[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\
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    \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).
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    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).
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    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.
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    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\
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    \7\Id. at 20-26.
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    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.
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    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).
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    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.