[Senate Report 118-116]
[From the U.S. Government Publishing Office]
Calendar No. 253
_______________________________________________________________________
118th Congress } { Report
SENATE
1st Session } { 118-116
_______________________________________________________________________
RECOGNIZING THE ROLE OF DIRECT SUPPORT PROFESSIONALS ACT
__________
R E P O R T
of the
COMMITTEE ON HOMELAND SECURITY AND
GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
to accompany
S. 1332
TO REQUIRE THE OFFICE OF MANAGEMENT AND BUDGET
TO REVISE THE STANDARD OCCUPATIONAL CLASSIFICATION
SYSTEM TO ESTABLISH A SEPARATE CODE FOR DIRECT
SUPPORT PROFESSIONALS, AND FOR OTHER PURPOSES
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
November 30, 2023.--Ordered to be printed
__________
U.S. GOVERNMENT PUBLISHING OFFICE
49-010 WASHINGTON : 2023
COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS
GARY C. PETERS, Michigan, Chairman
THOMAS R. CARPER, Delaware RAND PAUL, Kentucky
MAGGIE HASSAN, New Hampshire RON JOHNSON, Wisconsin
KYRSTEN SINEMA, Arizona JAMES LANKFORD, Oklahoma
JACKY ROSEN, Nevada MITT ROMNEY, Utah
JON OSSOFF, Georgia RICK SCOTT, Florida
RICHARD BLUMENTHAL, Connecticut JOSH HAWLEY, Missouri
LAPHONZA R. BUTLER, California ROGER MARSHALL, Kansas
David M. Weinberg, Staff Director
Lena C. Chang, Director of Governmental Affairs
Devin M. Parsons, Professional Staff Member
William E. Henderson III, Minority Staff Director
Christina N. Salazar, Minority Chief Counsel
Andrew J. Hopkins, Minority Counsel
Laura W. Kilbride, Chief Clerk
Calendar No. 253
118th Congress } { Report
SENATE
1st Session } { 118-116
======================================================================
RECOGNIZING THE ROLE OF DIRECT SUPPORT PROFESSIONALS ACT
_______
November 30, 2023.--Ordered to be printed
_______
Mr. Peters, from the Committee on Homeland Security and Governmental
Affairs, submitted the following
R E P O R T
[To accompany S. 1332]
[Including cost estimate of the Congressional Budget Office]
The Committee on Homeland Security and Governmental
Affairs, to which was referred the bill (S. 1332) to require
the Office of Management and Budget to revise the Standard
Occupational Classification system to establish a separate code
for direct support professionals, and for other purposes,
having considered the same, reports favorably thereon with an
amendment, in the nature of a substitute, and recommends that
the bill, as amended, do pass.
CONTENTS
Page
I. Purpose and Summary..............................................1
II. Background and Need for the Legislation..........................2
III. Legislative History..............................................4
IV. Section-by-Section Analysis of the Bill, as Reported.............4
V. Evaluation of Regulatory Impact..................................5
VI. Congressional Budget Office Cost Estimate........................6
VII. Changes in Existing Law Made by the Bill, as Reported............6
I. PURPOSE AND SUMMARY
S. 1332, the Recognizing the Role of Direct Support
Professionals Act, would direct the Office of Management and
Budget (OMB) to consider establishing a separate occupational
code for direct support professionals (DSPs) during the next
revision cycle for the Standard Occupational Classification
(SOC) system. DSPs provide a range of services to enhance the
independence of individuals with intellectual and developmental
disabilities at home and in community settings. The findings of
Congress outlined in the bill describe the work of DSPs and the
high turnover rate in the DSP workforce, as well as how
establishing a discrete SOC code for DSPs would allow states
and federal agencies to better analyze workforce trends and
account for DSP workforce challenges. If OMB does not establish
a distinct SOC code for DSPs during the next revision cycle,
the bill would require the Director of OMB to submit a report
to Congress to justify that decision.
II. BACKGROUND AND NEED FOR THE LEGISLATION
DSPs play a key role in ensuring that individuals with
intellectual and developmental disabilities receive the support
they need to achieve independent daily living through the
provision of highly personalized care. Services administered by
DSPs include assisting with daily living needs at home,
encouraging engagement with the community, acting as employment
advocates and caregivers, and providing emotional support,
among others.\1\ The skills and work of DSPs are critical for
many individuals with disabilities, but the availability of
DSPs is not keeping pace with demand.\2\
---------------------------------------------------------------------------
\1\U.S. Department of Labor, Office of Disability Employment
Policy, Direct Support Professionals (DSPs) (www.dol.gov/agencies/odep/
program-areas/individuals/DSP) (accessed July 24, 2023).
\2\President's Committee for People with Intellectual Disabilities,
America's Direct Support Workforce Crisis: Effects on People with
Intellectual Disabilities, Families, Communities and the U.S. Economy
(Feb. 14, 2018) (acl.gov/sites/default/files/programs/2018-02/
2017%20PCPID%20
Full%20Report_0.PDF).
---------------------------------------------------------------------------
The DSP workforce faces a high turnover rate that impacts
the quality of care provided to individuals with disabilities.
In 2021, the average turnover rate of the DSP workforce varied
from 28.5% to 87.5% from state to state, with an average
turnover rate of 43.3%. Over one quarter of provider agencies
reported that the number of DSPs on payroll decreased by over
10% in 2021.\3\
---------------------------------------------------------------------------
\3\National Core Indicators, National Core Indicators Intellectual
and Developmental Disabilities 2021 State of the Workforce Survey
Report (2023) (idd.nationalcoreindicators.org/wp-content/uploads/2023/
02/2021StateoftheWorkforceReport-20230209.pdf).
---------------------------------------------------------------------------
DSP wages and benefits may factor into the turnover rate. A
significant portion of provider agencies, around 40%, do not
offer health insurance to DSPs.\4\ The average hourly median
wage is $14.41 for DSPs, with high variability among states,
ranging from $8.91 per hour to $17.22 per hour.\5\ Many DSPs
need to work two or more jobs to support themselves and their
families.\6\
---------------------------------------------------------------------------
\4\Id.
\5\Id. at 44.
\6\President's Committee for People with Intellectual Disabilities,
supra note 2, at 19.
---------------------------------------------------------------------------
The lack of a stable DSP workforce has negative
repercussions on the health and wellbeing of individuals with
disabilities who benefit from DSP services and their family
members, and it can also lead to a strain on other local
resources sometimes turned to in the absence of DSPs, such as
emergency departments, ambulances, firefighters, and police.\7\
---------------------------------------------------------------------------
\7\Id. at 20-26.
---------------------------------------------------------------------------
Determining payment rates for DSP services typically
requires data from the Bureau of Labor Statistics (BLS), as
does assessing the DSP workforce to develop strategies for
addressing DSP turnover.\8\ However, BLS does not have a unique
occupational classification for DSPs, impacting the data
available for the DSP workforce.\9\ Public officials, care
providers, or any other entity seeking DSP workforce data must
instead turn to statistics tied to one or more alternate
occupational classifications. For example, many use a
combination of various other occupational codes when
determining DSP pay rates, including: Home Health and Personal
Care Aides (31-1120); Social and Human Service Assistants (21-
1093); Recreation Workers (39-9032); Rehabilitation Counselors
(21-1015); Psychiatric Aides (31-1133); Psychiatric Technicians
(29-2053); Medical Assistants (31-9092); Residential Advisors
(39-9041); Passenger Vehicle Drivers (53-3058); Physical
Therapist Aides (31-2022); Community and Social Service
Specialists, All Other (21-1099); and Healthcare Support
Workers, All Other (31-9099).\10\ Although each category in
this range of occupational codes captures aspects of the role
of DSPs, applying such a variety of occupational categories to
this profession for analytical purposes puts assessments of the
DSP workforce at risk of inaccuracies and inconsistencies.\11\
---------------------------------------------------------------------------
\8\Health Management Associates, Review of States' Approach to
Establishing Wage Assumptions for Direct Support Professionals When
Setting I/DD Provider Rates (July 6, 2022) (www.ancor.org/wp-content/
uploads/2022/08/Review-of-States-Approaches-to-Establishing-Wage-
Assumptions-for-Direct-Support-Professionals-When-Setting-IDD-Provider-
Rates.pdf).
\9\U.S. Bureau of Labor Statistics, Occupational Employment and
Wage Statistics (www.bls.gov/oes/current/oes_stru.htm) (accessed August
31, 2023).
\10\Health Management Associates, supra note 8, at 6.
\11\See e.g. Health Management Associates, supra note 8, at 5 and
11 and President's Committee for People with Intellectual Disabilities,
supra note 2, at 14.
---------------------------------------------------------------------------
The occupational categories used by BLS stem from the SOC
system, which is a resource that allows federal agencies to
accurately label and categorize workers into distinct groups
for the purpose of collecting quality data for analyzing and
illustrating workforce trends. Workers across the nation are
organized into 867 detailed occupational groups, 459 broad
occupations, 89 minor groups, and 23 major groups, based on job
duties and other occupational characteristics like relevant
training and required education.\12\ The SOC system impacts
decisions both within and outside of the federal government.
Employers, economists, career counselors, and other experts use
SOC system data for critical purposes, including setting pay
and salary scales, comparing workforce trends of all jobs in
the national economy, and helping individuals connect with job
opportunities.\13\
---------------------------------------------------------------------------
\12\U.S. Bureau of Labor Statistics, Standard Occupational
Classification (www.bls.gov/soc/) (accessed July 24, 2023).
\13\U.S. Bureau of Labor Statistics, 2018 Standard Occupational
Classification User Guide (Nov. 2017) (www.bls.gov/soc/2018/
soc_2018_user_guide.pdf).
---------------------------------------------------------------------------
The Recognizing the Role of Direct Support Professionals
Act directs OMB to consider creating a distinct occupational
code for DSPs as part of the next revision of the SOC system,
recognizing the current processes in place for SOC system
revision. The last revision of the SOC system occurred in 2018.
The next revision is expected in 2028, and OMB is likely to
publish an initial Federal Register notice soliciting public
comment in 2024.\14\ Revising the SOC system is a careful and
thorough process that looks to improve the collection of data
while maintaining data integrity. Creating a new occupational
code involves seeking multiple rounds of public input,
reviewing possible changes in accordance with classification
principles and coding guidelines, and inquiring about the
nature of work and surrounding aspects like training and
education.\15\
---------------------------------------------------------------------------
\14\U.S. Bureau of Labor Statistics, Standard Occupational
Classification, How often do Standard Occupational Classification (SOC)
codes change? (www.bls.gov/soc/notices/2023/code_changes.htm) (accessed
July 28, 2023).
\15\U.S. Bureau of Labor Statistics, Revising the Standard
Occupational Classification (Mar. 2014) (www.bls.gov/soc/
revising_the_standard_occupational_classification_2018.pdf).
---------------------------------------------------------------------------
Accounting for the work of DSPs across the United States is
an important step to ensure that individuals with disabilities
receive the support necessary to maximize their independence
and wellbeing. Directing OMB to consider creating an
occupational code for DSPs during the next revision cycle for
the SOC system may result in improved BLS data for the DSP
workforce going forward. Improved data would help government
officials, care providers, and others to develop effective
strategies to strengthen the DSP workforce.
III. LEGISLATIVE HISTORY
Senator Margaret Wood Hassan (D-NH) introduced S. 1332, the
Recognizing the Role of Direct Support Professionals Act, on
April 27, 2023, with original cosponsor Senator Susan Collins
(R-ME). The bill was referred to the Committee on Homeland
Security and Governmental Affairs.
The Committee considered S. 1332 at a business meeting on
July 26, 2023. At the business meeting, Senator Hassan offered
a substitute amendment to the bill and a modification to the
substitute amendment. The substitute amendment made significant
changes to the underlying bill text, including: (1) moving the
description of the DSP role to the ``Findings'' section; (2)
requiring OMB to consider a separate code for DSPs as part of
their revision process; and (3) adding the requirement for OMB
to provide Congress with an explanatory report if it does not
establish a separate DSP code in the next SOC system revision
cycle. The modification incorporated language to specify that
no additional funds may be appropriated to carry out this bill.
The modification to the substitute amendment and the substitute
amendment, as modified, were adopted by unanimous consent with
Senators Peters, Hassan, Rosen, Padilla, Blumenthal, Paul,
Lankford, and Scott present. Senator Hassan offered an
additional amendment that made a technical edit to the long
title of the bill. The Committee adopted the Hassan amendment
by voice vote, with Senators Peters, Hassan, Sinema, Rosen,
Blumenthal, Paul, Lankford, and Scott present. The bill, as
amended, was ordered reported favorably by roll call vote of 8
yeas to 0 nays, with Senators Peters, Hassan, Sinema, Rosen,
Blumenthal, Paul, Lankford, and Scott voting in the
affirmative. Senators Carper, Padilla, Ossoff, Johnson, Romney,
Hawley, and Marshall voted yea by proxy, for the record only.
IV. SECTION-BY-SECTION ANALYSIS OF THE BILL, AS REPORTED
Section 1. Short title
This section establishes the short title of the bill as the
``Recognizing the Role of Direct Support Professionals Act.''
Section 2. Findings
This section contains findings of Congress, including that:
DSPs play a critical role in the care provided to individuals
with intellectual and developmental disabilities; providers of
home- and community-based services are experiencing difficulty
hiring and retaining DSPs; high turnover rates can lead to
instability for individuals receiving services; and a discrete
occupational category for DSPs would help collect data on the
turnover rate, better interpret the DSP labor market shortage,
and recognize these professionals.
Section 3. Revision of standard occupational classification system
This section requires that, during the next revision cycle
of the SOC system following the enactment of this bill, the OMB
Director consider establishing a separate occupational code for
DSPs as a healthcare support occupation.
Section 4. Report to congress
If the OMB Director does not establish a separate code for
DSPs in the next revision cycle of the SOC system, this section
requires the Director to submit an explanatory report to
Congress within 30 days after the revision cycle is complete.
The Director would submit the report to the Senate Committee on
Homeland Security and Governmental Affairs and the House
Committee on Education and the Workforce.
Section 5. No new funds
This section requires that no additional funds be
appropriated to execute this bill.
V. EVALUATION OF REGULATORY IMPACT
Pursuant to the requirements of paragraph 11(b) of rule
XXVI of the Standing Rules of the Senate, the Committee has
considered the regulatory impact of this bill and determined
that the bill will have no regulatory impact within the meaning
of the rules. The Committee agrees with the Congressional
Budget Office's statement that the bill contains no
intergovernmental or private-sector mandates as defined in the
Unfunded Mandates Reform Act (UMRA) and would impose no costs
on state, local, or tribal governments.
VI. CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
S. 1332 would require the Office of Management and Budget
to consider creating a separate occupational code for direct
support professionals, listing them within the healthcare
support occupation, when it next revises the Standard
Occupational Classification (SOC) system. Those workers provide
direct care and support to people with disabilities. The SOC
system is a federal statistical standard used to classify
workers into occupational categories for the purpose of
collecting, calculating, and disseminating data.
Since 1977, the SOC system has been revised four times--in
1980, 2000, 2010, and 2018--to reflect changes in the economy
and the nature of work. Because of that ongoing but irregular
activity, CBO estimates that implementing S. 1332 would not
significantly affect federal spending over the 2024-2028
period.
The CBO staff contact for this estimate is Matthew
Pickford. The estimate was reviewed by Chad Chirico, Director
of Budget Analysis.
Phillip L. Swagel,
Director, Congressional Budget Office.
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
This legislation would make no change in existing law,
within the meaning of clauses (a) and (b) of subparagraph 12 of
rule XXVI of the Standing Rules of the Senate, because this
legislation would not repeal or amend any provision of current
law.