal year 2039--
(A) publish an annual report of State spending and
the analyses conducted under paragraph (2); and
(B) provide all such reports to the appropriate
committees of Congress; and
(4) share the data described in paragraph (1) with
researchers to encourage further analysis.
(d) Dissemination of Evaluation Findings.--The Secretary of Health
and Human Services shall--
(1) disseminate the findings from the evaluations conducted
under this section, and from any other evaluation conducted
under this Act or an amendment made by this Act, to--
(A) all State Medicaid agencies; and
(B) the appropriate committees of Congress; and
(2) make all such findings publicly available in an
accessible electronic format and any other accessible format
determined appropriate by the Secretary.
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