[Congressional Record Volume 172, Number 50 (Thursday, March 19, 2026)]
[Senate]
[Pages S1408-S1410]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 4706. Mr. KIM (for himself, Mr. Wyden, Mr. Lujan, Mr. Van Hollen,
Mr. Murphy, and Mr. Blumenthal) submitted an amendment intended to be
proposed by him to the bill S. 1383, to establish the Veterans Advisory
Committee on Equal Access, and for other purposes; which was ordered to
lie on the table; as follows:
In lieu of the matter proposed to be inserted, insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Nurses Belong in Nursing
Homes Act''.
SEC. 2. NURSE STAFFING REQUIREMENTS.
(a) Establishing Total Nurse Staffing Hours Per Resident
Day; Requiring 24-Hour Use of Registered Professional Nurses
in Nursing Homes; Removal of Waiver Authority.--
(1) Medicare.--Section 1819(b)(4) of the Social Security
Act (42 U.S.C. 1395i-3(b)(4)) is amended by striking
subparagraph (C) and inserting the following:
``(C) Required nursing care.--
``(i) In general.--A skilled nursing facility must
provide--
``(I) 24-hour licensed nursing services which are
sufficient to meet the nursing needs of its residents;
``(II) not later than the date described in clause (iii), a
minimum staffing requirement of at least 3.48 hours per
resident day (or the number of hours per resident day
recommended in the report most recently submitted by the
Secretary under section 1128L(b)(2), provided that such
number is at least 3.48 hours per resident day) of nursing
care provided by a combination of a registered professional
nurse, licensed practical nurse (or licensed vocational
nurse), or certified nursing assistant that--
``(aa) provides direct care services to residents in a
skilled nursing facility; and
``(bb) reflects an appropriate combination of competencies
and skills that is sufficient to ensure the safety of each
resident in the facility; and
``(III) the services of a registered professional nurse,
such that such services are furnished--
``(aa) before the date described in clause (iii), at least
8 consecutive hours a day, 7 days a week; and
``(bb) on or after such date, 24 hours a day, 7 days a
week.
``(ii) Definition of hours per resident day.--In this
subparagraph, the term `hours per resident day' means the
total number of hours worked by each type of staff described
in clause (i)(II) divided by the total number of residents,
as calculated by the Administrator of the Centers for
Medicare & Medicaid Services.
``(iii) Date described.--For purposes of subclauses (II)
and (III) of clause (i), the date described in this clause is
the date that is 180 days after the date of enactment of the
Nurses Belong in Nursing Homes Act.''.
(2) Medicaid.--Section 1919(b)(4) of the Social Security
Act (42 U.S.C. 1396r(b)(4)) is amended by striking
subparagraph (C) and inserting the following:
``(C) Required nursing care.--
``(i) In general.--A nursing facility must provide--
``(I) 24-hour licensed nursing services which are
sufficient to meet the nursing needs of its residents;
``(II) not later than the date described in section
1819(b)(4)(C)(iii), a minimum staffing requirement of at
least 3.48 hours per resident day (or the number of hours per
resident day recommended in the report most recently
submitted by the Secretary under section 1128L(b)(2),
provided that such number is at least 3.48 hours per resident
day) of nursing care provided by a combination of a
registered professional nurse, licensed practical nurse (or
licensed vocational nurse), or certified nursing assistant
that--
``(aa) provides direct care services to residents in a
nursing facility; and
``(bb) reflects an appropriate combination of competencies
and skills that is sufficient to ensure the safety of each
resident in the facility; and
``(III) the services of a registered professional nurse,
such that such services are furnished--
``(aa) before the date described in section
1819(b)(4)(C)(iii), at least 8 consecutive hours a day, 7
days a week; and
``(bb) on or after such date, 24 hours a day, 7 days a
week.
``(ii) Definition of hours per resident day.--In this
subparagraph, the term `hours per resident day' has the
meaning given such term in section 1819(b)(4)(C)(ii).''.
(b) Study.--Title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by inserting after section 1128K the
following new section:
``SEC. 1128L. STUDY AND REPORTS RECOMMENDING MINIMUM STAFFING
REQUIREMENTS FOR SKILLED NURSING FACILITIES AND
NURSING FACILITIES; PROMULGATION OF
REGULATIONS.
``(a) Study.--
``(1) In general.--Not later than 2 years after the date of
enactment of this section, and not less frequently than once
every 4 years thereafter, the Secretary shall direct the
Assistant Secretary for Planning and Evaluation, the
Comptroller General, or the Medicare Payment Advisory
Commission, in consultation with the Medicaid and CHIP
Payment and Access Commission (in this section referred to as
the `designated entity'), to complete a study analyzing nurse
staffing requirements at skilled nursing facilities (as
defined in section 1819(a)) and nursing facilities (as
defined in section 1919(a)) to provide care to individuals
seeking their services.
``(2) Contents.--With respect to each study required under
paragraph (1), the designated entity shall--
``(A) consult with--
``(i) residents, family members of residents, or authorized
representatives of residents;
``(ii) registered professional nurses, licensed practical
nurses (or licensed vocational nurses), certified nursing
assistants, and other categories of direct care professionals
(as determined by the Secretary) who work at such skilled
nursing facilities or nursing facilities;
``(iii) collective bargaining units or unions that
represent direct care workers or direct care professionals
who work at such skilled nursing facilities and nursing
facilities;
``(iv) operators of nursing facilities and skilled nursing
facilities;
``(v) researchers with expertise in the nursing home and
long-term care workforce, including the disclosure of funding
sources for previously conducted research and conflicts of
interest; and
``(vi) long-term care ombudsmen; and
``(B) address the following:
``(i) Whether the minimum staffing requirements established
in sections 1819(b)(4)(C)(i)(II) and 1919(b)(4)(C)(i)(II)
should be maintained or increased (but in no event decreased
below a minimum staffing requirement of at least 3.48 hours
per resident day), based on the severity of the health
conditions, complexity of health care needs, or other
measures of patient acuity of residents at such skilled
nursing facilities and nursing facilities, and, if so, how
such minimum staffing requirements shall be increased.
``(ii) Whether other minimum hours per resident day minimum
staffing requirements should be established for other
categories of direct care professionals or direct care
workers in addition to the requirements established in
sections 1819(b)(4)(C)(i)(II) and 1919(b)(4)(C)(i)(II).
[[Page S1409]]
``(iii) A review of staffing, safety, and quality data, as
well as staffing requirement exception data, to assess the
adequacy of existing staffing practices in such nursing
facilities and skilled nursing facilities.
``(b) Reports.--
``(1) To the secretary.--The designated entity shall submit
to the Secretary a report on the results of the study
conducted under subsection (a), together with recommendations
for such legislation and administrative action as the
designated entity determines appropriate.
``(2) To congress.--Not later than 180 days after receiving
each report under paragraph (1), the Secretary shall submit
to Congress a report on--
``(A) the findings and recommendations included in such
report; and
``(B) any plan to implement such recommendations, including
a justification for any recommendations the Secretary
determines should not be implemented.
``(c) Regulations.--
``(1) In general.--Not later than 1 year after the
Secretary submits an initial report under subsection (b)(2),
the Secretary shall--
``(A) specify through regulations, consistent with such
report, a minimum staffing requirement for nursing staff for
skilled nursing facilities (as defined in section 1819(a))
and nursing facilities (as defined in section 1919(a)); and
``(B) require such skilled nursing facilities and such
nursing facilities to comply with such staffing requirements,
including by providing the minimum staffing sufficient to
meet the needs of each resident in any such facility.
``(2) Update.--Not later than 1 year after the Secretary
submits each subsequent report under subsection (b)(2), the
Secretary shall, consistent with each such report, update the
regulations described in paragraph (1)(A) as necessary.
``(d) Funding.--The Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust Fund
under section 1817 to the Centers for Medicare & Medicaid
Services Program Management Account, of $50,000,000 for
fiscal year 2027 for purposes of carrying out this section.
Amounts transferred pursuant to the previous sentence shall
remain available until expended.''.
(c) Rule of Construction.--The moratorium imposed under
section 71111 of the Act titled ``An Act to provide for
reconciliation pursuant to title II of H. Con. Res. 14''
(Public Law 119-21) (relating to implementation of certain
staffing standards for long-term care facilities under the
Medicare and Medicaid programs) shall not be construed to
apply to the amendments made by this section.
SEC. 3. PERMANENT FUNDING FOR THE SURVEY AND CERTIFICATION
PROGRAM FOR NURSING HOMES AND OTHER HEALTH CARE
ENTITIES.
Part A of Title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by inserting after section 1150C the
following new section:
``SEC. 1150D. FUNDING FOR THE SURVEY AND CERTIFICATION
PROGRAM.
``There is appropriated to the Secretary, out of the
Federal Hospital Insurance Trust Fund under section 1817 and
the Federal Supplementary Medical Insurance Trust Fund under
section 1841 (in such proportions as the Secretary determines
to be appropriate), $800,000,000 for fiscal year 2027 and
each subsequent fiscal year for the purpose of conducting the
Secretary's Survey and Certification Program, including under
section 1864. Amounts appropriated under the preceding
sentence shall remain available until expended.''.
SEC. 4. INVESTING IN THE NURSING HOME WORKFORCE.
(a) Medicare.--Section 1819(h) of the Social Security Act
(42 U.S.C. 1395i-3(h)) is amended--
(1) in paragraph (2)(B)(ii)(IV)(ff), by inserting ``,
provided that not less than half of such amounts are provided
to the State in which the facility is located for the
purposes described in paragraph (7),'' after ``collected
may''; and
(2) by adding at the end the following new paragraph:
``(7) Use of civil money penalty amounts to support the
skilled nursing facility workforce.--
``(A) In general.--Subject to subparagraph (B), a State
shall use the amounts provided to such State pursuant to
paragraph (2)(B)(ii)(IV)(ff) for the fiscal year in which
such amounts are provided for the following purposes:
``(i) Providing grants to entities such as educational
institutions, advocacy organizations for skilled nursing
facility residents, senior citizens, or individuals with
disabilities, and unions that represent the skilled nursing
facility workforce to support projects that use community-
driven approaches to recruit, educate, and train individuals
to expand the skilled nursing facility workforce.
``(ii) The funding of projects that develop new career
pathway programs for the skilled nursing facility workforce.
``(iii) The repayment of student loans for qualified
skilled nursing facility providers (as defined in
subparagraph (C)) or the payment of tuition for such
providers who commit to serving in a skilled nursing facility
or a nursing facility (as defined in section 1919(a)) for not
less than 3 years within a 10-year period.
``(B) Prohibitions on use of funds.--
``(i) Prohibition on providing funds to entities related to
facilities.--A State may not provide any amounts provided to
such State pursuant to paragraph (2)(B)(ii)(IV)(ff) to an
entity that has a related party relationship with a nursing
facility or skilled nursing facility in such State.
``(ii) Prohibition on using funds for reimbursement of
costs incurred in completing nurse aide training and
competency evaluation programs and nurse aide competency
evaluation programs.--A State may not use any amounts
provided to such State pursuant to paragraph
(2)(B)(ii)(IV)(ff) to--
``(I) reimburse costs incurred in completing a nurse aide
training and competency evaluation program or a nurse aide
competency evaluation program under subsection (f)(2)(A); or
``(II) supplant the payment of such costs under such
subsection.
``(C) Definitions.--In this paragraph:
``(i) Qualified skilled nursing facility provider.--The
term `qualified skilled nursing facility provider' means--
``(I) a geriatrician or other physician, nurse
practitioner, physician assistant, or other practitioner who
provides services in a skilled nursing facility or nursing
facility; or
``(II) a registered professional nurse, a licensed
practical nurse (or a licensed vocational nurse), or a
certified nursing assistant who provides direct care services
to residents in a skilled nursing facility or nursing
facility, as determined by the Secretary.
``(ii) Related party.--The term `related party' means an
entity that, to a significant extent is associated or
affiliated with, or has control of, or is controlled by, a
nursing facility or skilled nursing facility.
``(D) Annual reporting.--
``(i) Report from states.--Not later than 1 year after the
date of enactment of this paragraph, and annually thereafter,
each State that receives amounts pursuant to paragraph
(2)(B)(ii)(IV)(ff) shall submit to the Secretary a report
describing--
``(I) how amounts received in the previous fiscal year were
allocated;
``(II) the mechanisms to ensure such amounts benefit the
development of the skilled nursing facility workforce;
``(III) how such amounts will impact measurable outcomes
for residents of skilled nursing facilities and nursing
facilities, such as staff vacancy rates, turnover rates,
median hourly wages, staffing hours per resident, and
resident quality outcomes; and
``(IV) how such State is ensuring compliance with
subparagraph (B).
``(ii) Report to congress.--Not later than 180 days after
the Secretary receives the annual reports from States under
clause (i), the Secretary shall submit to Congress a report
describing the information contained in such reports.''.
(b) Medicaid.--Section 1919(h) of the Social Security Act
(42 U.S.C. 1396r(h)) is amended--
(1) in paragraph (2)(A)(ii)--
(A) in the second sentence, by striking ``Funds collected''
and inserting ``Subject to the last sentence of this clause,
funds collected''; and
(B) by inserting the following sentence at the end: ``Not
less than half of the funds collected pursuant to this clause
shall be used for the purposes described in paragraph
(10).'';
(2) in paragraph (3)(C)(ii)(IV)(ff), by inserting ``,
provided that not less than half of such amounts are provided
to the State in which the facility is located for the
purposes described in paragraph (10),''; and
(3) by adding at the end the following new paragraph:
``(10) Use of civil money penalty amounts to support the
nursing facility workforce.--
``(A) In general.--Subject to subparagraph (B), a State
shall use not less than half of the funds collected under
paragraph (2)(A)(ii) and the amounts provided to such State
pursuant to paragraph (3)(C)(ii)(IV)(ff) (collectively
referred to in this paragraph as `civil money penalty
amounts') for the fiscal year in which such amounts are
collected or provided for the following activities:
``(i) Providing grants to entities such as educational
institutions, advocacy organizations for nursing facility
residents, senior citizens, or individuals with disabilities,
and unions that represent the nursing facility workforce to
support projects that use community-driven approaches to
recruit, educate, and train individuals to expand the nursing
facility workforce.
``(ii) The funding of projects that develop new career
pathway programs for the nursing facility workforce.
``(iii) The repayment of student loans for qualified
nursing facility providers (as defined in subparagraph (C))
or the payment of tuition for such providers who commit to
serving in a skilled nursing facility (as defined in section
1819(a)) or a nursing facility for not less than 3 years
within a 10-year period.
``(B) Prohibition on use of funds.--
``(i) Prohibition on providing funds to entities related to
facilities.--A State may not provide any civil money penalty
amounts to an entity that has a related party relationship
with a nursing facility or skilled nursing facility in such
State.
``(ii) Prohibition on using funds for reimbursement of
costs incurred in completing
[[Page S1410]]
nurse aide training and competency programs and nurse aide
competency evaluation programs.--A State may not use any
civil money penalty amounts to--
``(I) reimburse costs incurred in completing a nurse aid
training and competency evaluation program or a nurse aide
competency evaluation program under subsection (f)(2)(A); or
``(II) supplant the payment of such costs under such
subsection.
``(C) Definitions.--In this paragraph:
``(i) Qualified nursing facility provider.--The term
`qualified nursing facility provider' means--
``(I) a geriatrician or other physician, nurse
practitioner, physician assistant, or other practitioner who
provides services in a skilled nursing facility or nursing
facility; or
``(II) a registered professional nurse, licensed practical
nurse (or a licensed vocational nurse), or certified nursing
assistant who provides direct care services to residents in a
skilled nursing facility or nursing facility, as determined
by the Secretary.
``(ii) Related party.--The term `related party' means an
entity that, to a significant extent is associated or
affiliated with, or has control of, or is controlled by, a
nursing facility or skilled nursing facility.
``(D) Annual reporting.--
``(i) Report from states.--Not later than 1 year after the
date of enactment of this paragraph, and annually thereafter,
each State that receives any civil money penalty amounts
shall submit to the Secretary a report describing--
``(I) how amounts received in the previous fiscal year were
allocated;
``(II) the mechanisms to ensure such amounts benefit the
development of the nursing facility workforce;
``(III) how such amounts will impact measurable outcomes
for residents of skilled nursing facilities and nursing
facilities, such as staff vacancy rates, turnover rates,
median hourly wages, staffing hours per resident, and
resident quality outcomes; and
``(IV) how such State is ensuring compliance with
subparagraph (B).
``(ii) Report to congress.--Not later than 180 days after
the Secretary receives the annual reports from States under
clause (i), the Secretary shall submit to Congress a report
describing the information contained in such report.''.
SEC. 5. CODIFICATION OF REGULATIONS REGARDING REQUIREMENTS
FOR LONG-TERM SERVICES AND SUPPORTS AND PAYMENT
TRANSPARENCY REPORTING.
Sections 438.72 and 442.43 of title 42, Code of Federal
Regulations (as in effect on May 10, 2024), shall have the
force and effect of law.
______