II 

118TH CONGRESS 

2D SESSION S. 5175 

To amend subtitle A of title XX of the Social Security Act to authorize 

direct support worker career advancement demonstration projects, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 25, 2024 

Mr. KING (for himself and Mr. CASEY) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend subtitle A of title XX of the Social Security 

Act to authorize direct support worker career advancement demonstration projects, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Career Advancement 

5 for Direct Support Aid Workers Act’’ or the ‘‘CADSAW 

6 Act’’. 


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1 SEC. 2. DIRECT SUPPORT WORKER CAREER ADVANCEMENT 

2 DEMONSTRATION PROJECTS. 

3 (a) IN GENERAL.—Section 2008 of the Social Secu4 rity Act (42 U.S.C. 1397g) is amended— 

5 (1) by adding at the end the following new sub6 section: 

7 ‘‘(e) DIRECT SUPPORT WORKER CAREER ADVANCE8 MENT DEMONSTRATION PROJECTS.— 

9 ‘‘(1) IN GENERAL.—The Secretary, in consulta10 tion with the Secretary of Labor, shall award, from 

11 the amount appropriated under paragraph (4), 

12 grants to eligible entities to conduct demonstration 

13 projects that are designed to provide eligible individ14 uals with opportunities for education, training, and 

15 career advancement as a personal or home care aide, 

16 home health aide, or nursing assistant. 

17 ‘‘(2) DEFINITIONS.—In this subsection: 

18 ‘‘(A) ELIGIBLE ENTITY.—The term ‘eligi19 ble entity’ has the meaning given such term in 

20 subsection (a). 

21 ‘‘(B) ELIGIBLE INDIVIDUAL.—The term 

22 ‘eligible individual’ means an individual— 

23 ‘‘(i) whose income does not exceed 

24 200 percent of the poverty line (as defined 

25 in section 2110(c)(5)) applicable to a fam26 ily of the size involved; and 


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1 ‘‘(ii) who is employed as a personal or 

2 home care aide who— 

3 ‘‘(I) has at least 30 percent pa4 tient volume (as estimated in accord5 ance with a methodology established 

6 by the Secretary) attributable to indi7 viduals who are receiving medical as8 sistance under title XIX; or 

9 ‘‘(II) is employed by an agency 

10 that is a provider of personal or home 

11 care services that has at least 30 per12 cent of the agency’s patient volume 

13 (as so estimated) attributable to such 

14 individuals. 

15 ‘‘(C) PERSONAL OR HOME CARE AIDE.— 

16 The term ‘personal or home care aide’ has the 

17 meaning given such term in subsection (b). 

18 ‘‘(3) REQUIREMENTS.— 

19 ‘‘(A) PRIORITIZATION OF PROJECTS THAT

20 SUPPORT RURAL AREAS, UNDERSERVED AREAS, 

21 AND WOMEN AND BLACK AND LATINX INDIVID22 UALS.—The Secretary shall ensure that not less 

23 than half of the demonstration projects sup24 ported by grants awarded under this subsection 

25 support— 


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1 ‘‘(i) eligible individuals in rural areas 

2 (as defined in section 2007(f)(5)); 

3 ‘‘(ii) eligible individuals in under4 served urban areas (including urban health 

5 professional shortage areas (as defined in 

6 section 332 of the Public Health Service 

7 Act); or 

8 ‘‘(iii) eligible individuals who are 

9 women, who are Black or Latinx individ10 uals, or who belong to other underserved 

11 and diverse populations such as Asian, Pa12 cific Islander, Native American, or Alaska 

13 Native communities. 

14 ‘‘(B) AMOUNT OF GRANT.—In no case 

15 shall the Secretary award an eligible entity a 

16 grant to conduct a demonstration project under 

17 this subsection in an amount that exceeds 

18 $750,000 for each year that the entity conducts 

19 such project. 

20 ‘‘(C) REPORTS.— 

21 ‘‘(i) INTERIM REPORTS.—An eligible 

22 entity awarded a grant to conduct a dem23 onstration project under this subsection 

24 shall submit interim reports to the Sec25 retary on the activities carried out under 


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1 the project and a final report on such ac2 tivities upon the conclusion of the entities’ 

3 participation in the project. 

4 ‘‘(ii) EVALUATION.—The Adminis5 trator of the Health Resources and Serv6 ices Administration shall evaluate the dem7 onstration projects conducted under this 

8 subsection. Such evaluation shall include 

9 identification of successful activities for 

10 creating opportunities for developing and 

11 sustaining, particularly with respect to low12 income individuals and long-term workers, 

13 a health or human services professions 

14 workforce that has accessible opportunities 

15 for career advancement, that meets high 

16 standards for education, training, certifi17 cation, and professional development, that 

18 provides increased wages and affordable 

19 benefits, including health care coverage, 

20 that are responsive to the workforce’s 

21 needs, and that is responsive to the needs 

22 of diverse racial and ethnic communities. 

23 ‘‘(iii) REPORT TO CONGRESS.—Not 

24 later than 1 year after the demonstration 

25 projects conducted under this subsection 


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1 conclude, the Secretary shall submit a final 

2 report to Congress on such demonstration 

3 projects that includes— 

4 ‘‘(I) the result of the evaluation 

5 conducted under clause (ii); and 

6 ‘‘(II) such recommendations for 

7 legislation or administrative actions as 

8 the Secretary deems appropriate. 

9 ‘‘(iv) ADDITIONAL REPORT.—Not 

10 later than 1 year after the demonstration 

11 projects conducted under this subsection 

12 conclude, the Secretary shall submit to the 

13 Committee on Health, Education, Labor, 

14 and Pensions of the Senate and the Com15 mittee on Education and the Workforce of 

16 the House of Representatives and make 

17 publicly available, a report on the activities 

18 and results of such projects. Such report 

19 shall describe— 

20 ‘‘(I) the number and geographic 

21 distribution of the grants awarded 

22 under this subsection; 

23 ‘‘(II) the participation of under24 represented and economically dis25 advantaged participants in demonstraVerDate Sep 11 2014 18:22 Oct 10, 2024 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S5175.IS S5175

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1 tion projects conducted under this 

2 subsection; and 

3 ‘‘(III) recommendations for pro4 gram revisions to achieve the desired 

5 program outcome. 

6 ‘‘(4) APPROPRIATION.—Out of any funds in the 

7 Treasury not otherwise appropriated, there are ap8 propriated to the Secretary to carry out this sub9 section $5,000,000 for each of fiscal years 2025, 

10 2026, and 2027.’’. 

11 (b) INCENTIVE PAYMENTS FOR HOME HEALTH

12 SERVICES FURNISHED BY HOME HEALTH AIDES WHO

13 COMPLETE CERTAIN TRAINING.—Section 1834 of the So14 cial Security Act (42 U.S.C. 1395m) is amended by add15 ing at the end the following new subsection: 

16 ‘‘(aa) INCENTIVE PAYMENTS FOR HOME HEALTH

17 SERVICES FURNISHED BY HOME HEALTH AIDES WHO

18 COMPLETE CERTAIN TRAINING.—In the case of home 

19 health services furnished on or after October 1, 2025, by 

20 a home health aide who has successfully completed edu21 cation or training under a Direct Support Worker Career 

22 Advancement demonstration project under section 

23 2008(e), in addition to the amount of payment that would 

24 otherwise be made for such services under this part, there 


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1 also shall be paid an amount equal to 25 percent of the 

2 payment amount for the service under this part.’’. 

Æ 


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