II 

118TH CONGRESS 

2D SESSION S. 4120 

To support the direct care professional workforce, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 15, 2024 

Mr. CASEY (for himself, Mr. KAINE, Ms. BALDWIN, Mr. WYDEN, Mr. KING, 

Mrs. GILLIBRAND, Mr. FETTERMAN, Ms. DUCKWORTH, Mr. HEINRICH, 

Mr. WELCH, Mr. BLUMENTHAL, Ms. STABENOW, Ms. SMITH, Mr. VAN

HOLLEN, Mrs. MURRAY, Mr. SANDERS, Ms. KLOBUCHAR, Mr. BROWN, 

Ms. BUTLER, Mr. MERKLEY, Mr. MARKEY, Mr. BOOKER, Mr. PETERS, 

Ms. WARREN, and Ms. CANTWELL) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To support the direct care professional workforce, 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; TABLE OF CONTENTS. 

4 (a) IN GENERAL.—This Act may be cited as the 

5 ‘‘Long-Term Care Workforce Support Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings and purposes. 

Sec. 3. Definitions. 


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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. 


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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. 


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Sec. 404. Sunset provision. 

TITLE V—IMPROVING OVERSIGHT AND ACCOUNTABILITY 

Sec. 501. Evaluation of implementation and outcomes. 

1 SEC. 2. FINDINGS AND PURPOSES. 

2 (a) FINDINGS.—Congress finds the following: 

3 (1) The nearly 5,000,000 direct care profes4 sionals in the United States play a vital role in sup5 porting the health, well-being, and independence of 

6 older individuals and people with disabilities. 

7 (2) The United States faces a growing crisis in 

8 its direct care professional workforce at the same 

9 time that demand for services is rising at unprece10 dented rates. 

11 (3) There will be an estimated 9,300,000 total 

12 direct care professional job openings from 2021 to 

13 2031, including new jobs to support the growing 

14 number of people who need care and to fill the jobs 

15 of such professionals leaving the direct care profes16 sional workforce. 

17 (4) Workforce turnover and shortages have a 

18 direct impact on older individuals, people with dis19 abilities, and their families who suffer because they 

20 cannot get the high-quality care that they need and 

21 deserve. 


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1 (5) The median hourly wage for all direct care 

2 professionals in 2022 was only $15.43, with home 

3 care workers earning the least. 

4 (6) One in 8 direct care professionals live in 

5 poverty and three quarters earn less than the aver6 age living wage in their State. 

7 (7) Forty-six percent of direct care profes8 sionals rely on public assistance, such as Medicaid, 

9 food and nutrition assistance, or cash assistance. 

10 (8) Direct care professionals report high levels 

11 of burnout and professional fatigue from their phys12 ically and emotionally demanding work, lack of re13 spect for the essential, skilled care they provide, and 

14 lasting trauma from battling the COVID–19 pan15 demic, all of which further drives high turnover. 

16 (9) The long-term care industry is struggling to 

17 hire and retain direct care professionals, with a na18 tional turnover rate between 77 to nearly 100 per19 cent. 

20 (10) Ninety-two percent of nursing home re21 spondents and nearly 70 percent of assisted living 

22 facilities surveyed report significant or severe work23 force shortages. 


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1 (11) More than half of nursing homes surveyed 

2 in 2022 reported that they limited new patient ad3 missions due to staffing shortages. 

4 (12) A survey of State home and community5 based services (referred to in this section as 

6 ‘‘HCBS’’) programs showed that every State reports 

7 a shortage of workers, and in 43 States, some 

8 HCBS providers have closed permanently. 

9 (13) The low-quality of direct care professional 

10 jobs reflects and perpetuates the racial and gender 

11 inequities faced by direct care professionals, who are 

12 disproportionately women, immigrants, and people of 

13 color. 

14 (14) Efforts to support the direct care profes15 sional workforce have focused on specific care set16 tings, even though these issues are widespread 

17 across the long-term care landscape and direct care 

18 professionals across settings face similar challenges 

19 of low wages, few benefits, limited training and sup20 port, worker exploitation, and a lack of meaningful 

21 career ladders. 

22 (15) Stabilizing, growing, and supporting the 

23 direct care professional workforce across the con24 tinuum of long-term care is essential to ensuring a 

25 strong, qualified pipeline of workers, and improving 


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1 the lives of direct care professionals and the older 

2 individuals, people with disabilities, and the families 

3 and communities that they support. 

4 (b) PURPOSES.—The purposes of this Act are as fol5 lows: 

6 (1) To increase the capacity of the direct care 

7 professional workforce to ensure that older individ8 uals, people with disabilities, and their families re9 ceive the services they need in the settings of their 

10 choice as they deserve to live healthy, independent 

11 lives. 

12 (2) To increase compensation so that direct 

13 care professionals are paid a living wage and have 

14 access to essential job benefits, and so that direct 

15 care professional jobs are good jobs. 

16 (3) To ensure that direct care professionals are 

17 treated with respect, provided with a safe working 

18 environment, protected from exploitation, and fairly 

19 compensated for the skilled work they do. 

20 (4) To improve access to and quality of long21 term care, including collecting meaningful and ac22 tionable data on the direct care professional work23 force and the people they support. 


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1 (5) To eliminate the race, gender, sexual ori2 entation, age, and gender identity disparities that 

3 exist across the direct care professional workforce. 

4 (6) To strengthen the direct care professional 

5 workforce in order to support the 53,000,000 unpaid 

6 family caregivers who are often providing complex 

7 services and supports to their loved ones who are 

8 older individuals and people with disabilities in their 

9 homes, communities, and residential settings. 

10 SEC. 3. DEFINITIONS. 

11 In this Act: 

12 (1) ACTIVITIES OF DAILY LIVING.—The term 

13 ‘‘activities of daily living’’ means basic, personal, ev14 eryday activities, including tasks such as eating, 

15 toileting, grooming, dressing, bathing, and transfer16 ring. 

17 (2) AGING AND DISABILITY RESOURCE CEN18 TER.—The term ‘‘Aging and Disability Resource 

19 Center’’ has the meaning given such term in section 

20 102 of the Older Americans Act of 1965 (42 U.S.C. 

21 3002). 

22 (3) APPRENTICESHIP PROGRAM.—The term 

23 ‘‘apprenticeship program’’ means an apprenticeship 

24 program registered under the Act of August 16, 

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1 ticeship Act’’; 50 Stat. 664, chapter 663; 29 U.S.C. 

2 50 et seq.), including any requirement, standard, or 

3 rule promulgated under such Act. 

4 (4) APPROPRIATE COMMITTEES OF CON5 GRESS.—The term ‘‘appropriate committees of Con6 gress’’ means— 

7 (A) the Committee on Finance of the Sen8 ate; 

9 (B) the Committee on Health, Education, 

10 Labor, and Pensions of the Senate; 

11 (C) the Special Committee on Aging of the 

12 Senate; 

13 (D) the Committee on Ways and Means of 

14 the House of Representatives; 

15 (E) the Committee on Energy and Com16 merce of the House of Representatives; and 

17 (F) the Committee on Education and the 

18 Workforce of the House of Representatives. 

19 (5) AREA AGENCY ON AGING.—The term ‘‘area 

20 agency on aging’’ has the meaning given such term 

21 in section 102 of the Older Americans Act of 1965 

22 (42 U.S.C. 3002). 

23 (6) ASSISTED LIVING FACILITY.—The term 

24 ‘‘assisted living facility’’ means an adult care facility 

25 that— 


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1 (A) is a residential care setting licensed 

2 and regulated by the State in which the facility 

3 is located (or, if there is no State law providing 

4 for such licensing and regulation by the State, 

5 by the municipality or other political subdivision 

6 in which the facility is located); 

7 (B)(i) makes available to residents sup8 portive services to assist the residents in car9 rying out activities of daily living; 

10 (ii) provides 24-hour on-site monitoring, 

11 personal care planning, food services, and per12 sonal care; and 

13 (iii) may make available to residents home 

14 health care services, such as nursing and ther15 apy; and 

16 (C) provides dwelling units for residents, 

17 each of which may contain a full kitchen, bed18 room, and bathroom, and which includes com19 mon rooms and other facilities appropriate for 

20 the provision of supportive services to the resi21 dents of the facility. 

22 (7) CERTIFIED NURSING ASSISTANT.—The 

23 term ‘‘certified nursing assistant’’ means a nurse 

24 aide who has completed a State-approved training 

25 and competency evaluation program. 


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1 (8) COMMERCE.—Except as provided in section 

2 331, the term ‘‘commerce’’ has the meaning given 

3 such term in section 3 of the Fair Labor Standards 

4 Act of 1938 (29 U.S.C. 203). 

5 (9) COMMUNITY OR TECHNICAL COLLEGE.— 

6 The term ‘‘community or technical college’’ means a 

7 public institution of higher education at which the 

8 highest degree that is predominantly awarded to stu9 dents is an associate’s degree, including Tribal Col10 leges or Universities receiving grants under section 

11 316 of the Higher Education Act of 1965 (20 

12 U.S.C. 1059c) that offer a 2-year program for com13 pletion of such degree and State public institutions 

14 of higher education that offer such a 2-year pro15 gram. 

16 (10) DEVELOPMENTAL DISABILITY.—The term 

17 ‘‘developmental disability’’ has the meaning given 

18 such term in section 102 of the Developmental Dis19 abilities Assistance and Bill of Rights Act of 2000 

20 (42 U.S.C. 15002). 

21 (11) DIRECT CARE PROFESSIONAL.—The term 

22 ‘‘direct care professional’’ means— 

23 (A) a personal or home care aide; 

24 (B) a home and community-based services 

25 worker; 


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1 (C) a direct support professional; 

2 (D) a certified nursing assistant; 

3 (E) a nurse aide or nursing assistant; 

4 (F) a respite care provider; 

5 (G) a paid family caregiver; 

6 (H) a home health aide; 

7 (I) a private duty nurse; or 

8 (J) any other individual providing relevant 

9 services (as determined by the Secretary of 

10 Health and Human Services) for compensation, 

11 in the course of the profession of such indi12 vidual, at a long-term care setting to a resident 

13 of such setting. 

14 (12) DIRECT CARE PROFESSIONAL MANAGER.— 

15 The term ‘‘direct care professional manager’’ means 

16 a person who is a manager, or supervisory staff, 

17 with coaching, training, managerial, supervisory, or 

18 other oversight responsibilities of direct care profes19 sionals. 

20 (13) DIRECT CARE PROFESSIONAL WORK21 FORCE.—The term ‘‘direct care professional work22 force’’ means the broad workforce of direct care pro23 fessionals across all long-term care settings. 

24 (14) DISABILITY.—The term ‘‘disability’’, ex25 cept as provided in paragraph (10), has the meaning 


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1 given such term in section 3 of the Americans with 

2 Disabilities Act of 1990 (42 U.S.C. 12102). 

3 (15) DOMESTIC PARTNER.— 

4 (A) IN GENERAL.—The term ‘‘domestic 

5 partner’’, with respect to an individual, means 

6 another individual with whom the individual is 

7 in a committed relationship. 

8 (B) COMMITTED RELATIONSHIP DE9 FINED.—The term ‘‘committed relationship’’ 

10 for purposes of subparagraph (A)— 

11 (i) means a relationship between 2 in12 dividuals, each at least 18 years of age, in 

13 which both individuals share responsibility 

14 for a significant measure of each other’s 

15 common welfare; and 

16 (ii) includes any such relationship be17 tween 2 individuals, including individuals 

18 of the same sex, that is granted legal rec19 ognition by a State or political subdivision 

20 of a State as a marriage or analogous rela21 tionship, including a civil union or domes22 tic partnership. 

23 (16) EMPLOY.—The term ‘‘employ’’ has the 

24 meaning given the term in section 3 of the Fair 

25 Labor Standards Act of 1938 (29 U.S.C. 203). 


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1 (17) EMPLOYEE; EMPLOYER.—Except as pro2 vided in section 331, the terms ‘‘employee’’ and 

3 ‘‘employer’’ have the meanings given such terms in 

4 section 3 of such Act. 

5 (18) HOME AND COMMUNITY-BASED SERV6 ICES.—The term ‘‘home and community-based serv7 ices’’ means any of the following (whether provided 

8 on a fee-for-service, risk, or other basis): 

9 (A) Home health care services authorized 

10 under paragraph (7) of section 1905(a) of the 

11 Social Security Act (42 U.S.C. 1396d(a)). 

12 (B) Personal care services authorized 

13 under paragraph (24) of such section. 

14 (C) PACE services authorized under para15 graph (26) of such section. 

16 (D) Home and community-based services 

17 authorized under subsections (b), (c), (i), (j), 

18 and (k) of section 1915 of such Act (42 U.S.C. 

19 1396n), such services authorized under a waiver 

20 under section 1115 of such Act (42 U.S.C. 

21 1315), and such services provided through cov22 erage authorized under section 1937 of such 

23 Act (42 U.S.C. 1396u–7). 

24 (E) Case management services authorized 

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1 rity Act (42 U.S.C. 1396d(a)(19)) and section 

2 1915(g) of such Act (42 U.S.C. 1396n(g)). 

3 (F) Rehabilitative services, including those 

4 related to behavioral health, described in section 

5 1905(a)(13) of such Act (42 U.S.C. 

6 1396d(a)(13)). 

7 (G) Such other services specified by the 

8 Secretary of Health and Human Services. 

9 (19) HOME AND COMMUNITY-BASED SERVICES

10 SETTING.—The term ‘‘home and community-based 

11 services setting’’ means a setting where home and 

12 community-based services authorized under State 

13 options described in subsection (c) or (i) of section 

14 1915 of the Social Security Act (42 U.S.C. 1396n) 

15 or, as relevant, demonstration projects authorized 

16 under section 1115 of such Act (42 U.S.C. 1315), 

17 are provided to individuals enrolled for medical as18 sistance under a State plan under title XIX (or 

19 under a waiver of such a plan). 

20 (20) HOME AND COMMUNITY-BASED SERVICES

21 WORKER.—The term ‘‘home and community-based 

22 services worker’’— 

23 (A) means an individual who provides 

24 home and community-based services for com25 pensation; and 


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1 (B) may include individuals described in 

2 subparagraph (A) who are physical therapists, 

3 occupational therapists, or speech or language 

4 therapists. 

5 (21) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

6 The terms ‘‘Indian Tribe’’ and ‘‘Tribal organiza7 tion’’ have the meanings given such terms in section 

8 4 of the Indian Self-Determination and Education 

9 Assistance Act (25 U.S.C. 5304). 

10 (22) INSTITUTION OF HIGHER EDUCATION.— 

11 The term ‘‘institution of higher education’’ means— 

12 (A) an institution of higher education de13 fined in section 101 of the Higher Education 

14 Act of 1965 (20 U.S.C. 1001); or 

15 (B) an institution of higher education de16 fined in section 102(a)(1)(B) of such Act (20 

17 U.S.C. 1002(a)(1)(B)). 

18 (23) INSTRUMENTAL ACTIVITIES OF DAILY LIV19 ING.—The term ‘‘instrumental activities of daily liv20 ing’’ means tasks that are not necessary for funda21 mental functioning, but allow an individual to live 

22 independently in a community of daily living. Such 

23 tasks include— 

24 (A) housekeeping and room cleaning; 

25 (B) meal preparation; 


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1 (C) taking medications; 

2 (D) laundry; 

3 (E) transportation; 

4 (F) shopping for groceries, clothing, or 

5 other items; 

6 (G) managing communications, such as 

7 using the telephone; 

8 (H) managing finances; 

9 (I) writing letters; and 

10 (J) obtaining appointments. 

11 (24) LOCAL EDUCATIONAL AGENCY.—The term 

12 ‘‘local educational agency’’ has the meaning given 

13 the term in section 8101 of the Elementary and Sec14 ondary Education Act of 1965 (20 U.S.C. 7801). 

15 (25) LONG-TERM CARE SERVICES.—The term 

16 ‘‘long-term care services’’ means any services pro17 vided by a direct care professional in a long-term 

18 care setting. 

19 (26) LONG-TERM CARE SETTING.—The term 

20 ‘‘long-term care setting’’ means— 

21 (A) a nursing home; 

22 (B) a home and community-based services 

23 setting; 

24 (C) an assisted living facility; 

25 (D) an intermediate care facility; 


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1 (E) a State home, as defined in section 

2 101(19) of title 38, United States Code; 

3 (F) a Tribal nursing home operated pursu4 ant to an Indian health program (as defined in 

5 section 4 of the Indian Health Care Improve6 ment Act (25 U.S.C. 1603)); 

7 (G) a private home; 

8 (H) a respite setting; or 

9 (I) any other setting in which an individual 

10 provides relevant services (as determined by the 

11 Secretary of Health and Human Services), in 

12 the course of the profession of such individual, 

13 to a resident of such setting. 

14 (27) MEDICAID PROGRAM.—The term ‘‘Med15 icaid program’’ means, with respect to a State, the 

16 State program under title XIX of the Social Security 

17 Act (42 U.S.C. 1396 et seq.) (including any waiver 

18 or demonstration under such title or under section 

19 1115 of such Act (42 U.S.C. 1315) relating to such 

20 title). 

21 (28) NURSE AIDE.—The term ‘‘nurse aide’’ has 

22 the meaning given such term in section 1919(b)(5) 

23 of the Social Security Act (42 U.S.C. 1396r(b)(5)). 

24 (29) NURSING ASSISTANT.—The term ‘‘nursing 

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1 sists with the basic care or support of a patient 

2 under the direction of onsite licensed nursing staff, 

3 which may include performing duties such as— 

4 (A) monitoring of the health status, feed5 ing, bathing, dressing, grooming, toileting, or 

6 ambulation of patients or residents in a health 

7 facility or nursing home; and 

8 (B) medication administration and other 

9 health-related tasks of patients in a health facil10 ity or nursing home. 

11 (30) NURSING HOME.—The term ‘‘nursing 

12 home’’ means— 

13 (A) a nursing facility as defined in section 

14 1919(a) of the Social Security Act (42 U.S.C. 

15 1396r(a)); or 

16 (B) a skilled nursing facility as defined in 

17 section 1819(a) of such Act (42 U.S.C. 1395i– 

18 3(a)). 

19 (31) OLDER INDIVIDUAL.—The term ‘‘older in20 dividual’’ has the meaning given the term in section 

21 102 of the Older Americans Act of 1965 (42 U.S.C. 

22 3002). 

23 (32) PERSONAL OR HOME CARE AIDE.— 

24 (A) IN GENERAL.—The term ‘‘personal or 

25 home care aide’’ means an individual who helps 


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1 older individuals and people with serious illness, 

2 physical disability, cognitive impairment (in3 cluding Alzheimer’s disease or other dementias, 

4 a developmental disability, or another disability 

5 involving a mental impairment) to live in their 

6 own home or a residential care facility (such as 

7 a nursing home, assisted living facility, or any 

8 other facility the Secretary of Health and 

9 Human Services determines appropriate that is 

10 not described in subparagraph (B)(i)) by pro11 viding personal care services for compensation. 

12 (B) PERSONAL CARE SERVICES.—For pur13 poses of subparagraph (A), the term ‘‘personal 

14 care services’’ means assistance or services— 

15 (i) provided to an individual who is 

16 not an inpatient or resident of a hospital 

17 or institution for mental disease; and 

18 (ii) that enable the recipient to accom19 plish activities of daily living or instru20 mental activities of daily living. 

21 (33) SECONDARY SCHOOL.—The term ‘‘sec22 ondary school’’ has the meaning given such term in 

23 section 8101 of the Elementary and Secondary Edu24 cation Act of 1965 (20 U.S.C. 7801). 


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1 (34) SELF-DIRECTED CARE PROFESSIONAL.— 

2 The term ‘‘self-directed care professional’’ (also 

3 known as an ‘‘independent provider’’)— 

4 (A) means a direct care professional who is 

5 employed by an individual who is an older indi6 vidual, a person with a disability, or a rep7 resentative of such older individual or person 

8 with a disability, and such older individual or 

9 person with a disability has the decision-making 

10 authority over certain supports and services 

11 provided by the direct care professional and 

12 takes direct responsibility to manage those sup13 ports and services; and 

14 (B) includes paid family caregivers. 

15 (35) STATE.—The term ‘‘State’’, except as oth16 erwise provided in this Act, has the meaning given 

17 such term for purposes of title XIX of the Social Se18 curity Act (42 U.S.C. 1396 et seq.). 

19 (36) STATE EDUCATIONAL AGENCY.—The term 

20 ‘‘State educational agency’’ has the meaning given 

21 the term in section 8101 of the Elementary and Sec22 ondary Education Act of 1965 (20 U.S.C. 7801). 

23 (37) URBAN INDIAN ORGANIZATION.—The term 

24 ‘‘urban Indian organization’’ has the meaning given 


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1 the term in section 4 of the Indian Health Care Im2 provement Act (25 U.S.C. 1603). 

3 (38) WORKFORCE INNOVATION AND OPPOR4 TUNITY ACT TERMS.—The terms ‘‘career pathway’’, 

5 ‘‘career planning’’, ‘‘in-demand industry sector or 

6 occupation’’, ‘‘individual with a barrier to employ7 ment’’, ‘‘local board’’, ‘‘on-the-job training’’, ‘‘recog8 nized postsecondary credential’’, ‘‘region’’, and 

9 ‘‘State board’’ have the meanings given such terms 

10 in section 3 of the Workforce Innovation and Oppor11 tunity Act (29 U.S.C. 3102). 

12 (39) WORK-BASED LEARNING.—The term 

13 ‘‘work-based learning’’ has the meaning given such 

14 term in section 3 of the Carl D. Perkins Career and 

15 Technical Education Act of 2006 (20 U.S.C. 2302). 

16 TITLE I—IMPROVING 

17 REIMBURSEMENT 

18 SEC. 101. ADDITIONAL SUPPORT FOR MEDICAID LONG19 TERM CARE SERVICES PROVIDED BY DIRECT 

20 CARE PROFESSIONALS. 

21 Section 1905 of the Social Security Act (42 U.S.C. 

22 1396d) is amended— 

23 (1) in subsection (b), by striking ‘‘and (ii)’’ and 

24 inserting ‘‘(ii), and (kk)’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(kk) ADDITIONAL SUPPORT FOR LONG-TERM CARE

4 SERVICES PROVIDED BY DIRECT CARE PROFES5 SIONALS.— 

6 ‘‘(1) IN GENERAL.—Notwithstanding sub7 sections (b) and (ff), in the case of a State that sat8 isfies the conditions described in paragraph (2), for 

9 each fiscal quarter during the period of fiscal years 

10 2025 through 2034, the Federal medical assistance 

11 percentage otherwise determined for such State 

12 under such subsection (b) or (ff) shall, after the ap13 plication of any other increase to the Federal med14 ical assistance percentage for the State and quarter 

15 applicable under any other provision of law, be in16 creased by 10 percentage points (but not to exceed 

17 95 percent) with respect to amounts expended by the 

18 State for medical assistance for long-term care serv19 ices that are provided by direct care professionals 

20 during such quarter. 

21 ‘‘(2) REQUIREMENTS.—As a condition for re22 ceipt of the increase under paragraph (1) to the 

23 Federal medical assistance percentage determined 

24 for a State, the State shall submit to the Secretary, 

25 at such time and in such manner as specified by the 


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1 Secretary, an application that includes, in addition 

2 to such other information as the Secretary shall re3 quire— 

4 ‘‘(A) a description of which activities de5 scribed in paragraph (4) that a State plans to 

6 implement and a description of how it plans to 

7 implement such activities; 

8 ‘‘(B) assurances that all Federal funds at9 tributable to the increase under paragraph (1) 

10 will be— 

11 ‘‘(i) expended by the State in accord12 ance with this subsection not later than 

13 September 30, 2036; and 

14 ‘‘(ii) used— 

15 ‘‘(I) to implement the activities 

16 described in paragraph (4); 

17 ‘‘(II) to supplement, and not sup18 plant, the level of State funds ex19 pended for long-term care services 

20 provided by direct care professionals 

21 under the State plan (or under a 

22 waiver of such plan) as of the date of 

23 enactment of this subsection; and 

24 ‘‘(III) to increase reimbursement 

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1 vided by direct care professionals 

2 under the State plan (or under a 

3 waiver of such plan) to a level that 

4 will support recruitment and retention 

5 of a sufficient workforce to provide 

6 such services under the State plan (or 

7 waiver); 

8 ‘‘(C) assurances that the State will use 

9 funds to work to eliminate any home and com10 munity-based services waiting lists and ensure 

11 service capacity; 

12 ‘‘(D) assurances that the State will use at 

13 least 85 percent of the Federal funds attrib14 utable to the increase under paragraph (1) to 

15 improve compensation, benefits, working condi16 tions, and training for direct care professionals 

17 and direct care managers; and 

18 ‘‘(E) assurances that the State will con19 duct adequate oversight and ensure the validity 

20 of such data as may be required by the Sec21 retary. 

22 ‘‘(3) APPROVAL OF APPLICATION.—Not later 

23 than 90 days after the date of submission of an ap24 plication of a State under paragraph (2), the Sec25 retary shall certify if the application is complete. 


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1 Upon certification that an application of a State is 

2 complete, the application shall be deemed to be ap3 proved for purposes of this section. 

4 ‘‘(4) ACTIVITIES TO IMPROVE THE DIRECT

5 CARE PROFESSIONAL WORKFORCE.— 

6 ‘‘(A) IN GENERAL.—A State shall work 

7 with community partners such as Area Agencies 

8 on Aging, centers for independent living, as de9 scribed in part C of title VII of the Rehabilita10 tion Act of 1973, nonprofit long-term care serv11 ices providers, and other entities to implement 

12 some or all of the purposes described in sub13 paragraph (B). 

14 ‘‘(B) FOCUSED AREAS OF IMPROVE15 MENT.—The purposes described in this para16 graph, with respect to a State, are the fol17 lowing: 

18 ‘‘(i) To increase rates for service pro19 vider agencies that employ direct care pro20 fessionals (including independent providers 

21 in a self-directed or consumer-directed 

22 model) to provide long-term care services 

23 under the State plan (or under a waiver of 

24 such plan), provided that any service pro25 vider agency or individual that receives 


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1 payment under such an increased rate in2 creases the compensation it pay its direct 

3 care professionals. 

4 ‘‘(ii) To provide paid sick leave, paid 

5 family leave, and paid medical leave for di6 rect care professionals. 

7 ‘‘(iii) To provide hazard pay, overtime 

8 pay, and shift differential pay for direct 

9 care professionals. 

10 ‘‘(iv) To improve stability of direct 

11 care professional jobs, including consistent 

12 hours, scheduling, pay, and benefit eligi13 bility. 

14 ‘‘(v) To provide home and community15 based services to individuals who are on 

16 waiting lists for programs approved under 

17 sections 1115 or 1915. 

18 ‘‘(vi) To purchase emergency supplies 

19 and equipment, which may include items 

20 not typically covered under the State plan 

21 (or under a waiver of such plan), such as 

22 personal protective equipment, necessary to 

23 enhance access to services and to protect 

24 the health and well-being of direct care 

25 professionals. 


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1 ‘‘(vii) To pay for the travel of direct 

2 care professionals to conduct their job re3 sponsibilities. 

4 ‘‘(viii) To recruit new direct care pro5 fessionals. 

6 ‘‘(ix) To pay for training for direct 

7 care professionals, including apprenticeship 

8 programs. 

9 ‘‘(x) To pay for assistive technologies, 

10 staffing, and training to facilitate eligible 

11 individuals’ communication, and other 

12 costs incurred in order to facilitate commu13 nity integration and ensure an individual’s 

14 person-centered service plan is fully imple15 mented. 

16 ‘‘(xi) To prepare information and pub17 lic health and educational materials in ac18 cessible formats (including formats acces19 sible to people with low literacy or intellec20 tual disabilities about prevention, treat21 ment, recovery, and other aspects of com22 municable diseases and threats to the 

23 health of individuals who are enrolled for 

24 medical assistance under the State plan (or 

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1 lies, and the general community served by 

2 agencies described in clause (i). 

3 ‘‘(xii) To protect the health and safety 

4 of direct care professionals during public 

5 health emergencies and natural disasters. 

6 ‘‘(xiii) To pay for interpreters to as7 sist in providing long-term care services to 

8 individuals under the State plan (or under 

9 a waiver of such plan) and to inform the 

10 general public about communicable dis11 eases and other public health threats. 

12 ‘‘(xiv) To pay for other expenses 

13 deemed appropriate by the Secretary to en14 hance, expand, or strengthen long-term 

15 care services under the State plan (or 

16 under a waiver of such plan). 

17 ‘‘(5) REPORTING REQUIREMENTS.— 

18 ‘‘(A) STATE REPORTING REQUIRE19 MENTS.—Not later than December 31, 2027, 

20 and every 2 years thereafter until December 31, 

21 2039, any State with respect to which an appli22 cation is approved by the Secretary pursuant to 

23 paragraph (3) shall submit a report to the Sec24 retary that contains the following information: 


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1 ‘‘(i) Activities and programs that were 

2 funded using Federal funds attributable to 

3 the increase to the Federal medical assist4 ance percentage of the State under para5 graph (1). 

6 ‘‘(ii) The number of individuals en7 rolled under the State plan (or under a 

8 waiver of such plan) who were served by 

9 such activities and programs. 

10 ‘‘(iii) A detailed accounting of all 

11 spending of funds attributable to the in12 crease to the Federal medical assistance 

13 percentage of the State under paragraph 

14 (1) by the State and by any providers with 

15 whom the State entered into contracts or 

16 agreements to fulfill the requirements of 

17 this subsection. 

18 ‘‘(B) NON-APPLICATION OF THE PAPER19 WORK REDUCTION ACT.—Chapter 35 of title 

20 44, United States Code (commonly referred to 

21 as the ‘Paperwork Reduction Act of 1995’), 

22 shall not apply to the provisions of this sub23 section. 

24 ‘‘(6) ENFORCEMENT.— 


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1 ‘‘(A) IN GENERAL.—If the Secretary deter2 mines that a State with respect to which an ap3 plication is approved pursuant to paragraph (3) 

4 has failed to comply with the requirements of 

5 this subsection (including the requirement that 

6 all Federal funds attributable to the increase to 

7 the Federal medical assistance percentage of 

8 the State under paragraph (1) be spent in ac9 cordance with paragraph (4)) for any quarter 

10 during the period of fiscal years described in 

11 paragraph (1), the Secretary may reduce the 

12 number of percentage points by which the Fed13 eral medical assistance percentage for the State 

14 and quarter would otherwise be increased under 

15 paragraph (1) for such quarter. 

16 ‘‘(B) PENALTY BASED ON SEVERITY OF

17 FAILURE.—The Secretary shall impose reduc18 tions under this paragraph based on the degree 

19 to which a State has failed to comply with the 

20 requirements of this subsection. 

21 ‘‘(7) EVALUATION.—Not later than 2027 and 

22 annually until 2036, the Secretary, in conjunction 

23 with the Secretary of Labor, shall evaluate the im24 plementation and outcomes of this subsection on the 

25 availability of staff to cover shifts in all long-term 


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1 care settings serving, worker credentials and skills, 

2 and worker compensation through a contract with 

3 an external evaluator who has experience with eval4 uation related to people with disabilities and older 

5 individuals. 

6 ‘‘(8) DEFINITIONS.—In this subsection: 

7 ‘‘(A) DIRECT CARE PROFESSIONAL.—The 

8 term ‘direct care professional’ has the meaning 

9 given such term in section 3 of the Long-Term 

10 Care Workforce Support Act. 

11 ‘‘(B) HOME AND COMMUNITY-BASED SERV12 ICES.—The term ‘home and community-based 

13 services’ means any of the following: 

14 ‘‘(i) Home health care services author15 ized under paragraph (7) of subsection (a). 

16 ‘‘(ii) Personal care services authorized 

17 under paragraph (24) of such subsection. 

18 ‘‘(iii) PACE services authorized under 

19 paragraph (26) of such subsection. 

20 ‘‘(iv) Home and community-based 

21 services authorized under subsections (b), 

22 (c), (i), (j), and (k) of section 1915, such 

23 services authorized under a waiver under 

24 section 1115, and such services through 

25 coverage authorized under section 1937. 


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1 ‘‘(v) Case management services au2 thorized under subsection (a)(19) of this 

3 section and section 1915(g). 

4 ‘‘(vi) Rehabilitative services, including 

5 those related to behavioral health, de6 scribed in subsection (a)(13) of this sec7 tion. 

8 ‘‘(vii) Such other services specified by 

9 the Secretary.’’. 

10 SEC. 102. ADDITIONAL SUPPORT FOR MEDICAID LONG11 TERM CARE SERVICES AND DIRECT CARE 

12 PROFESSIONALS. 

13 (a) IN GENERAL.—Not later than 18 months after 

14 the date of enactment of this Act, the Secretary of Health 

15 and Human Services (referred to in this section as the 

16 ‘‘Secretary’’) shall award grants to States for the purpose 

17 of supporting and strengthening services provided by di18 rect care professionals across direct care settings and im19 proving recruitment, compensation, and retention of the 

20 direct care professional workforce. 

21 (b) APPLICATION.—Not later than 6 months after 

22 the date of enactment of this Act, each State that seeks 

23 to receive a grant under this section shall submit an appli24 cation, in such form and manner as the Secretary shall 

25 require, to the Secretary that includes— 


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1 (1) information on how the State will use grant 

2 funds to improve long-term care services and the re3 cruitment, compensation, and retention of direct 

4 care professionals in a manner that maximizes the 

5 independence of people with disabilities and older in6 dividuals, limits unnecessary institutionalization, and 

7 supports people living in residential settings; 

8 (2) specifies the proportion of grant funds that 

9 the State plans to spend on activities to support 

10 long-term professional care workers in nursing 

11 homes, home health settings, and home and commu12 nity-based services settings, respectively; 

13 (3) a plan for sustaining the work at the con14 clusion of the grant period; and 

15 (4) such other information as the Secretary 

16 shall require. 

17 (c) GRANT AMOUNTS.—The Secretary shall award 

18 each State that submits an application to the Secretary 

19 that meets the requirements of subsection (b) a 5-year 

20 grant in an amount that bears the same proportion to the 

21 amount appropriated under subsection (e) as— 

22 (1) the number of individuals who are enrolled 

23 for medical assistance under the Medicaid program 

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1 retary using the most recent data available as of the 

2 date of enactment of this Act); bears to 

3 (2) the total number of individuals who are en4 rolled for medical assistance under the Medicaid pro5 grams of all States that submit to the Secretary an 

6 application that meets the requirements of sub7 section (b). 

8 (d) USE OF GRANT FUNDS.— 

9 (1) IN GENERAL.—A State that receives a 

10 grant under this section shall use the funds of such 

11 grant in accordance with the requirements of this 

12 subsection. 

13 (2) SUPPLEMENT, NOT SUPPLANT.—A State 

14 shall use funds from a grant awarded under this sec15 tion to supplement, and not supplant, the level of 

16 State funds expended for services in long-term care 

17 settings through programs in effect as of January 1, 

18 2025. 

19 (3) REQUIRED IMPLEMENTATION OF CERTAIN

20 ACTIVITIES.—The State shall use funds from a 

21 grant awarded under this section to implement and 

22 evaluate, or supplement the implementation of, ac23 tivities (which shall include the activities described 

24 in paragraph (4)) to enhance, expand, or strengthen 


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1 long-term care services and to improve compensation 

2 to the workforce that provides such services. 

3 (4) ACTIVITIES TO STRENGTHEN AND EXPAND

4 THE DIRECT CARE PROFESSIONAL WORKFORCE.— 

5 (A) IN GENERAL.—The State strengthens 

6 and expands the direct care professional work7 force that provides services across long-term 

8 care settings by— 

9 (i) adopting a salary review process to 

10 ensure that the rates payable for long-term 

11 care services under the State Medicaid pro12 gram are sufficient to ensure access to 

13 such services under such program; 

14 (ii) requiring that at least 85 percent 

15 of all payments for long-term care services 

16 that are made under the State Medicaid 

17 program, including base payments and 

18 supplemental payments, are for compensa19 tion to direct care professionals and direct 

20 care professional managers; and 

21 (iii) updating, developing, and adopt22 ing qualification standards and training 

23 opportunities for the continuum of direct 

24 care professionals, including programs for 

25 independent direct care professionals and 


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1 agency direct care professionals, as well as 

2 unique programs. 

3 (B) PAYMENT RATES.—In carrying out 

4 subparagraph (A)(i), the State shall— 

5 (i) address insufficient payment rates 

6 under the State Medicaid program for de7 livery of long-term care services with an 

8 emphasis on supporting the recruitment 

9 and retention of direct care professionals; 

10 (ii) update payment rates under the 

11 State Medicaid program for long-term care 

12 services, including home and community13 based services, nursing home services, 

14 skilled nursing facility services, and inter15 mediate care facility services at least every 

16 2 years through a transparent process in17 volving meaningful input from stake18 holders, in which the majority of stake19 holders are recipients of such services, 

20 families, direct care professionals, chosen 

21 representatives of direct care workers, 

22 aging, disability, and workforce advocates, 

23 long-term care providers, and may also in24 clude health plans; and 


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1 (iii) ensure that, with respect to any 

2 increases in the payment rates under the 

3 State Medicaid program for long-term care 

4 services— 

5 (I) at a minimum, 85 percent of 

6 such payment rate increases are 

7 passed through to direct care profes8 sionals and direct care professional 

9 managers who provide such services 

10 and in a manner that is determined 

11 with input from the stakeholders de12 scribed in clause (ii); 

13 (II) such payment rate increases 

14 are incorporated into payment rates 

15 for such services provided under title 

16 XIX of the Social Security Act (42 

17 U.S.C. 1396 et seq.) by a managed 

18 care entity (as defined in section 

19 1932(a)(1)(B) of the Social Security 

20 Act (42 U.S.C. 1396u–2(a)(1)(B)) or 

21 a prepaid inpatient health plan or pre22 paid ambulatory health plan, as de23 fined in section 438.2 of title 42, 

24 Code of Federal Regulations (or any 


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1 successor regulation)), under a con2 tract with the State; 

3 (III) such payment rate increases 

4 are appropriately distributed across 

5 settings, populations, and services so 

6 as promote independence of people 

7 with disabilities and older individuals, 

8 not result in increased institutional9 ization, and assists in the facilitation 

10 of rebalancing the Medicaid program 

11 towards the least restrictive settings 

12 appropriate for individuals receiving 

13 services; and 

14 (IV) such payment rate increases 

15 are prioritized toward home and com16 munity-based service workers in 

17 States that have a waiting list for 

18 HCBS waiver services and have been 

19 determined by CMS to have inad20 equate HCBS capacity. 

21 (e) APPROPRIATION.—There is appropriated to the 

22 Secretary for awarding grants under this section an 

23 amount equal to $100,000,000,000. 

24 (f) EVALUATION OF IMPACT ON HCBS WAITING

25 LISTS.—The Secretary shall evaluate the implementation 


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1 and outcomes of this title on State Medicaid program 

2 waiting lists for home and community-based services 

3 through a contract with an external evaluator who has ex4 perience with evaluation related to people with disabilities 

5 and older individuals. 

6 SEC. 103. MAKING PERMANENT THE STATE OPTION TO EX7 TEND PROTECTION UNDER MEDICAID FOR 

8 RECIPIENTS OF HOME AND COMMUNITY9 BASED SERVICES AGAINST SPOUSAL IMPOV10 ERISHMENT. 

11 (a) IN GENERAL.—Section 1924(h)(1)(A) of the So12 cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend13 ed by striking ‘‘is described in section 

14 1902(a)(10)(A)(ii)(VI)’’ and inserting the following: ‘‘is 

15 eligible for medical assistance for home and community16 based services provided under subsection (c), (d), or (i) 

17 of section 1915, under a waiver approved under section 

18 1115, or who is eligible for such medical assistance by rea19 son of being determined eligible under section 

20 1902(a)(10)(C) or by reason of section 1902(f) or other21 wise on the basis of a reduction of income based on costs 

22 incurred for medical or other remedial care, or who is eligi23 ble for medical assistance for home and community-based 

24 attendant services and supports under section 1915(k)’’. 


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1 (b) CONFORMING AMENDMENT.—Section 2404 of the 

2 Patient Protection and Affordable Care Act (42 U.S.C. 

3 1396r–5 note) is amended by striking ‘‘September 30, 

4 2027’’ and inserting ‘‘the date of enactment of the Long5 Term Care Workforce Support Act’’. 

6 SEC. 104. PERMANENT EXTENSION OF MONEY FOLLOWS 

7 THE PERSON REBALANCING DEMONSTRA8 TION. 

9 (a) IN GENERAL.—Subsection (h)(1) of section 6071 

10 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 

11 note) is amended— 

12 (1) in subparagraph (K), by striking ‘‘; and’’ 

13 and inserting a semicolon; 

14 (2) in subparagraph (L), by striking ‘‘through 

15 2027.’’ and inserting ‘‘through 2025; and’’; and 

16 (3) by adding at the end the following new sub17 paragraph: 

18 ‘‘(M) $500,000,000 for each fiscal year 

19 after fiscal year 2025.’’. 

20 (b) REDISTRIBUTION OF UNEXPENDED GRANT

21 AWARDS.—Subsection (e)(2) of section 6071 of the Deficit 

22 Reduction Act of 2005 (42 U.S.C. 1396a note) is amended 

23 by adding at the end the following new sentence: ‘‘Any 

24 portion of a State grant award for a fiscal year under this 

25 section that is unexpended by the State at the end of the 


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1 fourth succeeding fiscal year shall be rescinded by the Sec2 retary and added to the appropriation for the fifth suc3 ceeding fiscal year for grants under this section.’’. 

4 TITLE II—TRAINING, RECRUIT5 MENT, CAREER ADVANCE6 MENT, AND WORKER SUP7 PORTS 

8 Subtitle A—Improving Workforce 

9 Training 

10 CHAPTER 1—GRANTS FOR SUPPORTING 

11 THE DIRECT CARE PROFESSIONAL 

12 WORKFORCE 

13 SEC. 201. DEFINITIONS. 

14 In this chapter: 

15 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti16 ty’’ means an entity— 

17 (A) that is— 

18 (i) a State; 

19 (ii) a labor organization, joint labor20 management organization, or employer of 

21 direct care professionals; 

22 (iii) a nonprofit entity with experience 

23 in aging, disability, or supporting the 

24 rights and interests of, the training of, or 

25 educating direct care professionals; 


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1 (iv) an Indian Tribe, Tribal organiza2 tion, or Urban Indian organization; 

3 (v) a community or technical college 

4 or other institution of higher education; or 

5 (vi) a consortium of entities listed in 

6 any of clauses (i) through (v); 

7 (B) that agrees, as applicable with respect 

8 to the type of grant the entity is seeking under 

9 this chapter and the activities supported 

10 through such grant, to include as advisors and 

11 trainers in such activities— 

12 (i) older individuals; 

13 (ii) people with disabilities; 

14 (iii) direct care professionals; and 

15 (iv) family members of such individ16 uals, persons, or professionals; and 

17 (C) that agrees to consult with the State 

18 Medicaid agency of the State (or each State) 

19 served by the grant on the grant activities, to 

20 the extent that such agency (or each such agen21 cy) is not the eligible entity. 

22 (2) PROJECT PARTICIPANT.—The term ‘‘project 

23 participant’’ means an individual participating in a 

24 project or activity assisted with a grant under this 

25 chapter, including (as applicable for the category of 


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1 the grant) a direct care professional or an individual 

2 training to be such a professional. 

3 (3) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (4) SUPPORTIVE SERVICES.—The term ‘‘sup6 portive services’’ means services that are necessary 

7 to enable an individual to participate in activities as8 sisted with a grant under this chapter, such as 

9 transportation, child care, dependent care, housing, 

10 workplace accommodations, employee benefits such 

11 as paid sick leave and child care, workplace health 

12 and safety protections, wages and overtime pay, and 

13 needs-related payments. 

14 SEC. 202. AUTHORITY TO AWARD GRANTS. 

15 (a) GRANTS.— 

16 (1) IN GENERAL.—Not later than 12 months 

17 after the date of enactment of this Act, the Sec18 retary, in consultation with the Administrator of the 

19 Centers for Medicare & Medicaid Services, the Sec20 retary of Labor, and the Secretary of Education, 

21 shall award grants described in paragraph (2) to eli22 gible entities. A grant awarded under this section 

23 may be in more than 1 category described in such 

24 paragraph. 


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1 (2) CATEGORIES OF GRANTS.—The categories 

2 of grants described in this paragraph are each of the 

3 following: 

4 (A) DIRECT CARE PROFESSIONALS

5 GRANTS.—Grants to eligible entities to create 

6 and carry out projects for the purposes of re7 cruiting, retaining, or providing advancement 

8 opportunities for direct care professionals who 

9 are not described in subparagraph (B), (C), or 

10 (D), including through education or training 

11 programs for such professionals or individuals 

12 seeking to become such professionals. 

13 (B) DIRECT CARE PROFESSIONAL MAN14 AGERS GRANTS.—Grants to eligible entities to 

15 create and carry out projects for the purposes 

16 of recruiting, retaining, or providing advance17 ment opportunities for direct care professional 

18 managers, including through education or train19 ing programs for such managers or individuals 

20 seeking to become such managers. 

21 (C) SELF-DIRECTED CARE PROFESSIONALS

22 GRANTS.—Grants to eligible entities to create 

23 and carry out projects for the purposes of re24 cruiting, retaining, or providing advancement 

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1 sionals, including through education or training 

2 programs for such professionals or individuals 

3 seeking to become such professionals. 

4 (D) HOME AND COMMUNITY-BASED SERV5 ICES GRANTS.—Grants to eligible entities to 

6 create and carry out projects to recruit, retain, 

7 or provide advancement opportunities for home 

8 and community-based services workers pro9 viding services and supports to older individ10 uals, or people with disabilities, who are eligible 

11 for coverage under a State Medicaid program. 

12 (3) PROJECTS FOR ADVANCEMENT OPPORTUNI13 TIES.—Not less than 30 percent of projects assisted 

14 with grants under this chapter shall be projects to 

15 provide career pathways that offer opportunities for 

16 professional development and advancement opportu17 nities to direct care professionals. 

18 (b) TREATMENT OF CONTINUATION ACTIVITIES.— 

19 An eligible entity that carries out activities described in 

20 subsection (a)(2) prior to receipt of a grant under this 

21 chapter may use such grant to continue carrying out such 

22 activities, and, in using such grant to continue such activi23 ties, shall be treated as an eligible entity carrying out a 

24 project through a grant under this chapter. 


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1 SEC. 203. PROJECT PLANS. 

2 (a) IN GENERAL.—An eligible entity seeking a grant 

3 under this chapter shall submit to the Secretary a project 

4 plan for each project to be developed and carried out (in5 cluding for activities to be continued as described in sec6 tion 202(b)) with the grant. Such project plan shall be 

7 submitted at such time, in such manner, and containing 

8 such information as the Secretary may require. 

9 (b) CONTENTS.—A project plan submitted by an eli10 gible entity under subsection (a) shall include a descrip11 tion of information determined relevant by the Secretary 

12 for purposes of the category of the grant and the activities 

13 to be carried out through the grant. Such information may 

14 include (as applicable) the following: 

15 (1) Demographic information regarding the 

16 population in the State, city or municipality, or re17 gion to be served by the project, including a descrip18 tion of the populations likely to need services pro19 vided by direct care professionals, such as people 

20 with disabilities and older individuals. 

21 (2) Projections of unmet need for services pro22 vided by direct care professionals based on enroll23 ment waiting lists under home and community-based 

24 waivers under section 1115 of the Social Security 

25 Act (42 U.S.C. 1315) or section 1915(c) of such Act 

26 (42 U.S.C. 1396n(c)) and other relevant data to the 


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1 extent practicable and feasible, such as direct care 

2 professional workforce vacancy rates and crude sepa3 ration rates and the number of direct care profes4 sionals, including such professionals who are man5 agers or supervisors, in the State or region to be 

6 served by the project. 

7 (3) An advisory committee to advise the eligible 

8 entity on activities to be carried out through the 

9 grant. Such advisory committee— 

10 (A) shall include— 

11 (i) older individuals and people with 

12 disabilities receiving services from the di13 rect care professionals targeted by the 

14 project; 

15 (ii) organizations representing the 

16 rights and interests of people receiving 

17 services by the direct care professionals 

18 targeted by the project; 

19 (iii) individuals who are direct care 

20 professionals targeted by the project and 

21 organizations representing the rights and 

22 interests of such direct care professionals; 

23 (iv) as applicable, employers of indi24 viduals described in clause (iii) and labor 


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1 organizations representing such individ2 uals; 

3 (v) representatives of the State Med4 icaid agency, the State agency defined in 

5 section 102 of the Older Americans Act of 

6 1965 (42 U.S.C. 3002), the State develop7 mental disabilities office, and the State 

8 mental health agency, in the State (or each 

9 State) to be served by the project; 

10 (vi) parents or caregivers of children 

11 with disabilities or chronic conditions; and 

12 (vii) representatives reflecting diverse 

13 racial, cultural, ethnic, geographic, socio14 economic, and gender identity and sexual 

15 orientation perspectives; and 

16 (B) may include any other individuals or 

17 entities listed in paragraph (12). 

18 (4) Current or projected job openings for, or 

19 relevant labor market information related to, the di20 rect care professionals targeted by the project in the 

21 State or region to be served by the project, and the 

22 geographic scope of the workforce to be served by 

23 the project. 

24 (5) Specific efforts and strategies that the 

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1 ment, retention, or advancement of the direct care 

2 professionals targeted by the project, including an 

3 assurance that such efforts will include— 

4 (A) an assessment of the wages or other 

5 compensation or benefits necessary to recruit 

6 and retain the direct care professionals targeted 

7 by the project; 

8 (B) a description of the project’s projected 

9 compensation or benefits for the direct care 

10 professionals targeted by the project at the 

11 State or local level, including a comparison of 

12 such projected compensation or benefits to re13 gional and national compensation or benefits 

14 and a description of how wages and benefits re15 ceived by project participants will be impacted 

16 by the participation in and completion of the 

17 project; and 

18 (C) a description of the projected impact of 

19 workplace safety issues on the recruitment and 

20 retention of direct care professionals targeted 

21 by the project, including the availability of per22 sonal protective equipment. 

23 (6) In the case of a project offering an edu24 cation or training program for direct care profes25 sionals, a description of such program (including 


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1 how the core competencies identified by the Centers 

2 for Medicare & Medicaid Services will be incor3 porated, curricula, models, and standards used 

4 under the program, and any associated recognized 

5 postsecondary credentials for which the program 

6 provides preparation, as applicable), which shall in7 clude an assurance that such program will provide to 

8 each project participant in such program— 

9 (A) relevant training regarding the rights 

10 of recipients of long-term care services, includ11 ing their rights to— 

12 (i) receive services in integrated set13 tings that provide access to the broader 

14 community; 

15 (ii) exercise self-determination; 

16 (iii) be free from all forms of abuse, 

17 neglect, or exploitation; and 

18 (iv) person-centered planning and 

19 practices, including participation in plan20 ning activities; 

21 (B) relevant training to ensure that each 

22 project participant has the necessary skills to 

23 recognize abuse and understand their obliga24 tions with regard to reporting and responding 


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1 to abuse appropriately in accordance with rel2 evant Federal and State law; 

3 (C) relevant training regarding the provi4 sion of culturally competent and disability com5 petent supports to recipients of services pro6 vided by the direct care professionals targeted 

7 by the project; 

8 (D) an apprenticeship program, work9 based learning, or on-the-job training opportu10 nities; 

11 (E) supervision or mentoring; and 

12 (F) for any on-the-job training portion of 

13 the program, a progressively increasing, clearly 

14 defined schedule of wages to be paid to each 

15 such participant that— 

16 (i) is consistent with skill gains or at17 tainment of a recognized postsecondary 

18 credential received as a result of participa19 tion in or completion of such program; 

20 (ii) ensures the entry wage is not less 

21 than the greater of— 

22 (I) the minimum wage required 

23 under section 6(a) of the Fair Labor 

24 Standards Act of 1938 (29 U.S.C. 

25 206(a)); or 


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1 (II) the applicable minimum 

2 wage required by other applicable 

3 Federal or State law, or a collective 

4 bargaining agreement; and 

5 (iii) does not use a certificate under 

6 section 14(c) of the Fair Labor Standards 

7 Act of 1938 (29 U.S.C. 214(c)). 

8 (7) Any other innovative models or processes 

9 the eligible entity will implement to support the re10 tention and career advancement of the direct care 

11 professionals targeted by the project. 

12 (8) The supportive services and benefits to be 

13 provided to the project participants in order to sup14 port the employment, retention, or career advance15 ment of the direct care professionals targeted by the 

16 project. 

17 (9) How the eligible entity will make use of ca18 reer planning to support the identification of ad19 vancement opportunities and career pathways for 

20 the direct care professionals in the State or region 

21 to be served by the project. 

22 (10) How the eligible entity will collect and sub23 mit to the Secretary direct care professional work24 force data and outcomes of the project. 

25 (11) How the project— 


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1 (A) will— 

2 (i) provide adequate and safe equip3 ment and facilities for training and super4 vision, including a safe work environment 

5 free from discrimination, which may in6 clude the provision of personal protective 

7 equipment and other necessary equipment 

8 to prevent the spread of infectious disease 

9 among the direct care professionals tar10 geted by the project and recipients of serv11 ices provided by such professionals; 

12 (ii) incorporate remote training and 

13 education opportunities or technology-sup14 ported opportunities; 

15 (iii) for training and education cur16 ricula, incorporate evidence-supported 

17 practices for adult learners and universal 

18 design for learning and ensure recipients 

19 of services provided by the direct care pro20 fessionals targeted by the project partici21 pate in the development and implementa22 tion of such training and education cur23 ricula; 


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1 (iv) use outreach, recruitment, and re2 tention strategies designed to reach and re3 tain a diverse workforce; 

4 (v) incorporate methods to monitor 

5 satisfaction with project activities for 

6 project participants and individuals receiv7 ing services from such participants; and 

8 (vi) incorporate core competencies 

9 identified by the Centers for Medicare & 

10 Medicaid Services; and 

11 (B) may incorporate continuing education 

12 programs and specialty training, with a specific 

13 focus on— 

14 (i) trauma-informed care; 

15 (ii) behavioral health; 

16 (iii) developmental disabilities or other 

17 disabilities involving mental impairment; 

18 (iv) co-occurring behavioral health 

19 conditions and a disability described in 

20 clause (iii); 

21 (v) Alzheimer’s and dementia care; 

22 (vi) infection prevention and control 

23 measures; 

24 (vii) chronic disease management; 

25 (viii) age-related conditions; and 


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1 (ix) the use of supportive or assistive 

2 technology. 

3 (12) How the eligible entity will consult 

4 throughout the implementation of the project, or co5 ordinate the project with, each of the following: 

6 (A) Older individuals and people with dis7 abilities. 

8 (B) The State Medicaid agency, the State 

9 agency defined in section 102 of the Older 

10 Americans Act of 1965 (42 U.S.C. 3002), and 

11 the State developmental disabilities office for 

12 the State (or each State) to be served by the 

13 project. 

14 (C) The local board and State board for 

15 each region, or State, to be served by the 

16 project. 

17 (D) In the case of a project that carries 

18 out an education or training program, a non19 profit organization with demonstrated experi20 ence in the development or delivery of curricula 

21 or coursework. 

22 (E) A nonprofit organization, including a 

23 labor organization, that fosters the professional 

24 development and collective engagement of the 

25 direct care professionals targeted by the project. 


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1 (F) Organizations representing the rights 

2 and interests of people receiving services by the 

3 direct care professionals targeted by the project. 

4 (G) Area agencies on aging. 

5 (H) Centers for independent living, as de6 scribed in part C of chapter I of title VII of the 

7 Rehabilitation Act of 1973 (29 U.S.C. 796f et 

8 seq.). 

9 (I) The State Council on Developmental 

10 Disabilities (as such term is used in subtitle B 

11 of title I of the Developmental Disabilities As12 sistance and Bill of Rights Act of 2000 (42 

13 U.S.C. 15021 et seq.)) for the State (or each 

14 State) to be served by the project. 

15 (J) Aging and Disability Resource Centers. 

16 (K) A nonprofit State provider association 

17 that represents providers who employ the direct 

18 care professionals targeted by the project, 

19 where such associations exist. 

20 (L) An entity that employs the direct care 

21 professionals targeted by the project. 

22 (M) University Centers for Excellence in 

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1 sistance and Bill of Rights Act of 2000 (42 

2 U.S.C. 15061 et seq.). 

3 (N) The State protection and advocacy 

4 system described in section 143 of such Act (42 

5 U.S.C. 15043) of the State (or each State) to 

6 be served by the project. 

7 (O) Direct care professionals, and direct 

8 care professional workforce organizations, rep9 resenting underserved communities, including 

10 communities of color. 

11 (P) Individuals employed or working as the 

12 direct care professionals targeted by the project. 

13 (Q) Representatives of such professionals. 

14 (R) Individuals receiving services from 

15 such professionals. 

16 (S) The families of such professionals. 

17 (T) The families of individuals receiving 

18 services from such professionals. 

19 (U) Individuals receiving education or 

20 training to become such professionals. 

21 (13) Outreach efforts to individuals for partici22 pation in such project, including targeted outreach 

23 efforts to— 

24 (A) individuals who are recipients of assist25 ance under a State program funded under part 


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1 A of title IV of the Social Security Act (42 

2 U.S.C. 601 et seq.) or individuals who are eligi3 ble for such assistance; and 

4 (B) individuals with a barrier to employ5 ment. 

6 (c) CONSIDERATIONS.—In selecting eligible entities 

7 to receive a grant under this chapter, the Secretary shall 

8 ensure— 

9 (1) equitable geographic and demographic di10 versity, including by selecting recipients serving 

11 rural areas and selecting recipients serving urban 

12 areas; and 

13 (2) that selected eligible entities will serve areas 

14 where the occupation of direct care professional, or 

15 a related occupation, is an in-demand industry sec16 tor or occupation. 

17 SEC. 204. USES OF FUNDS; SUPPLEMENT, NOT SUPPLANT. 

18 (a) USES OF FUNDS.— 

19 (1) IN GENERAL.—Each eligible entity receiving 

20 a grant under this chapter shall use the funds of 

21 such grant to carry out at least 1 project described 

22 in section 202(a)(2). 

23 (2) ADMINISTRATIVE COSTS.—Each eligible en24 tity receiving a grant under this chapter shall not 

25 use more than 5 percent of the funds of such grant 


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1 for costs associated with the administration of activi2 ties under this chapter. 

3 (3) DIRECT SUPPORT.—Each eligible entity re4 ceiving a grant under this chapter shall use not less 

5 than 5 percent of the funds of such grant to provide 

6 direct financial benefits or supportive services to di7 rect care professionals to support the financial needs 

8 of such participants during the duration of the 

9 project activities. 

10 (b) SUPPLEMENT, NOT SUPPLANT.—An eligible enti11 ty receiving a grant under this chapter shall use such 

12 grant only to supplement, and not supplant, the amount 

13 of funds that, in the absence of such grant, would be avail14 able to address the recruitment, training and education, 

15 retention, and advancement of direct care professionals, 

16 in the State or region served by the eligible entity. 

17 (c) PROHIBITION.—No amounts made available 

18 under this chapter may be used for any activity that is 

19 subject to the reporting requirements set forth in section 

20 203(a) of the Labor-Management Reporting and Disclo21 sure Act of 1959 (29 U.S.C. 433(a)). 

22 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated for grants under section 

24 202, $500,000,000 for each of fiscal years 2025 through 

25 2029. 


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1 CHAPTER 2—OTHER WORKFORCE 

2 TRAINING GRANTS 

3 SEC. 205. WORKFORCE INVESTMENT ACTIVITIES GRANTS 

4 FOR DOMESTIC WORKERS. 

5 (a) DEFINITIONS.—In this section: 

6 (1) DOMESTIC SERVICES.—The term ‘‘domestic 

7 services’’— 

8 (A) means services— 

9 (i) of a household nature; 

10 (ii) provided in interstate commerce; 

11 and 

12 (iii) performed by an individual in or 

13 about a private home (permanent or tem14 porary); and 

15 (B) includes services performed by individ16 uals such as companions, housekeepers, nurses, 

17 home health aides, or personal or home care 

18 aides. 

19 (2) DOMESTIC WORKER.—The term ‘‘domestic 

20 worker’’— 

21 (A) means, except as provided in subpara22 graph (B), an individual, including an em23 ployee, who is compensated directly or indirectly 

24 for the performance of domestic services; and 

25 (B) does not include— 


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1 (i) an individual who is a family mem2 ber, friend, neighbor, or parent of a child 

3 and who provides child care for the child in 

4 the child’s home; and 

5 (ii) any employee described in section 

6 13(a)(15) of the Fair Labor Standards Act 

7 of 1938 (29 U.S.C. 213(a)(15)). 

8 (3) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Labor, in consultation with the Sec10 retary of Education and the Secretary of Health and 

11 Human Services. 

12 (4) SUPPORTIVE SERVICES; TRAINING SERV13 ICES; WORKFORCE INVESTMENT ACTIVITIES.—The 

14 terms ‘‘supportive services’’, ‘‘training services’’, and 

15 ‘‘workforce investment activities’’ have the meanings 

16 given the terms in section 3 of the Workforce Inno17 vation and Opportunity Act (29 U.S.C. 3102). 

18 (b) NATIONAL GRANT PROGRAM FOR DOMESTIC

19 WORKERS.—Every 3 years, the Secretary shall, on a com20 petitive basis, make grants to, or enter into contracts with, 

21 eligible entities to carry out the activities described in sub22 section (d). The Secretary shall make the grants, or enter 

23 into the contracts, for periods of 4 years. 

24 (c) ELIGIBILITY.— 


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1 (1) ELIGIBLE ENTITIES.—To be eligible to re2 ceive a grant or enter into a contract under this sec3 tion, an entity— 

4 (A) shall have experience working with 

5 older individuals or people with disabilities; and 

6 (B) shall be— 

7 (i)(I) a nonprofit organization that is 

8 described in paragraph (3), (5), or (6) of 

9 section 501(c) of the Internal Revenue 

10 Code of 1986, and exempt from taxation 

11 under section 501(a) of such Code; 

12 (II) an organization with a board of 

13 directors, at least one-half of the members 

14 of which is comprised of— 

15 (aa) domestic workers; or 

16 (bb) representatives of an organi17 zation of such workers, including such 

18 workers who are direct care profes19 sionals, which organization is inde20 pendent from all businesses, organiza21 tions, corporations, or individuals that 

22 would pursue any financial interest in 

23 conflict with that of the workers; 


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1 (III) an organization that is inde2 pendent as described in subclause (II)(bb); 

3 and 

4 (IV) an organization that has exper5 tise in domestic work and the workforce of 

6 domestic workers, including such workers 

7 who are direct care professionals; 

8 (ii) an eligible provider of training 

9 services listed pursuant to section 122(d) 

10 of the Workforce Innovation and Oppor11 tunity Act (29 U.S.C. 3152(d)); or 

12 (iii) an entity that carries out an ap13 prenticeship program. 

14 (2) PROGRAM PLAN.— 

15 (A) IN GENERAL.—To be eligible to receive 

16 a grant or enter into a contract under this sec17 tion, an entity described in paragraph (1) shall 

18 submit to the Secretary of Labor a plan that 

19 describes a 4-year strategy for meeting the 

20 needs of domestic workers, including such work21 ers who are direct care professionals, in the 

22 area to be served by such entity. 

23 (B) CONTENTS.—Such plan shall— 

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1 ers who provide long-term care services, to 

2 be served and identify the needs of such 

3 population to be served for workforce in4 vestment activities and related assistance, 

5 which may include employment and sup6 portive services; 

7 (ii) identify the manner in which ca8 reer pathways to be provided will strength9 en the ability of the domestic workers to be 

10 served to obtain or retain employment and 

11 to improve wages or working conditions, 

12 including improved employment standards 

13 and opportunities in the field of domestic 

14 work; 

15 (iii) specifically address how the fund16 ing provided through the grant or contract 

17 for services under this section to domestic 

18 workers will improve wages and skills for 

19 domestic workers in a way that helps meet 

20 the need to recruit workers for and retain 

21 workers in in-demand occupations or ca22 reers; and 

23 (iv) provide an assurance that the 

24 workforce investment activities and related 

25 assistance carried out under this section 


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1 will include relevant training for domestic 

2 workers who are direct care professionals, 

3 including— 

4 (I) training regarding the rights 

5 of recipients of long-term care serv6 ices, including the rights of such re7 cipients to— 

8 (aa) receive services in inte9 grated settings that provide ac10 cess to the broader community; 

11 (bb) exercise self-determina12 tion; 

13 (cc) be free from all forms 

14 of abuse, neglect, or exploitation; 

15 and 

16 (dd) receive person-centered 

17 planning and practices, including 

18 through the participation of such 

19 recipients in planning activities; 

20 (II) training to ensure that each 

21 participant of such training has the 

22 necessary skills to recognize abuse 

23 and understand their obligations with 

24 regard to reporting and responding to 

25 abuse appropriately in accordance 


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1 with relevant Federal and State law; 

2 and 

3 (III) training regarding the pro4 vision of culturally competent and dis5 ability-competent supports to recipi6 ents of long-term care services. 

7 (3) AWARDS AND ADMINISTRATION.—The 

8 grants and contracts under this subsection shall be 

9 awarded by the Secretary using full and open com10 petitive procedures and shall be administered by the 

11 Secretary. 

12 (d) AUTHORIZED ACTIVITIES.—Funds made avail13 able under this section shall be used to carry out workforce 

14 investment activities and provide related assistance for do15 mestic workers, including such workers who are direct care 

16 professionals, which may include— 

17 (1) outreach, employment, training services, 

18 educational assistance, digital literacy assistance, 

19 English language and literacy instruction, worker 

20 safety training, supportive services, school dropout 

21 prevention and recovery activities, individual career 

22 services, and career pathways; 

23 (2) follow-up services for those individuals 

24 placed in employment; 


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1 (3) development or education as needed by do2 mestic workers, including domestic workers who are 

3 direct care professionals; 

4 (4) customized career and technical education 

5 in occupations that will lead to higher wages, en6 hanced benefits, and long-term employment in do7 mestic work or another area; and 

8 (5) the creation or maintenance of employment 

9 and training-related placement services, including 

10 digital placement services. 

11 (e) FUNDING ALLOCATION.—From the funds appro12 priated and made available to carry out this section, the 

13 Secretary shall reserve not more than 1 percent for discre14 tionary purposes related to carrying out this section, such 

15 as providing technical assistance to eligible entities. 

16 (f) ELIGIBLE PROVIDER PERFORMANCE REPORTS.— 

17 Each eligible entity shall prepare performance reports to 

18 report on outcomes achieved by the programs of workforce 

19 investment activities and related assistance carried out 

20 under this section. The performance report for an eligible 

21 entity shall include, with respect to each such program (re22 ferred to in this subsection as a ‘‘program of study’’) of 

23 such entity— 

24 (1) information specifying the levels of perform25 ance achieved with respect to the primary indicators 


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1 of performance described in subclauses (I) through 

2 (V) of section 116(b)(2)(A)(i) of the Workforce In3 novation and Opportunity Act (29 U.S.C. 

4 3141(b)(2)(A)(i)) with respect to all individuals en5 gaging in the program of study; 

6 (2) the total number of individuals exiting from 

7 the program of study; 

8 (3) the total number of participants who re9 ceived training services through the program; 

10 (4) the total number of participants who exited 

11 from training services, disaggregated by the type of 

12 entity that provided the training services, during the 

13 most recent program year and the 3 preceding pro14 gram years; 

15 (5) the average cost per participant for the par16 ticipants who received training services, 

17 disaggregated by the type of entity that provided the 

18 training services, during the most recent program 

19 year and the 3 preceding program years; and 

20 (6) information on indicators specified by the 

21 Secretary concerning the impact of the training serv22 ices on the wages, skills, recruitment, and retention 

23 of participants. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $10,000,000 for each of fiscal years 2025 through 2029. 

4 SEC. 206. DIRECT CARE PROFESSIONAL CAREER ADVANCE5 MENT DEMONSTRATION PROJECTS. 

6 (a) IN GENERAL.—Section 2008 of the Social Secu7 rity Act (42 U.S.C. 1397g) is amended— 

8 (1) by adding at the end the following new sub9 section: 

10 ‘‘(e) DIRECT CARE PROFESSIONAL CAREER AD11 VANCEMENT DEMONSTRATION PROJECTS.— 

12 ‘‘(1) IN GENERAL.—The Secretary, in consulta13 tion with the Secretary of Labor, shall award, from 

14 the amount appropriated under paragraph (4), 

15 grants to eligible entities to conduct demonstration 

16 projects that are designed to provide eligible individ17 uals with opportunities for education, training, and 

18 career advancement as a direct care professional, in19 cluding as a personal or home care aide, home 

20 health aide, or nursing aide or assistant. 

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

22 ‘‘(A) ELIGIBLE ENTITY.—The term ‘eligi23 ble entity’ has the meaning given such term in 

24 subsection (a). 


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

2 ‘eligible individual’ means an individual— 

3 ‘‘(i) whose income does not exceed 

4 200 percent of the poverty line (as defined 

5 in section 2110(c)(5)) applicable to a fam6 ily of the size involved; and 

7 ‘‘(ii) who is employed as a direct care 

8 professional who— 

9 ‘‘(I) has at least 30 percent pa10 tient volume (as estimated in accord11 ance with a methodology established 

12 by the Secretary) attributable to indi13 viduals who are receiving medical as14 sistance under title XIX; or 

15 ‘‘(II) is employed by an agency 

16 that is a provider of personal or home 

17 care services that has at least 30 per18 cent of the agency’s patient volume 

19 (as so estimated) attributable to such 

20 individuals. 

21 ‘‘(C) DIRECT CARE PROFESSIONAL.—The 

22 term ‘direct care professional’ has the meaning 

23 given such term in section 3 of the Long-Term 

24 Care Workforce Support Act. 

25 ‘‘(3) REQUIREMENTS.— 


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1 ‘‘(A) PRIORITIZATION OF PROJECTS THAT

2 SUPPORT RURAL AREAS, UNDERSERVED AREAS, 

3 AND WOMEN, INDIVIDUALS FROM COMMUNITIES

4 OF COLOR, AND INDIVIDUALS WITH DISABIL5 ITIES.—The Secretary shall ensure that not less 

6 than half of the demonstration projects sup7 ported by grants awarded under this subsection 

8 support— 

9 ‘‘(i) eligible individuals in rural areas 

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

11 ‘‘(ii) eligible individuals in under12 served urban areas (including urban health 

13 professional shortage areas (as defined in 

14 section 332 of the Public Health Service 

15 Act); 

16 ‘‘(iii) eligible individuals who are 

17 women, who are from communities of 

18 color, or who belong to other underserved 

19 and diverse populations such as Asian, Pa20 cific Islander, Native American, or Alaska 

21 Native communities; and 

22 ‘‘(iv) eligible individuals with disabil23 ities. 

24 ‘‘(B) AMOUNT OF GRANT.—In no case 

25 shall the Secretary award an eligible entity a 


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1 grant to conduct a demonstration project under 

2 this subsection in an amount that exceeds 

3 $750,000 for each year that the entity conducts 

4 such project. 

5 ‘‘(C) REPORTS.— 

6 ‘‘(i) INTERIM REPORTS.—An eligible 

7 entity awarded a grant to conduct a dem8 onstration project under this subsection 

9 shall submit interim reports to the Sec10 retary on the activities carried out under 

11 the project and a final report on such ac12 tivities upon the conclusion of the entities’ 

13 participation in the project. 

14 ‘‘(ii) EVALUATION.—The Adminis15 trator of the Health Resources and Serv16 ices Administration shall evaluate the dem17 onstration projects conducted under this 

18 subsection. Such evaluation shall include 

19 identification of successful activities for 

20 creating opportunities for developing and 

21 sustaining, particularly with respect to low22 income individuals and direct care profes23 sionals, a health or human services profes24 sions workforce that has accessible oppor25 tunities for career advancement, that 


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1 meets high standards for education, train2 ing, certification, and professional develop3 ment, that provides increased wages and 

4 affordable benefits, including health care 

5 coverage, that are responsive to the 

6 workforce’s needs, and that is responsive 

7 to the needs of diverse racial and ethnic 

8 communities. 

9 ‘‘(iii) REPORT TO CONGRESS.—Not 

10 later than 1 year after the demonstration 

11 projects conducted under this subsection 

12 conclude, the Secretary shall submit a final 

13 report to Congress on such demonstration 

14 projects that includes— 

15 ‘‘(I) the result of the evaluation 

16 conducted under clause (ii); 

17 ‘‘(II) recommendations for best 

18 practices; and 

19 ‘‘(III) such recommendations for 

20 legislation or administrative actions as 

21 the Secretary deems appropriate. 

22 ‘‘(iv) ADDITIONAL REPORT.—Not 

23 later than 1 year after the demonstration 

24 projects conducted under this subsection 

25 conclude, the Secretary shall submit to the 


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1 Committee on Health, Education, Labor, 

2 and Pensions and the Special Committee 

3 on Aging of the Senate and the Committee 

4 on Education and the Workforce and the 

5 Committee on Energy and Commerce of 

6 the House of Representatives and make 

7 publicly available, a report on the activities 

8 and results of such projects. Such report 

9 shall describe— 

10 ‘‘(I) the number and geographic 

11 distribution of the grants awarded 

12 under this subsection; 

13 ‘‘(II) the participation of under14 represented and economically dis15 advantaged participants in demonstra16 tion projects conducted under this 

17 subsection; and 

18 ‘‘(III) recommendations for pro19 gram revisions to achieve the desired 

20 program outcome. 

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

22 Treasury not otherwise appropriated, there are ap23 propriated to the Secretary to carry out this sub24 section $10,000,000 for each of fiscal years 2025 

25 through 2029.’’. 


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1 (b) INCENTIVE PAYMENTS FOR LONG-TERM CARE

2 SERVICES FURNISHED BY DIRECT CARE PROFESSIONALS

3 WHO COMPLETE CERTAIN TRAINING.—Section 1834 of 

4 the Social Security Act (42 U.S.C. 1395m) is amended 

5 by adding at the end the following new subsection: 

6 ‘‘(aa) INCENTIVE PAYMENTS FOR DIRECT CARE

7 SERVICES FURNISHED BY DIRECT CARE PROFESSIONALS

8 WHO COMPLETE CERTAIN TRAINING.—In the case of 

9 long-term care services furnished on or after October 1, 

10 2025, by a direct care professional who has successfully 

11 completed education or training under a demonstration 

12 project under section 2008(e), in addition to the amount 

13 of payment that would otherwise be made for such services 

14 under this part, there also shall be paid an amount equal 

15 to 25 percent of the payment amount for the service under 

16 this part to be paid to the direct care professional.’’. 

17 SEC. 207. PATHWAYS TO HEALTH CAREERS. 

18 Effective October 1, 2024, title XX of the Social Se19 curity Act (42 U.S.C. 1397–1397n–13) is amended by 

20 adding at the end the following: 


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1 ‘‘Subtitle D—Career Pathways 

2 Through Health Profession Op3 portunity Grants 

4 ‘‘SEC. 2071. CAREER PATHWAYS THROUGH HEALTH PRO5 FESSION OPPORTUNITY GRANTS. 

6 ‘‘(a) APPLICATION REQUIREMENTS.—An eligible en7 tity desiring a grant under this section for a project shall 

8 submit to the Secretary an application for the grant, that 

9 includes the following: 

10 ‘‘(1) A description of how the applicant will use 

11 a career pathways approach to train eligible individ12 uals for health professions, including direct care pro13 fessionals, that will put eligible individuals on a ca14 reer path to an occupation that pays well, under the 

15 project. 

16 ‘‘(2) A description of the adult basic education 

17 and literacy activities, work readiness activities, 

18 training activities, and case management, career 

19 coaching, and mentoring support services that the 

20 applicant will use to assist eligible individuals to 

21 gain work experience, connection to employers, and 

22 job placement, and a description of the plan for re23 cruiting, hiring, and training staff to provide the 

24 case management, mentoring, and career coaching 

25 services, under the project directly or through local 


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1 governmental, apprenticeship, educational, or chari2 table institutions. 

3 ‘‘(3) A demonstration that the applicant has ex4 perience working with low-income populations, or a 

5 description of the plan of the applicant to work with 

6 a partner organization that has the experience. 

7 ‘‘(4) A plan for providing post-employment sup8 port and ongoing training as part of a career path9 way under the project. 

10 ‘‘(5) A description of the support services that 

11 the applicant will provide under the project, includ12 ing a plan for how child care and transportation 

13 support services will be guaranteed and, if the appli14 cant will provide a cash stipend or wage supplement, 

15 how the stipend or supplement would be calculated 

16 and distributed. 

17 ‘‘(6) A certification by the applicant that the 

18 project development included— 

19 ‘‘(A) consultation or commitment to con20 sult with a local workforce development board; 

21 ‘‘(B) consideration of registered appren22 ticeship and pre-apprenticeship models; 

23 ‘‘(C) consideration of career pathway pro24 grams in the State in which the project is to be 

25 conducted; and 


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1 ‘‘(D) a review of the State plan under sec2 tion 102 or 103 of the Workforce Innovation 

3 and Opportunity Act. 

4 ‘‘(7) A description of the availability and rel5 evance of recent labor market information and other 

6 pertinent evidence of in-demand jobs or worker 

7 shortages. 

8 ‘‘(8) A certification that the applicant will di9 rectly provide or contract for the training services 

10 described in the application. 

11 ‘‘(9) A commitment by the applicant that, if the 

12 grant is made to the applicant, the applicant will— 

13 ‘‘(A) during the planning period for the 

14 project, provide the Secretary with any informa15 tion needed by the Secretary to establish ade16 quate data reporting and administrative struc17 ture for the project; 

18 ‘‘(B) hire a person to direct the project not 

19 later than the end of the planning period appli20 cable to the project; 

21 ‘‘(C) accept all technical assistance offered 

22 by the Secretary with respect to the grant; 

23 ‘‘(D) participate in peer technical assist24 ance conferences as are regularly scheduled by 

25 the Secretary; and 


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1 ‘‘(E) provide all data required by the Sec2 retary under subsection (g). 

3 ‘‘(b) ADDITIONAL APPLICATION ELEMENT.—In con4 sidering applications for a grant under this section, the 

5 Secretary shall require qualified applicants to have at least 

6 1 of the following application elements: 

7 ‘‘(1) Applications submitted by applicants to 

8 whom a grant was made under this section or any 

9 predecessor to this section. 

10 ‘‘(2) Applications submitted by applicants who 

11 have business and community partners in each of 

12 the following categories: 

13 ‘‘(A) State and local government agencies 

14 and social service providers, including a State 

15 or local entity that administers a State program 

16 funded under part A of this title. 

17 ‘‘(B) Institutions of higher education, ap18 prenticeship programs, and local workforce de19 velopment boards. 

20 ‘‘(C) Health care employers, home and 

21 community-based services agencies, health care 

22 industry or sector partnerships, labor unions, 

23 and labor-management partnerships. 


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1 ‘‘(3) Applications that include opportunities for 

2 mentoring or peer support, and make career coach3 ing available, as part of the case management plan. 

4 ‘‘(4) Applications which describe a project that 

5 will serve a rural area in which— 

6 ‘‘(A) the community in which the individ7 uals to be enrolled in the project reside is lo8 cated; 

9 ‘‘(B) the project will be conducted; or 

10 ‘‘(C) an employer partnership that has 

11 committed to hiring individuals who successfully 

12 complete all activities under the project is lo13 cated. 

14 ‘‘(5) Applications that include a commitment to 

15 providing project participants with a cash stipend or 

16 wage supplement. 

17 ‘‘(6) Applications submitted by applicants who 

18 are serving or situated in communities of color and 

19 other underserved communities. 

20 ‘‘(7) Applications which have an emergency 

21 cash fund to assist project participants financially in 

22 emergency situations. 

23 ‘‘(c) GRANTS.— 

24 ‘‘(1) COMPETITIVE GRANTS.— 

25 ‘‘(A) GRANT AUTHORITY.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall make a grant in accordance with this 

3 paragraph to an eligible entity whose appli4 cation for the grant is approved by the 

5 Secretary, to conduct a project designed to 

6 train low-income individuals for allied 

7 health professions, health information tech8 nology, physician assistants, nursing as9 sistants, licensed practical/vocational 

10 nurse, registered nurse, advanced practice 

11 nurse, direct care professionals, and other 

12 professions considered part of a health 

13 care career pathway model. 

14 ‘‘(ii) GUARANTEE OF GRANTEES IN

15 EACH STATE AND THE DISTRICT OF CO16 LUMBIA.—For each grant cycle, the Sec17 retary shall award a grant under this para18 graph to at least 2 eligible entities in each 

19 State that is not a territory, to the extent 

20 there are a sufficient number of applica21 tions that have a high likelihood of success 

22 and that are submitted by the entities that 

23 meet the requirements applicable with re24 spect to such a grant. If, for a grant cycle, 

25 there are fewer than 2 such eligible entities 


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1 in a State that have submitted applications 

2 with a high likelihood of success, the Sec3 retary shall identify qualified eligible appli4 cants located elsewhere, that are otherwise 

5 approved but un-funded, and issue a Sub6 stitution of Grant and tailored technical 

7 assistance. In the preceding sentence, the 

8 term ‘issue a Substitution of Grant’ 

9 means, in a case in which an approved 

10 grantee does not complete its full project 

11 period, or in which there are fewer than 2 

12 qualified grantees per State with a high 

13 likelihood of success, substitute an appli14 cant located in another State that was ap15 proved but un-funded during the competi16 tion for the award for the award recipient. 

17 ‘‘(B) GUARANTEE OF GRANTS FOR INDIAN

18 POPULATIONS.—The Secretary shall award a 

19 grant under this paragraph to at least 10 eligi20 ble entities that are an Indian tribe, a tribal or21 ganization, or a tribal college or university, to 

22 the extent there are a sufficient number of ap23 plications submitted by the entities that meet 

24 the requirements applicable with respect to such 

25 a grant. 


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1 ‘‘(C) GUARANTEE OF GRANTEES IN THE

2 TERRITORIES.—The Secretary shall award a 

3 grant under this paragraph to at least 2 eligible 

4 entities that are located in a territory, to the 

5 extent there are a sufficient number of applica6 tions submitted by the entities that meet the re7 quirements applicable with respect to such a 

8 grant. 

9 ‘‘(2) GRANT CYCLE.—The grant cycle under 

10 this section shall be not less than 5 years, with a 

11 planning period of not more than the first 12 

12 months of the grant cycle. During the planning pe13 riod, the amount of the grant shall be in such lesser 

14 amount as the Secretary determines appropriate. 

15 ‘‘(d) USE OF GRANT.— 

16 ‘‘(1) IN GENERAL.—An entity to which a grant 

17 is made under this section shall use the grant in ac18 cordance with the approved application for the 

19 grant. 

20 ‘‘(2) SUPPORT TO BE PROVIDED.— 

21 ‘‘(A) REQUIRED SUPPORT.—A project for 

22 which a grant is made under this section shall 

23 include the following: 

24 ‘‘(i) An assessment for adult basic 

25 skill competency, and provision of adult 


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1 basic skills education if necessary for eligi2 ble individuals to enroll in the project and 

3 go on to enter and complete post-secondary 

4 training, through means including the fol5 lowing: 

6 ‘‘(I) Establishing a network of 

7 partners that offer pre-training activi8 ties for project participants who need 

9 to improve basic academic skills or 

10 English language proficiency before 

11 entering a health occupational train12 ing career pathway program. 

13 ‘‘(II) Offering resources to enable 

14 project participants to continue ad15 vancing adult basic skill proficiency 

16 while enrolled in a career pathway 

17 program. 

18 ‘‘(III) Embedding adult basic 

19 skill maintenance as part of ongoing 

20 post-graduation career coaching and 

21 mentoring. 

22 ‘‘(ii) A guarantee that child care and 

23 transportation are available and affordable 

24 support services for project participants 

25 through means such as the following: 


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1 ‘‘(I) Referral to, and assistance 

2 with, enrollment in a subsidized child 

3 care program. 

4 ‘‘(II) Direct payment to a child 

5 care provider if a slot in a subsidized 

6 child care program is not available or 

7 reasonably accessible. 

8 ‘‘(III) Payment of co-payments 

9 or associated fees for child care and 

10 transportation. 

11 ‘‘(iii) Case management plans that in12 clude career coaching (with the option to 

13 offer appropriate peer support and men14 toring opportunities to help develop soft 

15 skills and social capital), which may be of16 fered on an ongoing basis before, during, 

17 and after initial training as part of a ca18 reer pathway model. 

19 ‘‘(iv) A plan to provide project partici20 pants with transportation through means 

21 such as the following: 

22 ‘‘(I) Referral to, and assistance 

23 with enrollment in, a subsidized trans24 portation program. 


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1 ‘‘(II) If a subsidized transpor2 tation program is not reasonably 

3 available, direct payments to subsidize 

4 transportation costs. 

5 ‘‘(B) TRANSPORTATION.—For purposes of 

6 this paragraph, the term ‘transportation’ in7 cludes public transit, or gasoline for a personal 

8 vehicle if public transit is not reasonably acces9 sible or available. 

10 ‘‘(C) ALLOWED SUPPORT.—The goods and 

11 services provided under a project for which a 

12 grant is made under this section may include 

13 the following: 

14 ‘‘(i) A cash stipend. 

15 ‘‘(ii) A reserve fund for financial as16 sistance to project participants in emer17 gency situations. 

18 ‘‘(iii) Tuition, certification exam fees, 

19 and training materials such as books, soft20 ware, uniforms, shoes, connection to the 

21 internet, hair nets, and personal protective 

22 equipment. 

23 ‘‘(iv) In-kind resource donations such 

24 as interview clothing and conference at25 tendance fees. 


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1 ‘‘(v) Assistance with accessing and 

2 completing high school equivalency or adult 

3 basic education courses as necessary to 

4 achieve success in the project and make 

5 progress toward career goals. 

6 ‘‘(vi) Other support services as 

7 deemed necessary for family well-being, 

8 success in the project, and progress toward 

9 career goals. 

10 ‘‘(3) TRAINING.—The number of hours of train11 ing provided to an eligible individual under a project 

12 for which a grant is made under this section, for a 

13 recognized postsecondary credential (including an in14 dustry-recognized credential, and a certificate 

15 awarded by a local workforce development board), 

16 which is awarded in recognition of attainment of 

17 measurable technical or occupational skills necessary 

18 to gain employment or advance within an occupa19 tion, shall be— 

20 ‘‘(A) not less than the number of hours of 

21 training required for certification in that level 

22 of skill by the State in which the project is con23 ducted; or 


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1 ‘‘(B) if there is no such requirement, such 

2 number of hours of training as the Secretary 

3 finds is necessary to achieve that skill level. 

4 ‘‘(4) INCLUSION OF TANF RECIPIENTS.—In the 

5 case of a project for which a grant is made under 

6 this section that is conducted in a State that has a 

7 program funded under part A of title IV, at least 10 

8 percent of the eligible individuals to whom support 

9 is provided under the project shall meet the income 

10 eligibility requirements under that State program, 

11 without regard to whether the individuals receive 

12 benefits or services directly under that State pro13 gram. 

14 ‘‘(5) INCOME LIMITATION.—An entity to which 

15 a grant is made under this section shall not use the 

16 grant to provide support to a person who is not an 

17 eligible individual. 

18 ‘‘(6) PROHIBITION.—An entity to which a grant 

19 is made under this section shall not use the grant 

20 for purposes of entertainment, except that case man21 agement and career coaching services may include 

22 celebrations of specific career-based milestones such 

23 as completing a semester, graduation, or job place24 ment. 

25 ‘‘(e) TECHNICAL ASSISTANCE.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall provide 

2 technical assistance— 

3 ‘‘(A) to assist eligible entities in applying 

4 for grants under this section; 

5 ‘‘(B) that is tailored to meet the needs of 

6 grantees at each stage of the administration of 

7 projects for which grants are made under this 

8 section; 

9 ‘‘(C) that is tailored to meet the specific 

10 needs of Indian tribes, tribal organizations, and 

11 tribal colleges and universities; 

12 ‘‘(D) that is tailored to meet the specific 

13 needs of the territories; 

14 ‘‘(E) that is tailored to meet the specific 

15 needs of applicants, eligible entities, and grant16 ees, in carrying out dedicated career pathway 

17 projects pursuant to subsection (h); and 

18 ‘‘(F) to facilitate the exchange of informa19 tion among eligible entities regarding best prac20 tices and promising practices used in the 

21 projects. 

22 ‘‘(2) CONTINUATION OF PEER TECHNICAL AS23 SISTANCE CONFERENCES.—The Secretary shall con24 tinue to hold peer technical assistance conferences 

25 for entities to which a grant is made under this secVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 tion or was made under the immediate predecessor 

2 of this section. The preceding sentence shall not be 

3 interpreted to require any such conference to be held 

4 in person. 

5 ‘‘(f) EVALUATION OF DEDICATED CAREER PATH6 WAYS.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall, by 

8 grant, contract, or interagency agreement, conduct 

9 rigorous and well-designed evaluations of the dedi10 cated career pathway projects carried out pursuant 

11 to subsection (h). 

12 ‘‘(2) REQUIREMENT APPLICABLE TO SECOND

13 CHANCE CAREER PATHWAY.—In the case of a 

14 project of the type described in subsection (i), the 

15 evaluation shall include identification of successful 

16 activities for creating opportunities for developing 

17 and sustaining, particularly with respect to low-in18 come individuals with arrest or conviction records, a 

19 health professions workforce that has accessible 

20 entry points, that meets high standards for edu21 cation, training, certification, and professional devel22 opment, and that provides increased wages and af23 fordable benefits, including health care coverage, 

24 that are responsive to the needs of the workforce. 


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1 ‘‘(g) REPORTS.—As a condition of funding, an eligi2 ble entity awarded a grant to conduct a project under this 

3 section shall submit interim reports to the Secretary on 

4 the activities carried out under the project, and, on the 

5 conclusion of the project, a final report on the activities. 

6 ‘‘(h) SECOND CHANCE CAREER PATHWAY.— 

7 ‘‘(1) GRANT AUTHORITY.—The Secretary shall 

8 award grants in accordance with this subsection to 

9 eligible entities to conduct career pathway projects 

10 for the purpose of providing education and training 

11 for eligible individuals with arrest or conviction 

12 records to enter and follow a career pathway in the 

13 health professions through occupations that are ex14 pected to experience a labor shortage or be in high 

15 demand. 

16 ‘‘(2) DURATION.—A grant awarded under this 

17 subsection shall have the same grant cycle as is pro18 vided in subsection (c)(2), and as a condition of 

19 funding the grantee shall comply with all data re20 porting requirements associated with the grant cycle. 

21 ‘‘(3) APPLICATION REQUIREMENTS.—An entity 

22 seeking a grant under this subsection for a project 

23 shall submit to the Secretary an application for the 

24 grant, that includes the following: 


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1 ‘‘(A) A demonstration that the State in 

2 which the project is to be conducted has in ef3 fect policies or laws that permit certain allied 

4 health and behavioral health care credentials to 

5 be awarded to people with certain arrest or con6 viction records (which policies or laws shall in7 clude appeals processes and other opportunities 

8 to demonstrate rehabilitation to obtain licensure 

9 and approval to work in the proposed health ca10 reers), and a plan described in the application 

11 which will use a legally permitted career path12 way to train people with such a record to be 

13 trained and employed in such a career. 

14 ‘‘(B) A discussion of how the project or fu15 ture strategic hiring decisions will demonstrate 

16 the experience and expertise of the project in 

17 working with job seekers who have arrest or 

18 conviction records or employers with experience 

19 working with people with arrest or conviction 

20 records. 

21 ‘‘(C) A demonstration that the applicant 

22 has experience working with low-income popu23 lations, or a description of the plan of the appli24 cant to work with a partner that has the experi25 ence. 


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1 ‘‘(D) An identification of promising inno2 vations or best practices that can be used to 

3 provide the training. 

4 ‘‘(E) A proof of concept or demonstration 

5 that the applicant has done sufficient research 

6 on workforce shortage or in-demand jobs for 

7 which people with certain types of criminal 

8 records can be hired. 

9 ‘‘(F) A plan for recruiting students who 

10 are eligible individuals into the project. 

11 ‘‘(G) A plan for providing post-employment 

12 support and ongoing training as part of a ca13 reer pathway under the project. 

14 ‘‘(4) SUPPORT TO BE PROVIDED.—A recipient 

15 of a grant under this subsection for a project shall 

16 provide— 

17 ‘‘(A) access to legal assistance for project 

18 participants for the purpose of addressing ar19 rest or conviction records and associated work20 force barriers; 

21 ‘‘(B) assistance with programs and activi22 ties deemed necessary to address arrest or con23 viction records as an employment barrier; and 

24 ‘‘(C) required supportive services described 

25 in subsection (d)(2)(A) to participants who 


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1 need the services, and may expend funds on eli2 gible supportive services described in subsection 

3 (d)(2)(B). 

4 ‘‘(i) DEFINITIONS.—In this section: 

5 ‘‘(1) ALLIED HEALTH PROFESSION.—The term 

6 ‘allied health profession’ has the meaning given in 

7 section 799B(5) of the Public Health Service Act. 

8 ‘‘(2) CAREER PATHWAY.—The term ‘career 

9 pathway’ has the meaning given that term in section 

10 3(7) of the Workforce Innovation and Opportunity 

11 Act. 

12 ‘‘(3) DIRECT CARE PROFESSIONAL.—The term 

13 ‘direct care professional’ has the meaning given such 

14 term in section 3 of the Long-Term Care Workforce 

15 Support Act. 

16 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en17 tity’ means any of the following entities that dem18 onstrates in an application submitted under this sec19 tion that the entity has the capacity to fully develop 

20 and administer the project described in the applica21 tion: 

22 ‘‘(A) A local workforce development board 

23 established under section 107 of the Workforce 

24 Innovation and Opportunity Act. 


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1 ‘‘(B) A State or territory, a political sub2 division of a State or territory, or an agency of 

3 a State, territory, or such a political subdivi4 sion, including a State or local entity that ad5 ministers a State program funded under part A 

6 of this title. 

7 ‘‘(C) An Indian tribe, a tribal organization, 

8 or a tribal college or university. 

9 ‘‘(D) An institution of higher education (as 

10 defined in the Higher Education Act of 1965). 

11 ‘‘(E) A hospital (as defined in section 

12 1861(e)). 

13 ‘‘(F) A high-quality skilled nursing facility. 

14 ‘‘(G) A Federally qualified health center 

15 (as defined in section 1861(aa)(4)). 

16 ‘‘(H) A nonprofit organization described in 

17 section 501(c)(3) of the Internal Revenue Code 

18 of 1986, a labor organization, or an entity with 

19 shared labor-management oversight, that has a 

20 demonstrated history of providing health profes21 sion training to eligible individuals. 

22 ‘‘(I) An opioid treatment program (as de23 fined in section 1861(jjj)(2)), and other com24 prehensive addiction care providers. 


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1 ‘‘(J) A home and community-based serv2 ices provider agency. 

3 ‘‘(5) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

4 individual’ means an individual whose family income 

5 does not exceed 200 percent of the Federal poverty 

6 level and has not been charged with or convicted of 

7 a violent crime or financial fraud (as determined by 

8 the Secretary). 

9 ‘‘(6) FEDERAL POVERTY LEVEL.—The term 

10 ‘Federal poverty level’ means the poverty line (as de11 fined in section 673(2) of the Omnibus Budget Rec12 onciliation Act of 1981, including any revision re13 quired by such section applicable to a family of the 

14 size involved). 

15 ‘‘(7) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

16 The terms ‘Indian tribe’ and ‘tribal organization’ 

17 have the meaning given the terms in section 4 of the 

18 Indian Self-Determination and Education Assistance 

19 Act (25 U.S.C. 450b). 

20 ‘‘(8) INSTITUTION OF HIGHER EDUCATION.— 

21 The term ‘institution of higher education’ has the 

22 meaning given the term in section 101 or 

23 102(a)(1)(B) of the Higher Education Act of 1965. 

24 ‘‘(9) TERRITORY.—The term ‘territory’ means 

25 the Commonwealth of Puerto Rico, the United 


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1 States Virgin Islands, Guam, the Northern Mariana 

2 Islands, and American Samoa. 

3 ‘‘(10) TRIBAL COLLEGE OR UNIVERSITY.—The 

4 term ‘tribal college or university’ has the meaning 

5 given the term in section 316(b) of the Higher Edu6 cation Act of 1965. 

7 ‘‘(j) EVALUATION.—The Secretary of Health and 

8 Human Services, in conjunction with the Secretary of 

9 Labor, shall evaluate the implementation and outcomes of 

10 this section on the adoption of paid leave by long-term 

11 care services providers and the recruitment and retention 

12 of direct care professionals through a contract with an ex13 ternal evaluator who has experience with evaluation of 

14 labor practices and people with disabilities and older indi15 viduals. 

16 ‘‘(k) FUNDING.—In addition to amounts otherwise 

17 available, there is appropriated to the Secretary— 

18 ‘‘(1) $318,750,000 for grants under subsection 

19 (c)(1)(A) for each of fiscal years 2025 through 

20 2029; 

21 ‘‘(2) $17,000,000 for grants under subsection 

22 (c)(1)(B) for each of fiscal years 2025 through 

23 2029; 


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1 ‘‘(3) $21,250,000 for grants under subsection 

2 (c)(1)(C) for each of fiscal years 2025 through 

3 2029; 

4 ‘‘(4) $25,500,000 for projects conducted under 

5 subsection (h) for each of fiscal years 2025 through 

6 2029; 

7 ‘‘(5) $25,500,000, plus all amounts referred to 

8 in paragraphs (1) through (4) of this subsection that 

9 remain unused after all grant awards are made for 

10 the fiscal year, for each of fiscal years 2025 through 

11 2029, for the provision of technical assistance and 

12 administration; and 

13 ‘‘(6) $17,000,000 for each of fiscal years 2025 

14 through 2029 for studying the effects of the projects 

15 for which a grant is made under this section, and for 

16 administration, for the purpose of supporting the 

17 rigorous evaluation of the projects, and supporting 

18 the continued study of the short-, medium-, and 

19 long-term effects of all such projects, including the 

20 effectiveness of new or added elements of the 

21 projects.’’. 


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1 SEC. 208. INCREASING WORKFORCE DIVERSITY IN ALLIED 

2 HEALTH PROFESSIONALS AND DIRECT SUP3 PORT PROFESSIONALS. 

4 Title VII of the Public Health Service Act is amend5 ed— 

6 (1) by redesignating part G (42 U.S.C. 295j et 

7 seq.) as part H; and 

8 (2) by inserting after part F (42 U.S.C. 295h 

9 et seq.) the following new part: 

10 ‘‘PART G—INCREASING WORKFORCE DIVERSITY 

11 IN ALLIED HEALTH PROFESSIONALS AND DI12 RECT CARE PROFESSIONALS 

13 ‘‘SEC. 783. SCHOLARSHIPS AND STIPENDS. 

14 ‘‘(a) IN GENERAL.—The Secretary may award grants 

15 and contracts to eligible entities to increase educational 

16 opportunities in the professions of physical therapy, occu17 pational therapy, respiratory therapy, audiology, speech18 language pathology, and direct care professionals for eligi19 ble individuals by— 

20 ‘‘(1) providing student scholarships or stipends, 

21 including for— 

22 ‘‘(A) completion of an accelerated degree 

23 program; 

24 ‘‘(B) completion of an associate’s, bach25 elor’s, master’s, or doctoral degree program; 

26 and 


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1 ‘‘(C) entry by a diploma or associate’s de2 gree practitioner into a bridge or degree com3 pletion program; 

4 ‘‘(2) providing assistance for completion of pre5 requisite courses or other preparation necessary for 

6 acceptance for enrollment in the eligible entity; 

7 ‘‘(3) carrying out activities to increase the re8 tention of students in 1 or more programs in the 

9 professions of physical therapy, occupational ther10 apy, respiratory therapy, audiology, speech-language 

11 pathology, and direct care professionals; and 

12 ‘‘(4) building or strengthening career pipeline 

13 programs, including those for high school students, 

14 older workers and retirees, veterans, and other dis15 placed workers. 

16 ‘‘(b) CONSIDERATION OF RECOMMENDATIONS.—In 

17 carrying out subsection (a), the Secretary shall take into 

18 consideration the recommendations of national organiza19 tions representing the professions of physical therapy, oc20 cupational therapy, respiratory therapy, audiology, speech21 language pathology, and direct care professionals, includ22 ing the American Physical Therapy Association, the Amer23 ican Occupational Therapy Association, the American 

24 Speech-Language-Hearing Association, the American As25 sociation for Respiratory Care, the American Academy of 


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1 Audiology, the Academy of Doctors of Audiology, and the 

2 National Alliance for Direct Support Professionals. 

3 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

4 AWARD RECIPIENTS.— 

5 ‘‘(1) IN GENERAL.—The Secretary may require 

6 recipients of awards under this section to report to 

7 the Secretary concerning the annual admission, re8 tention, and graduation rates for eligible individuals 

9 in programs of the recipient leading to a degree in 

10 any of the professions of physical therapy, occupa11 tional therapy, respiratory therapy, audiology, 

12 speech-language pathology, and direct care profes13 sionals. 

14 ‘‘(2) FALLING RATES.—If any of the rates re15 ported by a recipient under paragraph (1) fall below 

16 the average for such recipient over the 2 years pre17 ceding the year covered by the report, the recipient 

18 shall provide the Secretary with plans for imme19 diately improving such rates. 

20 ‘‘(3) INELIGIBILITY.—A recipient described in 

21 paragraph (2) shall be ineligible for continued fund22 ing under this section if the plan of the recipient 

23 fails to improve the rates within the 1-year period 

24 beginning on the date such plan is implemented. 

25 ‘‘(d) EVALUATION.— 


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1 ‘‘(1) IN GENERAL.—In accordance with para2 graph (2), the Secretary, in conjunction with the 

3 Secretary of Labor, shall evaluate the implementa4 tion and outcomes of this section on the recruitment 

5 and retention in long-term care settings of certified 

6 nursing assistants, physical therapists, occupational 

7 therapists, audiologists, speech-language patholo8 gists, respiratory therapists, direct support profes9 sionals, and any other direct care professionals de10 termined by the Secretary. 

11 ‘‘(2) EXTERNAL EVALUATOR.—The Secretary 

12 shall conduct the evaluation under paragraph (1) 

13 through a contract with an external evaluator who 

14 has experience with evaluation related to people with 

15 disabilities and older individuals. 

16 ‘‘(e) DEFINITIONS.—In this section: 

17 ‘‘(1) DIRECT CARE PROFESSIONAL; DIS18 ABILITY.—The terms ‘direct care professional’ and 

19 ‘disability’ have the meanings given such terms in 

20 section 3 of the Long-Term Care Workforce Support 

21 Act. 

22 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en23 tity’ means an education program that— 

24 ‘‘(A) is accredited by— 


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1 ‘‘(i) the Council on Academic Accredi2 tation in Audiology and Speech-Language 

3 Pathology or the Accreditation Commission 

4 for Audiology Education; 

5 ‘‘(ii) the Commission on Accreditation 

6 in Physical Therapy Education; 

7 ‘‘(iii) the Accreditation Council for 

8 Occupational Therapy Education; 

9 ‘‘(iv) the Commission on Accreditation 

10 for Respiratory Care; or 

11 ‘‘(v) the National Alliance for Direct 

12 Support Professionals Certification Pro13 gram; and 

14 ‘‘(B) is carrying out a program for recruit15 ing and retaining students underrepresented in 

16 the professions of physical therapy, occupa17 tional therapy, respiratory therapy, audiology, 

18 speech-language pathology, and direct care pro19 fessionals (including racial or ethnic minorities, 

20 students with disabilities, or students from dis21 advantaged backgrounds). 

22 ‘‘(3) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

23 individual’ means an individual who— 

24 ‘‘(A) is a member of a class of persons who 

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1 ical therapy, occupational therapy, respiratory 

2 therapy, audiology, speech-language pathology, 

3 and direct care professionals, including— 

4 ‘‘(i) individuals who are racial or eth5 nic minorities; or 

6 ‘‘(ii) individuals who are from dis7 advantaged backgrounds; 

8 ‘‘(B) has a financial need for a scholarship 

9 or stipend; and 

10 ‘‘(C) is enrolled (or accepted for enroll11 ment) at a physical therapy, occupational ther12 apy, respiratory therapy, audiology, speech-lan13 guage pathology, or direct care professionals 

14 program as a full-time student at an eligible en15 tity. 

16 ‘‘(4) INDIVIDUALIZED EDUCATION PROGRAM.— 

17 The term ‘individualized education program’ has the 

18 meaning given such term in section 602 of the Indi19 viduals with Disabilities Education Act. 

20 ‘‘(5) LONG-TERM CARE SETTING.—The term 

21 ‘long-term care setting’ has the meaning given such 

22 term in section 3 of the Long-Term Care Workforce 

23 Support Act. 


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1 ‘‘(6) OLDER INDIVIDUAL.—The term ‘older in2 dividual’ has the meaning given such term in section 

3 102 of the Older Americans Act of 1965. 

4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated to carry out this section 

6 $10,000,000 for each of fiscal years 2025 through 2029.’’. 

7 Subtitle B—Improving Workforce 

8 Recruitment 

9 SEC. 211. TECHNICAL ASSISTANCE CENTER FOR BUILDING 

10 THE DIRECT CARE PROFESSIONAL WORK11 FORCE. 

12 (a) GRANT PROGRAM AUTHORIZED.— 

13 (1) IN GENERAL.—The Secretary of Health and 

14 Human Services (referred to in this section as the 

15 ‘‘Secretary’’) shall award a grant, on a competitive 

16 basis, to an eligible partnership described in sub17 section (b) to create a national technical assistance 

18 center (referred to in this section as the ‘‘Center’’) 

19 for supporting direct care professional workforce cre20 ation, training and education, recruitment, retention, 

21 and advancement, including through the activities 

22 under subsection (c). 

23 (2) CONSULTATION.—The Center shall carry 

24 out activities under this section in consultation with 

25 the Secretary of Labor, the Secretary of Education, 


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1 the Secretary of Veterans Affairs, the Administrator 

2 of the Administration for Community Living, the 

3 Administrator of the Centers for Medicare & Med4 icaid Services, the Administrator of the Health Re5 sources and Services Administration, and the heads 

6 of other entities as necessary. 

7 (b) ELIGIBLE PARTNERSHIPS.— 

8 (1) IN GENERAL.—An eligible partnership de9 scribed in this subsection is a partnership of 3 or 

10 more of the following: 

11 (A) An institution of higher education. 

12 (B) A disability-led organization. 

13 (C) An organization focusing on older indi14 viduals. 

15 (D) An organization focusing on direct 

16 care professionals. 

17 (E) An organization that represents service 

18 provider agencies that employ direct care pro19 fessionals. 

20 (F) An organization, including a labor or21 ganization, that fosters professional develop22 ment. 

23 (G) A University Center for Excellence in 

24 Developmental Disabilities Education, Re25 search, and Service supported under subtitle D 


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1 of title I of the Developmental Disabilities As2 sistance and Bill of Rights Act of 2000 (42 

3 U.S.C. 15061 et seq.). 

4 (H) An agency implementing a State pro5 tection and advocacy system described in sec6 tion 143 of such Act (42 U.S.C. 15043). 

7 (I) A State Council on Developmental Dis8 abilities (as such term is used in subtitle B of 

9 title I of the Developmental Disabilities Assist10 ance and Bill of Rights Act of 2000 (42 U.S.C. 

11 15021 et seq.)). 

12 (J) An organization representing a center 

13 for independent living, as described in part C of 

14 title VII of the Rehabilitation Act of 1973 (29 

15 U.S.C. 796f et seq.). 

16 (K) An organization representing veterans. 

17 (L) An organization representing parents 

18 or caregivers of children with disabilities or 

19 chronic conditions. 

20 (M) Any other entity the Secretary des21 ignates as important to improving the direct 

22 care professional workforce. 

23 (2) APPLICATIONS.—To be eligible for a grant 

24 under this section, an eligible partnership described 

25 in paragraph (1) shall submit an application to the 


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1 Secretary at such time, in such manner, and con2 taining such information as the Secretary may re3 quire. 

4 (c) ACTIVITIES.—The Center may— 

5 (1) develop recommendations for training and 

6 education curricula for direct care professionals, 

7 which such recommendations may include rec8 ommendations for curricula for higher education, 

9 postsecondary credentials, and programs with com10 munity and technical colleges; 

11 (2) develop learning and dissemination strate12 gies to— 

13 (A) engage States and other entities in ac14 tivities supported under this section and best 

15 practices for supporting the direct care profes16 sional workforce; and 

17 (B) distribute findings from activities sup18 ported by the grant under this section; 

19 (3) explore the national data gaps, workforce 

20 shortage areas, and data collection strategies for di21 rect care professionals and make recommendations 

22 to the Director of the Office of Management and 

23 Budget for an occupation category in the Standard 

24 Occupational Classification system for direct care 


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1 professionals as a healthcare support occupation; 

2 and 

3 (4) recommend career development and ad4 vancement opportunities for direct care profes5 sionals, which may include occupational frameworks, 

6 national standards, recruitment campaigns, pre-ap7 prenticeship and on-the-job training opportunities, 

8 apprenticeship programs, career pathways, speciali9 zations or certifications, educational information 

10 about career opportunities in long-term care set11 tings, or other activities. 

12 (d) ADVISORY COUNCIL.— 

13 (1) IN GENERAL.—The Secretary shall convene 

14 an advisory council to provide recommendations to 

15 the Center with respect to the duties of the Center 

16 under this section and may engage individuals de17 scribed in paragraph (2) for service on the advisory 

18 council. 

19 (2) INDIVIDUALS.—The individuals described in 

20 this paragraph include— 

21 (A) older individuals and people with dis22 abilities; 

23 (B) organizations representing the rights 

24 and interests of people receiving services from 

25 direct care professionals; 


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1 (C) individuals who are direct care profes2 sionals and organizations representing the 

3 rights and interests of direct care professionals; 

4 (D) as applicable, employers of individuals 

5 described in subparagraph (C) and labor orga6 nizations representing such individuals; 

7 (E) representatives of State Medicaid 

8 agencies, State agencies defined in section 102 

9 of the Older Americans Act of 1965 (42 U.S.C. 

10 3002), State developmental disabilities offices, 

11 and State mental health agencies; 

12 (F) representatives reflecting diverse ra13 cial, cultural, ethnic, geographic, socioeconomic, 

14 and gender identity and sexual orientation per15 spectives; 

16 (G) representatives of local boards and 

17 State boards; 

18 (H) a nonprofit organization with dem19 onstrated experience in the development or de20 livery of curricula or coursework; 

21 (I) a nonprofit organization, including a 

22 labor organization, that fosters the professional 

23 development and collective engagement of direct 

24 care professionals; 

25 (J) area agencies on aging; 


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1 (K) centers for independent living, as de2 scribed in part C of title VII of the Rehabilita3 tion Act of 1973 (29 U.S.C. 796f et seq.); 

4 (L) representatives of State Councils on 

5 Developmental Disabilities (as such term is 

6 used in subtitle B of title I of the Develop7 mental Disabilities Assistance and Bill of 

8 Rights Act of 2000 (42 U.S.C. 15021 et seq.)); 

9 (M) representatives of Aging and Dis10 ability Resource Centers; 

11 (N) representatives of nonprofit State pro12 vider associations that represents providers who 

13 employ direct care professionals; 

14 (O) representatives of entities that employ 

15 direct care professionals; 

16 (P) representatives of University Centers 

17 for Excellence in Developmental Disabilities 

18 Education, Research, and Service supported 

19 under subtitle D of title I of the Developmental 

20 Disabilities Assistance and Bill of Rights Act of 

21 2000 (42 U.S.C. 15061 et seq.); 

22 (Q) representatives of State protection and 

23 advocacy systems described in section 143 of 

24 such Act (42 U.S.C. 15043); and 


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1 (R) representatives of direct care profes2 sional organizations representing underserved 

3 communities, including communities of color. 

4 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated $10,000,000 to carry 

6 out this section for each of fiscal years 2025 through 

7 2029. 

8 SEC. 212. REPORT ON EFFORTS TO ENHANCE THE DIRECT 

9 CARE PROFESSIONAL WORKFORCE. 

10 Not later than 180 days after the date of enactment 

11 of this Act, the Secretary of Health and Human Services 

12 shall submit to the appropriate committees of Congress, 

13 a report that contains an assessment of the programs and 

14 activities of the Department of Health and Human Serv15 ices related to enhancing the direct care professional work16 force, including the extent to which programs and activi17 ties authorized under titles VII and VIII of the Public 

18 Health Service Act (42 U.S.C. 292 et seq.; 42 U.S.C. 296 

19 et seq.) address— 

20 (1) increasing nursing faculty who are trained 

21 in geriatric nursing; 

22 (2) increasing individuals preparing for careers 

23 in or advanced degrees in geriatric nursing or long24 term care; 

25 (3) increasing direct care professionals; 


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1 (4) the extent to which the Department coordi2 nates with other Federal departments regarding pro3 grams designed to improve the direct care profes4 sional workforce; and 

5 (5) recommendations for best practices. 

6 SEC. 213. COMPREHENSIVE GERIATRIC EDUCATION. 

7 Section 865 of the Public Health Service Act (42 

8 U.S.C. 298) is amended— 

9 (1) in subsection (a), by striking ‘‘the elderly’’ 

10 and inserting ‘‘older individuals’’; 

11 (2) in subsection (b)— 

12 (A) in paragraph (1), by striking ‘‘the el13 derly’’ and inserting ‘‘older individuals’’; 

14 (B) in paragraph (2), by striking ‘‘treat15 ment’’ and all that follows and inserting 

16 ‘‘health care needs of older individuals;’’; and 

17 (C) in paragraph (5), by striking ‘‘the el18 derly population’’ and inserting ‘‘older individ19 uals’’; 

20 (3) in subsection (d)— 

21 (A) in the heading, by striking ‘‘ELIGIBLE

22 ENTITY’’ and inserting ‘‘DEFINITIONS’’; 

23 (B) by striking ‘‘For purposes of this sec24 tion, the term’’ and inserting ‘‘For purposes of 

25 this section: 


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1 ‘‘(1) ELIGIBLE ENTITY.—The term’’; and 

2 (C) by adding at the end the following: 

3 ‘‘(2) OLDER INDIVIDUAL.—The term ‘older in4 dividual’ has the meaning given such term in section 

5 102 of the Older Americans Act of 1965.’’; and 

6 (4) in subsection (e), by striking ‘‘years’’ and 

7 all that follows and inserting ‘‘years 2025 through 

8 2029.’’. 

9 SEC. 214. REVIEW OF THE AVAILABILITY AND QUALITY OF 

10 APPRENTICESHIP PROGRAMS IN LONG-TERM 

11 CARE SETTINGS. 

12 Not later than 180 days after the date of enactment 

13 of this Act, the Secretary of Labor, in coordination with 

14 the Secretary of Health and Human Services, shall submit 

15 a report to the appropriate committees of Congress that— 

16 (1) identifies the extent of vacancies at employ17 ers that employ direct care professionals at the State 

18 and local levels within the direct care professional 

19 workforce, including with respect to vacancies of di20 rect care professionals; 

21 (2) review existing apprenticeship programs in 

22 the direct care professional workforce; 

23 (3) provide recommendations on the design of 

24 apprenticeship programs in the direct care profes25 sional workforce, including about potential funding 


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1 opportunities, potential apprenticeship program 

2 sponsors, and a national competency-based occupa3 tional framework; and 

4 (4) identify opportunities for coordination with 

5 other State and local entities, including State edu6 cational agencies, local educational agencies, career 

7 and technical education programs, institutions of 

8 higher education, State agencies with responsibility 

9 for administering a State Medicaid program, and 

10 labor management organizations, to create appren11 ticeship programs and other ways to incorporate as12 sociate and bachelor’s degrees in apprenticeship pro13 grams. 

14 SEC. 215. RURAL HEALTH WORKFORCE GRANT PROGRAM. 

15 Part D of title VII of the Public Health Service Act 

16 (42 U.S.C. 294 et seq.) is amended by adding at the end 

17 the following: 

18 ‘‘SEC. 760A. RURAL HEALTH WORKFORCE GRANT PRO19 GRAM. 

20 ‘‘(a) DEFINITIONS.—In this section: 

21 ‘‘(1) CARL D. PERKINS CAREER AND TECH22 NICAL EDUCATION ACT DEFINITIONS.—The terms 

23 ‘career and technical education’, ‘career guidance 

24 and academic counseling’, and ‘program of study’ 

25 have the meanings given the terms in section 3 of 


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1 the Carl D. Perkins Career and Technical Education 

2 Act of 2006. 

3 ‘‘(2) ESEA DEFINITIONS.—The terms ‘elemen4 tary school’, ‘local educational agency’, and ‘sec5 ondary school’ have the meanings given the terms in 

6 section 8101 of the Elementary and Secondary Edu7 cation Act of 1965. 

8 ‘‘(3) INSTITUTION OF HIGHER EDUCATION.— 

9 The term ‘institution of higher education’ has the 

10 meaning given the term in section 102 of the Higher 

11 Education Act of 1965. 

12 ‘‘(4) LONG-TERM CARE WORKFORCE SUPPORT

13 ACT.—The terms ‘direct care professional’ and ‘di14 rect care professional workforce’ have the meanings 

15 given such terms in section 3 of the Long-Term 

16 Care Workforce Support Act. 

17 ‘‘(5) WORKFORCE INNOVATION AND OPPOR18 TUNITY ACT DEFINITIONS.—The terms ‘career path19 way’, ‘industry or sector partnership’, and ‘local 

20 board’ have the meanings given the terms in section 

21 3 of the Workforce Innovation and Opportunity Act. 

22 ‘‘(b) AUTHORIZATION OF GRANTS.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Administrator of the Health Resources 

25 and Services Administration and in consultation 


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1 with the Secretary of Education, shall award grants 

2 on a competitive basis to eligible entities to develop 

3 career exploration programs aligned to career and 

4 technical education programs of study to bring 

5 awareness to elementary school and secondary school 

6 students in underserved rural communities about 

7 health care professions careers and provide children 

8 and youth underserved rural community health care 

9 experiences related to such careers. 

10 ‘‘(2) GRANT AMOUNT.—Each grant awarded 

11 under this section shall be in an amount that is not 

12 more than $250,000 per year. 

13 ‘‘(3) GRANT PERIOD.—Each grant awarded 

14 under this section shall be for a period not to exceed 

15 5 years. 

16 ‘‘(c) ELIGIBLE ENTITIES.— 

17 ‘‘(1) IN GENERAL.—To be eligible to receive a 

18 grant under this section, an entity shall meet the fol19 lowing requirements: 

20 ‘‘(A) Be a consortium consisting of a local 

21 educational agency and at least 2 of the fol22 lowing: 

23 ‘‘(i) An institution of higher education 

24 that provides a recognized postsecondary 

25 credential in health care. 


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1 ‘‘(ii) A health care practice, facility, 

2 or provider organization. 

3 ‘‘(iii) A State, Indian Tribe or Tribal 

4 organization, or a local governmental enti5 ty. 

6 ‘‘(iv) A local board. 

7 ‘‘(v) An industry or sector partner8 ship. 

9 ‘‘(vi) A nonprofit organization rep10 resenting the interests of underserved rural 

11 communities and rural health care. 

12 ‘‘(vii) An area health education cen13 ter. 

14 ‘‘(viii) A rural health clinic. 

15 ‘‘(ix) Any other entity as determined 

16 appropriate by the Secretary. 

17 ‘‘(B) Submit an application to the Sec18 retary at such time, in such manner, and con19 taining such information that the Secretary 

20 may require, including a plan for the long-term 

21 tracking of participants supported by the grant 

22 under this section. 

23 ‘‘(2) MATCHING FUNDS.—In order to ensure 

24 the institutional commitment of an entity to a pro25 gram supported by a grant under this section, to be 


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1 eligible to receive such a grant, the Secretary may 

2 require the entity seeking such grant to agree to 

3 make available (directly or through contributions 

4 from State, county or municipal governments, or the 

5 public or private sector) recurring non-Federal con6 tributions in cash or in kind (including plant, equip7 ment, or services) towards the costs of operating the 

8 program in an amount that is equal to not less than 

9 50 percent of the total costs of operating such pro10 gram. 

11 ‘‘(d) PRIORITY.—In awarding grants under this sec12 tion, the Secretary shall give priority to eligible entities 

13 that— 

14 ‘‘(1) include in its consortium— 

15 ‘‘(A) an entity that has demonstrated 

16 alignment with a State plan or local application 

17 developed under the Carl D. Perkins Career 

18 and Technical Education Act of 2006; 

19 ‘‘(B) a high-need local educational agency, 

20 as defined in section 200 of the Higher Edu21 cation Act of 1965, or a local educational agen22 cy eligible to receive assistance under part B of 

23 title V of the Elementary and Secondary Edu24 cation Act of 1965; 


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1 ‘‘(C) an institution of higher education at 

2 which at least 30 percent of the enrolled stu3 dents are Federal Pell Grant recipients; 

4 ‘‘(D) a minority-serving institution of high5 er education described in any of paragraphs (1) 

6 through (7) of section 371(a) of the Higher 

7 Education Act of 1965; or 

8 ‘‘(E) a local educational agency that serves 

9 the greatest number of students; and 

10 ‘‘(2) provide a plan to sustain the program 

11 funded under the grant beyond the period of the 

12 grant. 

13 ‘‘(e) USE OF FUNDS; REQUIREMENTS.—An eligible 

14 entity receiving a grant under this section shall use the 

15 grant funds to establish, improve, or expand an under16 served rural community training program for elementary 

17 school students and secondary school students that meets 

18 the following requirements: 

19 ‘‘(1) Carrying out program planning, includ20 ing— 

21 ‘‘(A) development and support of a coordi22 nating body to organize, administer, and over23 see the activities of the consortium; 

24 ‘‘(B) conducting a needs analysis using 

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1 force estimates, and capacity of training pro2 grams to direct work of the consortium; and 

3 ‘‘(C) developing a regional articulation 

4 plan that benefits students with respect to re5 ducing barriers to program entry, reducing time 

6 to graduation, and lower cost training options. 

7 ‘‘(2) Carrying out age-appropriate education ac8 tivities and promotion of the program that align 

9 with section 135(b)(1) of the Carl D. Perkins Career 

10 and Technical Education Act of 2006, including— 

11 ‘‘(A) engaging students in underserved 

12 rural communities in elementary school for ex13 posure to health career workforce opportunities, 

14 and including direct care professionals in edu15 cational opportunities as practicable; 

16 ‘‘(B) exposing secondary school students in 

17 underserved rural communities to health career 

18 workforce opportunities available in their com19 munities, including by providing career guid20 ance and academic counseling on such opportu21 nities; 

22 ‘‘(C) developing strategies to address resil23 iency and mental health among elementary 

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1 served rural communities interested in health 

2 care professions careers in such communities; 

3 ‘‘(D) providing age-appropriate mentoring, 

4 academic enrichment, or support for elementary 

5 school and secondary school students in under6 served rural communities, carried out by health 

7 care professionals or peers; 

8 ‘‘(E) enrolling secondary school students 

9 (including those in underserved rural commu10 nities) in health care career and technical edu11 cation programs of study or career pathways in 

12 underserved rural communities; 

13 ‘‘(F) developing and enrolling of secondary 

14 school students in pre- and youth-apprentice15 ships or summer programs that provide clinical 

16 or other health care professions focused experi17 ences in underserved rural communities; 

18 ‘‘(G) providing financial supplemental sup19 port for student transportation to, and housing 

20 at, the program site, as appropriate; and 

21 ‘‘(H) such other activities as the Secretary 

22 determines appropriate. 

23 ‘‘(3) Each such program shall be carried out for 

24 a term of not less than 5 years. 


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1 ‘‘(f) TECHNICAL ASSISTANCE.—The Administrator of 

2 the Health Resources and Services Administration shall, 

3 directly or indirectly, provide technical assistance to grant 

4 recipients for purposes of carrying out the programs de5 scribed in subsection (e). 

6 ‘‘(g) REPORTING.— 

7 ‘‘(1) ANNUAL REPORTING BY RECIPIENTS.— 

8 ‘‘(A) IN GENERAL.—An eligible entity re9 ceiving a grant under this section shall submit 

10 an annual report to the Secretary on the 

11 progress of the program supported by such 

12 grant, based on criteria the Secretary deter13 mines appropriate, including the program selec14 tion of students who participated in the pro15 gram. 

16 ‘‘(B) CONTENTS.—Each report required 

17 under subparagraph (A) shall include any data 

18 requested by the Secretary, which may include, 

19 as appropriate, the number of participants and 

20 the demographics of such participants served by 

21 the program supported by the grant, including 

22 the number of participants who enrolled in the 

23 program and withdrew prior to completion of 

24 the program. 

25 ‘‘(2) REPORTS TO CONGRESS.— 


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1 ‘‘(A) ANNUAL REPORTS.—Not later than 2 

2 years after the date of enactment of this sec3 tion, and annually thereafter until all programs 

4 supported through a grant under this section 

5 are completed, the Secretary shall prepare and 

6 submit to Congress a report that includes the 

7 progress of each program supported by a grant 

8 under this section and the challenges experi9 enced by grantees with respect to such pro10 grams. 

11 ‘‘(B) GRANT CYCLE FINAL REPORT.—Not 

12 later than September 30, 2030, the Adminis13 trator of the Health Resources and Services Ad14 ministration shall submit a report to Congress 

15 on the lessons learned through the programs 

16 supported by grants under this section and that 

17 based on such lessons identifies best practices 

18 for career exploration programs with a focus on 

19 underserved rural communities and the direct 

20 care professional workforce. 

21 ‘‘(h) REGULATIONS.—The Secretary shall, by regula22 tion, define the term ‘underserved rural community’ for 

23 purposes of this section. 

24 ‘‘(i) SUPPLEMENT NOT SUPPLANT.—Any eligible en25 tity receiving funds under this section shall use such funds 


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1 to supplement, not supplant, any other Federal, State, and 

2 local funds that would otherwise be expended by such enti3 ty to carry out the activities described in this section. 

4 ‘‘(j) EVALUATION.— 

5 ‘‘(1) IN GENERAL.—The Secretary, in conjunc6 tion with the Secretary of Labor, shall evaluate the 

7 implementation and outcomes of this section on the 

8 recruitment of secondary school students residing in 

9 underserved rural communities entering professions 

10 of direct care professionals. 

11 ‘‘(2) EXTERNAL EVALUATOR.—The Secretary 

12 shall conduct the evaluation under paragraph (1) 

13 through a contract with an external evaluator who 

14 has experience with evaluation related to workforce 

15 development and people with disabilities and older 

16 individuals. 

17 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section 

19 $10,000,000 for each of fiscal years 2025 through 2029.’’. 


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1 Subtitle C—Providing Career Ad2 vancement Opportunities; As3 sessment of Worker Well-being 

4 SEC. 221. ASSESSMENT OF DIRECT CARE PROFESSIONAL 

5 WELL-BEING. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (referred to in this section as the ‘‘Sec8 retary’’), in coordination with the Director of the National 

9 Institute for Occupational Safety and Health of the Cen10 ters for Disease Control and Prevention, the Assistant 

11 Secretary for Mental Health and Substance Use, and the 

12 Administrator of the Health Resources and Services Ad13 ministration, shall— 

14 (1) not later than 1 year after the date of en15 actment of this Act, develop a research-based tool 

16 for assessing direct care professional well-being, as 

17 described in subsection (b); and 

18 (2) not less frequently than biennially, collect 

19 data on worker well-being using the tool developed 

20 pursuant to paragraph (1) and make such data pub21 licly available as described in subsection (c). 

22 (b) ASSESSMENT TOOL.—The tool for the assessment 

23 of direct care professional well-being developed under sub24 section (a)(1) shall— 


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1 (1) include the use of an anonymous, validated 

2 survey of direct care professionals; 

3 (2) at a minimum, assess and include the views 

4 of such professionals on— 

5 (A) workplace policies and culture, includ6 ing meaningful engagement of such profes7 sionals; 

8 (B) workplace physical environment and 

9 safety; 

10 (C) circumstances outside of work for such 

11 professionals; and 

12 (D) the physical and mental health status 

13 of such professionals; and 

14 (3) be developed with input from direct care 

15 professionals, older individuals, people with disabil16 ities, and family members of older individuals and 

17 people with disabilities. 

18 (c) PUBLIC AVAILABILITY OF AGGREGATE DATA AND

19 THE ASSESSMENT TOOL.—The Secretary shall— 

20 (1) make available, through a publicly available 

21 data repository, aggregated and de-identified data 

22 collected by the assessment of direct care profes23 sional well-being under subsection (a); 

24 (2) make the assessment tool developed under 

25 subsection (a)(1) publicly available in a format that 


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1 allows employers, researchers, and other entities to 

2 voluntarily use and administer such assessment for 

3 purposes of using information collected by the as4 sessment to improve the well-being of direct care 

5 professionals; and 

6 (3) conduct outreach to employers, researchers, 

7 and other relevant entities to increase awareness of 

8 the availability of the tool for the assessment of the 

9 well-being of direct care professionals. 

10 (d) BURDEN ON PARTICIPANTS.—In developing the 

11 assessment tool under subsection (a)(1), the Secretary 

12 shall minimize the burden of the data collection process 

13 on direct care professionals. 

14 (e) CONFIDENTIALITY.—The Secretary shall ensure 

15 that the assessment tool developed under subsection 

16 (a)(1), the process of data collection under subsection (a), 

17 and the publicly available data under subsection (c)(1), do 

18 not involve the collection or disclosure of any individually 

19 identifiable information regarding the direct care profes20 sionals who are being assessed. 

21 (f) RULE OF CONSTRUCTION.—Nothing in this sec22 tion shall be construed to require that the assessment tool 

23 developed under subsection (a)(1) or the data collected 

24 through such tool be used for purposes of quality measure25 ment or payment systems under the Medicare program 


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1 under title XVIII of the Social Security Act (42 U.S.C. 

2 1395 et seq.) or a State Medicaid program. 

3 (g) REPORT.—Not later than 2 years after the date 

4 of enactment of this Act, and biennially thereafter, the 

5 Secretary shall— 

6 (1) submit to Congress a report on the findings 

7 of the assessment under subsection (a), including 

8 any recommendations to address direct care profes9 sional well-being; and 

10 (2) make such report publicly available on the 

11 website of the Centers for Disease Control and Pre12 vention. 

13 (h) DEFINITION OF WELL-BEING.—For purposes of 

14 this section, the term ‘‘well-being’’, with respect to a direct 

15 care professional, means the quality of life with respect 

16 to the health and work-related environment of such profes17 sional as related to organizational and psychosocial fac18 tors. 

19 (i) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to the Secretary to carry 

21 out this section $6,000,000 for each of fiscal years 2025 

22 through 2030. 

23 SEC. 222. NATIONAL DIRECT CARE PROFESSIONAL TRAIN24 ING STANDARDS COMMISSION. 

25 (a) ESTABLISHMENT.— 


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1 (1) IN GENERAL.—Not later than 1 year after 

2 the date of enactment of this Act, the Secretary of 

3 Health and Human Services shall establish the Na4 tional Direct Care Professional Training Standards 

5 Commission (referred to in this section as the ‘‘Com6 mission’’) to advise the Secretary on— 

7 (A) developing national direct care profes8 sional training standards described in para9 graph (2) to recommend to States to imple10 ment; and 

11 (B) providing support for States in imple12 menting such standards. 

13 (2) STANDARDS.—The standards under this 

14 subsection shall be— 

15 (A) competency-based; 

16 (B) industry-recognized; and 

17 (C) portable across settings and States. 

18 (3) MEMBERSHIP.—The Commission shall in19 clude representatives from the following: 

20 (A) An organization representing older in21 dividuals. 

22 (B) An organization led by people with dis23 abilities. 


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1 (C) An organization representing the 

2 rights and interests of people receiving services 

3 from direct care professionals. 

4 (D) An organization (other than a labor 

5 organization) representing direct care profes6 sionals. 

7 (E) Labor organizations representing di8 rect care professionals. 

9 (F) An organization representing State 

10 Medicaid agencies, State agencies defined in 

11 section 102 of the Older Americans Act of 1965 

12 (42 U.S.C. 3002), State developmental disabil13 ities offices, and State mental health agencies. 

14 (G) An organization representing local 

15 boards and State boards. 

16 (H) An organization representing area 

17 agencies on aging. 

18 (I) An organization representing centers 

19 for independent living, as described in part C of 

20 title VII of the Rehabilitation Act of 1973 (29 

21 U.S.C. 796f et seq.). 

22 (J) An organization representing State 

23 Councils on Developmental Disabilities (as such 

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1 velopmental Disabilities Assistance and Bill of 

2 Rights Act of 2000 (42 U.S.C. 15021 et seq.)). 

3 (K) An organization representing Aging 

4 and Disability Resource Centers. 

5 (L) An organization representing nonprofit 

6 State provider associations. 

7 (M) An organization representing entities 

8 that employ direct care professionals. 

9 (N) An organization representing Univer10 sity Centers for Excellence in Developmental 

11 Disabilities Education, Research, and Service 

12 supported under subtitle D of title I of the De13 velopmental Disabilities Assistance and Bill of 

14 Rights Act of 2000 (42 U.S.C. 15061 et seq.). 

15 (O) An organization representing State 

16 protection and advocacy systems described in 

17 section 143 of such Act (42 U.S.C. 15043). 

18 (P) Representatives of direct care profes19 sional organizations representing underserved 

20 communities, including communities of color. 

21 (Q) Representatives reflecting diverse ra22 cial, cultural, ethnic, geographic, socioeconomic, 

23 and gender identity and sexual orientation per24 spectives. 

25 (4) PERIOD OF APPOINTMENT; VACANCIES.— 


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1 (A) IN GENERAL.—A member of the Com2 mission shall be appointed for the life of the 

3 Commission. 

4 (B) VACANCIES.—A vacancy in the Com5 mission— 

6 (i) shall not affect the powers of the 

7 Commission; and 

8 (ii) shall be filled in the same manner 

9 as the original appointment. 

10 (5) MEETINGS.— 

11 (A) INITIAL MEETING.—Not later than 

12 180 days after the date on which all members 

13 of the Commission have been appointed, the 

14 Commission shall hold the first meeting of the 

15 Commission. 

16 (B) FREQUENCY.—The Commission shall 

17 meet at the call of the Chairperson. 

18 (C) QUORUM.—A majority of the members 

19 of the Commission shall constitute a quorum, 

20 but a lesser number of members may hold hear21 ings. 

22 (6) CHAIRPERSON AND VICE CHAIRPERSON.— 

23 The Commission shall select a Chairperson and Vice 

24 Chairperson from among the members of the Com25 mission. 


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1 (b) DUTIES.— 

2 (1) STUDY.—The Commission shall conduct a 

3 thorough study of all matters relating to direct care 

4 professional training standards. 

5 (2) RECOMMENDATIONS.—The Commission 

6 shall develop recommendations on— 

7 (A) national training standards for direct 

8 care professionals that meet the requirements 

9 under subsection (a)(2); and 

10 (B) methods for supporting States in im11 plementing such standards. 

12 (3) REPORT.—Not later than 3 years after the 

13 date of enactment of this Act, the Commission shall 

14 submit to the Secretary and the appropriate commit15 tees of Congress a report that contains a detailed 

16 statement of the findings and conclusions of the 

17 Commission, together with the recommendations of 

18 the Commission for such legislation and administra19 tive actions as the Commission considers appro20 priate. 

21 (c) POWERS OF COMMISSION.— 

22 (1) HEARINGS.—The Commission may hold 

23 such hearings, sit and act at such times and places, 

24 take such testimony, and receive such evidence as 


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1 the Commission considers advisable to carry out this 

2 section. 

3 (2) INFORMATION FROM FEDERAL AGENCIES.— 

4 (A) IN GENERAL.—The Commission may 

5 secure directly from a Federal department or 

6 agency such information as the Commission 

7 considers necessary to carry out this section. 

8 (B) FURNISHING INFORMATION.—On re9 quest of the Chairperson of the Commission, 

10 the head of the department or agency shall fur11 nish the information to the Commission. 

12 (3) POSTAL SERVICES.—The Commission may 

13 use the United States mails in the same manner and 

14 under the same conditions as other departments and 

15 agencies of the Federal Government. 

16 (4) GIFTS.—The Commission may accept, use, 

17 and dispose of gifts or donations of services or prop18 erty. 

19 (d) COMMISSION PERSONNEL MATTERS.— 

20 (1) COMPENSATION OF MEMBERS.—A member 

21 of the Commission who is not an officer or employee 

22 of the Federal Government shall be compensated at 

23 a rate equal to the daily equivalent of the annual 

24 rate of basic pay prescribed for level IV of the Exec25 utive Schedule under section 5315 of title 5, United 


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1 States Code, for each day (including travel time) 

2 during which the member is engaged in the perform3 ance of the duties of the Commission. 

4 (2) TRAVEL EXPENSES.—A member of the 

5 Commission shall be allowed travel expenses, includ6 ing per diem in lieu of subsistence, at rates author7 ized for employees of agencies under subchapter I of 

8 chapter 57 of title 5, United States Code, while 

9 away from their homes or regular places of business 

10 in the performance of services for the Commission. 

11 (3) STAFF.— 

12 (A) IN GENERAL.—The Chairperson of the 

13 Commission may, without regard to the civil 

14 service laws (including regulations), appoint 

15 and terminate an executive director and such 

16 other additional personnel as may be necessary 

17 to enable the Commission to perform its duties, 

18 except that the employment of an executive di19 rector shall be subject to confirmation by the 

20 Commission. 

21 (B) COMPENSATION.—The Chairperson of 

22 the Commission may fix the compensation of 

23 the executive director and other personnel with24 out regard to chapter 51 and subchapter III of 

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1 ing to classification of positions and General 

2 Schedule pay rates, except that the rate of pay 

3 for the executive director and other personnel 

4 may not exceed the rate payable for level V of 

5 the Executive Schedule under section 5316 of 

6 that title. 

7 (4) DETAIL OF GOVERNMENT EMPLOYEES.—A 

8 Federal Government employee may be detailed to 

9 the Commission without reimbursement, and such 

10 detail shall be without interruption or loss of civil 

11 service status or privilege. 

12 (5) PROCUREMENT OF TEMPORARY AND INTER13 MITTENT SERVICES.—The Chairperson of the Com14 mission may procure temporary and intermittent 

15 services under section 3109(b) of title 5, United 

16 States Code, at rates for individuals that do not ex17 ceed the daily equivalent of the annual rate of basic 

18 pay prescribed for level V of the Executive Schedule 

19 under section 5316 of that title. 

20 (e) TERMINATION OF COMMISSION.—The Commis21 sion shall terminate 90 days after the date on which the 

22 Commission submits the report required under subsection 

23 (b)(3). 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section 


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1 $500,000 for fiscal year 2025, to remain available, with2 out fiscal year limitation, until expended. 

3 Subtitle D—Increasing Supports 

4 for the Existing Direct Care 

5 Professional Workforce 

6 SEC. 231. MENTAL HEALTH SERVICES. 

7 (a) PROGRAMS TO PROMOTE MENTAL HEALTH

8 AMONG DIRECT CARE PROFESSIONALS.— 

9 (1) IN GENERAL.—The Secretary of Health and 

10 Human Services (in this section referred to as the 

11 ‘‘Secretary’’) shall award grants, contracts, or coop12 erative agreements to eligible entities to establish or 

13 enhance evidence-based or evidence-informed pro14 grams dedicated to improving mental health and re15 siliency for direct care professionals. 

16 (2) ELIGIBILITY.—To be eligible to receive an 

17 award under this subsection, an entity shall be— 

18 (A) a State; 

19 (B) a labor organization, joint labor man20 agement organization, or employer of direct 

21 care professionals; 

22 (C) a nonprofit entity with experience in 

23 aging, disability, or supporting the rights and 

24 interests of, the training of, or educating direct 

25 care professionals; or 


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1 (D) an Indian Tribe, Tribal organization, 

2 or Urban Indian organization. 

3 (3) USE OF FUNDS.—A recipient of an award 

4 under this subsection shall use funds received 

5 through the award to implement and evaluate a new 

6 program or enhance an existing program to promote 

7 mental health among direct care professionals, which 

8 may include— 

9 (A) improving awareness among direct 

10 care professionals about risk factors for, and 

11 signs of, suicide and mental health or substance 

12 use disorders, in accordance with evidence13 based or evidence-informed practices; 

14 (B) establishing new, or enhancing exist15 ing, evidence-based or evidence-informed pro16 grams for preventing suicide and improving 

17 mental health and resiliency among direct care 

18 professionals; 

19 (C) establishing new, or enhancing exist20 ing, peer-support programs for direct care pro21 fessionals; or 

22 (D) providing— 

23 (i) mental health care; 

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1 sional (including by means of telehealth); 

2 or 

3 (iii) a referral for such services or 

4 care by such a professional, as appropriate. 

5 (4) PRIORITY.—In awarding grants, contracts, 

6 and cooperative agreements under this subsection, 

7 the Secretary shall give priority to an eligible entity 

8 in— 

9 (A) a rural area; or 

10 (B) an area where the number of direct 

11 care professional vacancies, in the year of the 

12 application, is greater than 30 percent of the 

13 total number of direct care professional posi14 tions in the area. 

15 (b) TRAINING GRANTS.— 

16 (1) IN GENERAL.—The Secretary may establish 

17 a program to award grants to eligible entities to 

18 support the inclusion, in direct care professional 

19 preparation programs and in training, continuing 

20 education, or professional development programs for 

21 direct care professionals, of evidence-based or evi22 dence-informed strategies— 

23 (A) to address mental and substance use 

24 disorders of direct care professionals; and 


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1 (B) to improve mental health and resil2 iency among direct care professionals. 

3 (2) ELIGIBILITY.—To be eligible to receive a 

4 grant under this subsection, an entity shall be— 

5 (A) an institution of higher education; 

6 (B) a State or local government; 

7 (C) an Indian Tribe or Tribal organization; 

8 (D) a public or private nonprofit entity de9 termined appropriate by the Secretary; or 

10 (E) a consortia of entities described in any 

11 of subparagraphs (A) through (D), including 

12 such entities promoting multidisciplinary ap13 proaches. 

14 (c) GRANT TERMS.—A grant, contract, or coopera15 tive agreement awarded under subsection (a) or (b) shall 

16 be for a period of 3 years. 

17 (d) APPLICATION SUBMISSION.—An entity seeking 

18 an award under subsection (a) or (b) shall submit an ap19 plication to the Secretary at such time, in such manner, 

20 and accompanied by such information as the Secretary 

21 may require. 

22 (e) ANNUAL REPORT.—An entity receiving an award 

23 under subsection (a) or (b) shall submit to the Secretary 

24 an annual report evaluating the activities supported by the 

25 award. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $20,000,000 for each of fiscal years 2025 through 2029. 

4 SEC. 232. DISSEMINATION OF BEST PRACTICES WITH RE5 SPECT TO MENTAL HEALTH OF DIRECT CARE 

6 PROFESSIONALS. 

7 Not later than 2 years after the date of enactment 

8 of this Act, the Secretary of Health and Human Services 

9 shall— 

10 (1) identify evidence-based or evidence-informed 

11 best practices— 

12 (A) for preventing suicide and improving 

13 mental health and resiliency among direct care 

14 professionals; and 

15 (B) for training direct care professionals in 

16 appropriate strategies to promote their mental 

17 health; and 

18 (2) disseminate those best practices to the ap19 propriate committees of Congress. 

20 SEC. 233. EDUCATION AND AWARENESS INITIATIVE EN21 COURAGING USE OF MENTAL HEALTH AND 

22 SUBSTANCE USE DISORDER SERVICES BY DI23 RECT CARE PROFESSIONALS. 

24 (a) IN GENERAL.—The Secretary of Health and 

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1 retary’’), in consultation with relevant stakeholders, in2 cluding medical professional associations, shall establish a 

3 national evidence-based or evidence-informed education 

4 and awareness initiative— 

5 (1) with the goal of preventing suicide, mental 

6 health conditions, and substance use disorders of di7 rect care professionals, to— 

8 (A) encourage direct care professionals to 

9 seek support and care for their mental health or 

10 substance use concerns; 

11 (B) help such professionals identify risk 

12 factors associated with suicide and mental 

13 health conditions; and 

14 (C) help such professionals learn how best 

15 to respond to such risk factors; and 

16 (2) to address stigma associated with seeking 

17 mental health and substance use disorder services. 

18 (b) REPORTING.—Not later than 2 years after the 

19 date of enactment of this Act, the Secretary shall provide 

20 to the appropriate committees of Congress an update on 

21 the activities and outcomes of the initiative under sub22 section (a), including a description of quantitative and 

23 qualitative metrics used to evaluate such activities and 

24 outcomes. 


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1 SEC. 234. DIRECT CARE PROFESSIONAL TRAINING GRANTS. 

2 Section 2041 of the Social Security Act (42 U.S.C. 

3 1397m) is amended to read as follows: 

4 ‘‘SEC. 2041. DIRECT CARE PROFESSIONAL TRAINING 

5 GRANTS. 

6 ‘‘(a) IN GENERAL.— 

7 ‘‘(1) STATE ENTITLEMENT.— 

8 ‘‘(A) IN GENERAL.—Each State shall be 

9 entitled to receive from the Secretary for each 

10 fiscal year specified in subsection (e) a grant in 

11 an amount equal to the amount allotted to the 

12 State under subparagraph (B). 

13 ‘‘(B) STATE ALLOTMENTS.— 

14 ‘‘(i) IN GENERAL.—Subject to clauses 

15 (ii), (iii), and (iv) the amount allotted to a 

16 State under this subparagraph for a fiscal 

17 year shall be equal to the product of— 

18 ‘‘(I) the available amount for the 

19 fiscal year; and 

20 ‘‘(II) the ratio of— 

21 ‘‘(aa) the number of State 

22 residents who have attained 60 

23 years of age or are under a dis24 ability (as defined in section 

25 216(i)(1)), as determined by the 

26 Secretary using the most recent 


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1 version of the American Commu2 nity Survey published by the Bu3 reau of the Census or a successor 

4 data set; divided by 

5 ‘‘(bb) the total number of 

6 such residents of all States. 

7 ‘‘(ii) LIMITATION.—The amount allot8 ted to a State under this subparagraph for 

9 a fiscal year shall be not less than 0.25 

10 percent of the available amount for the fis11 cal year. 

12 ‘‘(iii) ADJUSTMENT OF STATE ALLOT13 MENTS.—Subject to clause (ii), the Sec14 retary shall proportionately increase or de15 crease the amounts allotted under this sub16 paragraph for a fiscal year as necessary to 

17 ensure that the available amount for the 

18 fiscal year is allotted among the States. 

19 ‘‘(iv) REDETERMINATIONS.— 

20 ‘‘(I) FREQUENCY.—The Sec21 retary shall make the determination 

22 referred to in clause (i)(II)(aa) every 

23 5 years. 

24 ‘‘(II) LIMITATION.—Subject to 

25 clause (ii), the amount allotted to a 


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1 State under this subparagraph, on the 

2 basis of such a determination, for a 

3 fiscal year after fiscal year 2029 shall 

4 be— 

5 ‘‘(aa) not less than 90 per6 cent of the amount of the grant 

7 made to the State under this 

8 subparagraph for the preceding 

9 fiscal year; and 

10 ‘‘(bb) not more than 110 

11 percent of the amount referred to 

12 in item (aa). 

13 ‘‘(2) GRANTS TO INDIAN TRIBES AND TRIBAL

14 ORGANIZATIONS.— 

15 ‘‘(A) IN GENERAL.—The Secretary, in con16 sultation with the Secretary of the Interior, 

17 shall make grants in accordance with this sec18 tion to Indian tribes and tribal organizations 

19 who operate at least 1 eligible setting. 

20 ‘‘(B) GRANT FORMULA.—The Secretary, in 

21 consultation with the Secretary of the Interior, 

22 shall devise a formula for distributing among 

23 Indian tribes and tribal organizations the 

24 amount required to be reserved by subsection 

25 (e) for each fiscal year. 


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1 ‘‘(3) SUB-GRANTS.—A State, Indian tribe, or 

2 tribal organization to which an amount is paid under 

3 this section may use the amount to make sub-grants 

4 to local organizations, including community organi5 zations, local non-profits, elder rights and justice 

6 groups, and workforce development boards for any 

7 purpose described in paragraph (1) or (2) of sub8 section (b). 

9 ‘‘(b) USE OF FUNDS.— 

10 ‘‘(1) REQUIRED USES.—A State, Indian tribe, 

11 or tribal organization to which an amount is paid 

12 under this section shall use the amount to— 

13 ‘‘(A) provide wage subsidies to eligible in14 dividuals; 

15 ‘‘(B) provide student loan repayment or 

16 tuition assistance to eligible individuals for a 

17 degree or certification in a field relevant to 

18 their position referred to in subsection 

19 (f)(2)(A); 

20 ‘‘(C) guarantee affordable and accessible 

21 child care for eligible individuals, including help 

22 with referrals, co-pays, or other direct assist23 ance; and 

24 ‘‘(D) provide assistance where necessary 

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1 cluding public transportation if available, or gas 

2 money if public transportation is unavailable or 

3 impractical based on work hours or location. 

4 ‘‘(2) AUTHORIZED USES.—A State, Indian 

5 tribe, or tribal organization to which an amount is 

6 paid under this section may use the amount to— 

7 ‘‘(A) establish a reserve fund for financial 

8 assistance to eligible individuals in emergency 

9 situations; 

10 ‘‘(B) provide in-kind resource donations, 

11 such as interview clothing and conference at12 tendance fees; 

13 ‘‘(C) provide assistance with programs and 

14 activities, including legal assistance, deemed 

15 necessary to address arrest or conviction 

16 records that are an employment barrier; 

17 ‘‘(D) support employers operating an eligi18 ble setting in the State, Indian tribe, or tribal 

19 organization in providing employees with not 

20 less than 2 weeks of paid leave per year; or 

21 ‘‘(E) provide other support services the 

22 Secretary deems necessary to allow for success23 ful recruitment and retention of workers. 

24 ‘‘(3) PROVISION OF FUNDS ONLY FOR THE

25 BENEFIT OF ELIGIBLE INDIVIDUALS IN ELIGIBLE


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1 SETTINGS.—A State, Indian tribe, or tribal organi2 zation to which an amount is paid under this section 

3 may provide the amount to only an eligible indi4 vidual or a partner organization serving an eligible 

5 individual. 

6 ‘‘(4) NONSUPPLANTATION.—A State, Indian 

7 tribe, or tribal organization to which an amount is 

8 paid under this section shall not use the amount to 

9 supplant the expenditure of any State or tribal funds 

10 for recruiting or retaining employees in an eligible 

11 setting. 

12 ‘‘(5) OBLIGATION DEADLINE.—A State, Indian 

13 tribe, or tribal organization shall remit to the Sec14 retary for reallotment under this section any amount 

15 paid under this section for a fiscal year that is not 

16 obligated within 2 years after the end of the fiscal 

17 year. 

18 ‘‘(c) ADMINISTRATION.—A State, Indian tribe, or 

19 tribal organization to which a grant is made under this 

20 section shall reserve not more than 10 percent of the grant 

21 to— 

22 ‘‘(1) administer subgrants in accordance with 

23 this section; 


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1 ‘‘(2) provide technical assistance and support 

2 for applying for and accessing such a subgrant op3 portunity; 

4 ‘‘(3) publicize the availability of the subgrants; 

5 ‘‘(4) carry out activities to increase the supply 

6 of eligible individuals; and 

7 ‘‘(5) provide technical assistance to help sub8 grantees find and train individuals to provide the 

9 services for which they are contracted. 

10 ‘‘(d) REPORTS.— 

11 ‘‘(1) STATE REPORTS.—Not less frequently 

12 than annually, each State, Indian tribe, or tribal or13 ganization to which a grant has been made under 

14 this section shall transmit to the Secretary a written 

15 report describing the activities undertaken by the 

16 State pursuant to this section during the period cov17 ered by the report, which shall include— 

18 ‘‘(A) the total amount expended in the 

19 State for each type of use described in para20 graph (1) or (2) of subsection (b); 

21 ‘‘(B) the total number of non-State organi22 zations in the State to which grant funds were 

23 provided, and the amount so provided to each 

24 such organization; 


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1 ‘‘(C) the change in the number of individ2 uals working in each job category described in 

3 subsection (f)(2)(A) in an eligible setting in the 

4 State; 

5 ‘‘(D) the average duration of employment 

6 for each such job category; 

7 ‘‘(E) the average annual wage of workers 

8 in each job category described in subsection 

9 (f)(2)(A) in an eligible setting in the State; 

10 ‘‘(F) the average amount of paid time off 

11 to which a worker in each job category de12 scribed in subsection (f)(2)(A) in an eligible set13 ting in the State is entitled by their contract; 

14 and 

15 ‘‘(G) such other data elements as the Sec16 retary deems relevant. 

17 ‘‘(2) REPORT TO CONGRESS.—Not later than 3 

18 years after the date of the enactment of this section, 

19 and every 4 years thereafter, the Secretary shall 

20 submit to the Committee on Health, Education, 

21 Labor, and Pensions and the Special Committee on 

22 Aging of the Senate and the Committee on Energy 

23 and Commerce and the Committee on Education 

24 and the Workforce of the House of Representatives 

25 a written report outlining how the grant recipients 


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1 have used the grants made under this section during 

2 the period covered by the report, which shall in3 clude— 

4 ‘‘(A) the total amount expended by each 

5 State, Indian tribe, or tribal organization for 

6 each type of use described in paragraph (1) or 

7 (2) of subsection (b); 

8 ‘‘(B) the total number of non-State or non9 tribal organizations in each State, Indian tribe, 

10 or tribal organization to which grant funds were 

11 provided, and the amount so provided to each 

12 such non-State or non-tribal organization; 

13 ‘‘(C) the change in the number of individ14 uals working in each job category described in 

15 subsection (f)(2)(A) in an eligible setting; 

16 ‘‘(D) the average duration of employment 

17 for each such job category, by State, Indian 

18 tribe, or tribal organization; 

19 ‘‘(E) the average annual wage of workers 

20 in each job category described in subsection 

21 (f)(2)(A) in an eligible setting; 

22 ‘‘(F) the average amount of paid time off 

23 to which a worker in each job category de24 scribed in subsection (f)(2)(A) in an eligible set25 ting is entitled by their contract; and 


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1 ‘‘(G) such other data elements as the Sec2 retary deems relevant. 

3 ‘‘(e) APPROPRIATION.—Out of any funds in the 

4 Treasury not otherwise appropriated, there is appro5 priated to the Secretary $400,000,000 for each of fiscal 

6 years 2025 through 2029 to carry out this section, of 

7 which 2 percent shall be reserved for grants to Indian 

8 tribes and tribal organizations. 

9 ‘‘(f) DEFINITIONS.—In this section: 

10 ‘‘(1) AVAILABLE AMOUNT.—The term ‘available 

11 amount’ means, with respect to a fiscal year, the 

12 amount specified in subsection (e) that remains after 

13 the reservation required by such subsection for the 

14 fiscal year, plus all amounts remitted to the Sec15 retary under subsection (b)(5) that have not been 

16 reallotted under subsection (a)(1)(B)(iii). 

17 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

18 individual’ means an individual who— 

19 ‘‘(A)(i) is a qualified home health aide, as 

20 defined in section 484.80(a) of title 42, Code of 

21 Federal Regulations; 

22 ‘‘(ii) is a nurse aide approved by the State 

23 as meeting the requirements of sections 

24 483.150 through 483.154 of such title, and is 


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1 listed in good standing on the State nurse aide 

2 registry; 

3 ‘‘(iii) is a personal care aide approved by 

4 the State, and furnishes personal care services, 

5 as defined in section 440.167 of such title; 

6 ‘‘(iv) is a qualified hospice aide, as defined 

7 in section 418.76 of such title; 

8 ‘‘(v) is a licensed practical nurse or a li9 censed or certified social worker; 

10 ‘‘(vi) is receiving training to be certified or 

11 licensed as such an aide, nurse, or social work12 er; or 

13 ‘‘(vii) is any other direct care professional; 

14 and 

15 ‘‘(B) provides (or, in the case of a trainee, 

16 intends to provide) services as such an aide, 

17 nurse, or social worker in an eligible setting. 

18 ‘‘(3) ELIGIBLE SETTING.—The term ‘eligible 

19 setting’ means— 

20 ‘‘(A) a skilled nursing facility, as defined 

21 in section 1819; 

22 ‘‘(B) a nursing facility, as defined in sec23 tion 1919; 

24 ‘‘(C) a home health agency, as defined in 

25 section 1891; 


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1 ‘‘(D) a setting approved to deliver home or 

2 community-based services authorized under 

3 State options described in subsection (c) or (i) 

4 of section 1915 or, as relevant, demonstration 

5 projects authorized under section 1115; 

6 ‘‘(E) a hospice, as defined in section 1814; 

7 ‘‘(F) another long-term care setting; or 

8 ‘‘(G) a tribal assisted living facility. 

9 ‘‘(4) TRIBAL ORGANIZATION.—The term ‘tribal 

10 organization’ has the meaning given the term in sec11 tion 4 of the Indian Self-Determination and Edu12 cation Assistance Act.’’. 

13 SEC. 235. CREDIT FOR CERTAIN HEALTH CARE PROFES14 SIONALS. 

15 (a) IN GENERAL.—Subpart C of part IV of sub16 chapter A of chapter 1 of the Internal Revenue Code of 

17 1986 is amended by inserting after section 36 the fol18 lowing new section: 

19 ‘‘SEC. 36A. CREDIT FOR CERTAIN HEALTH CARE PROFES20 SIONALS. 

21 ‘‘(a) ALLOWANCE OF CREDIT.—In the case of an in22 dividual who is a health care professional described in sub23 section (b) with respect to the taxable year, there shall 

24 be allowed a credit of $5,000 against the tax imposed by 

25 this subtitle for such taxable year. 


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1 ‘‘(b) HEALTH CARE PROFESSIONALS DESCRIBED.— 

2 A health care professional described in this subsection, 

3 with respect to any taxable year, is any individual who, 

4 at any time during such taxable year, is— 

5 ‘‘(1) a practitioner, as defined in section 

6 1842(b)(18)(C) of the Social Security Act (42 

7 U.S.C. 1395u(b)(18)(C)), providing services for 

8 compensation as such practitioner in a long-term 

9 care setting, 

10 ‘‘(2) a certified nursing assistant providing 

11 services for compensation as such assistant in a 

12 long-term care setting, 

13 ‘‘(3) a licensed practical nurse, or registered 

14 professional nurse, providing services for compensa15 tion as such a nurse in a long-term care setting, 

16 ‘‘(4) a home health aide providing services for 

17 compensation as such aide in a long-term care set18 ting, 

19 ‘‘(5) a personal or home care aide providing 

20 services for compensation as such aide in a long21 term care setting, or 

22 ‘‘(6) a direct care professional, who is not oth23 erwise described in any of paragraphs (1) through 

24 (5), providing services for compensation as such pro25 fessional in a long-term care setting. 


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1 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

2 terms ‘direct care professional’, ‘long-term care setting’, 

3 and ‘personal or home care aide’ have the meanings given 

4 such terms in section 3 of the Long-Term Care Workforce 

5 Support Act.’’. 

6 (b) CONFORMING AMENDMENTS.— 

7 (1) Section 6211(b)(4)(A) of the Internal Rev8 enue Code of 1986 is amended by inserting ‘‘, 36A’’ 

9 after ‘‘36’’. 

10 (2) The table of section for subpart C of part 

11 IV of subchapter A of chapter 1 such Code is 

12 amended by amending by inserting after the item re13 lating to section 36 the following new item: 

‘‘Sec. 36A. Credit for certain health care professionals.’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section shall apply to taxable years beginning after 

16 December 31, 2023. 

17 SEC. 236. DIRECT CARE PROFESSIONAL WORKFORCE EQ18 UITY TECHNICAL ASSISTANCE CENTER. 

19 (a) IN GENERAL.—The Secretary of Health and 

20 Human Services (referred to in this section as the ‘‘Sec21 retary’’), in consultation with the Secretary of Labor, the 

22 Administrator of the Centers for Medicare & Medicaid 

23 Services, and the heads of other entities as necessary, shall 

24 establish a national technical assistance center to— 


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1 (1) address inequities and disparities facing the 

2 direct care professional workforce; and 

3 (2) ensure that long-term care settings are 

4 meeting the unique demographic, cultural, and lin5 guistic needs of the community in which such set6 tings are situated and the community of workers 

7 within such settings. 

8 (b) ACTIVITIES.—The Center may— 

9 (1) maintain a centralized online hub of equity10 focused direct care professional workforce resources; 

11 (2) conduct studies and develop trainings and 

12 resources on the inequities facing direct care profes13 sionals and enhancing diversity, equity, inclusion, 

14 and accessibility among long-term care settings; 

15 (3) develop equity-specific tools and resources 

16 to support State and local governments in building 

17 an equitable direct care professional workforce; 

18 (4) design and inform interventions in the di19 rect care professional workforce that reduce dispari20 ties and promote equity within the direct care pro21 fessional workforce; 

22 (5) convene experts in the direct care profes23 sional workforce, including direct care professionals, 

24 to develop equity-based resources; and 


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1 (6) collaborate with organizations representing 

2 people with disabilities, older individuals, people of 

3 color, women, immigrants, and LGBT communities, 

4 and others as determined by the Secretary. 

5 (c) REPORTING.—Not later than 2 years after the 

6 date of enactment of this Act, the Secretary shall provide 

7 to the appropriate committees of Congress an update on 

8 the activities and outcomes of the initiative under sub9 section (a) 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 to the Secretary $10,000,000 for each of fiscal years 2025 

13 through 2029. 

14 TITLE III—WORKFORCE LABOR 

15 PROTECTIONS 

16 Subtitle A—Long-term Care Work17 force Wage Theft Prevention 

18 and Wage Recovery Act 

19 SEC. 301. DEFINITIONS. 

20 In this subtitle: 

21 (1) ADMINISTRATOR.—The term the ‘‘Adminis22 trator’’ means the Administrator of the Wage and 

23 Hour Division of the Department of Labor. 

24 (2) COMMUNITY PARTNER.—The term ‘‘com25 munity partner’’ means any stakeholder with a comVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 mitment to enforcing wage and hour laws and pre2 venting abuses of such laws, including any— 

3 (A) State department of labor; 

4 (B) attorney general of a State or other 

5 similar authorized official of a political subdivi6 sion thereof; 

7 (C) law enforcement agency; 

8 (D) consulate; 

9 (E) employee or advocate of employees, in10 cluding a labor organization, community- and 

11 faith-based organization, business association, 

12 disability organization, older individual organi13 zation, or nonprofit legal aid organization; 

14 (F) academic institution that plans, coordi15 nates, and implements programs and activities 

16 to prevent wage and hour violations and recover 

17 unpaid wages, damages, and penalties; or 

18 (G) any municipal agency responsible for 

19 the enforcement of local wage and hour laws. 

20 (3) COMMUNITY PARTNERSHIP.—The term 

21 ‘‘community partnership’’ means a partnership be22 tween— 

23 (A) a working group consisting of commu24 nity partners; and 

25 (B) the Department of Labor. 


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1 (4) COVERED EMPLOYEE.—The term ‘‘covered 

2 employee’’ means a direct care professional working 

3 in a long-term care setting. 

4 (5) COVERED EMPLOYER.—The term ‘‘covered 

5 employer’’ means an employer who employs covered 

6 employees to work in or provide services in a long7 term care setting. 

8 (6) ELIGIBLE ENTITY.—The term ‘‘eligible enti9 ty’’ means an entity that is any of the following: 

10 (A) A nonprofit organization, including 

11 such an organization that is a community-based 

12 organization, faith-based organization, disability 

13 organization, older individuals organization, or 

14 labor organization, that provides services and 

15 support to employees, including assisting such 

16 employees in recovering unpaid wages. 

17 (B) An employer. 

18 (C) A business association. 

19 (D) An institution of higher education, as 

20 defined by section 101 of the Higher Education 

21 Act of 1965 (20 U.S.C. 1001). 

22 (E) A partnership between any of the enti23 ties described in subparagraphs (A) through 

24 (D). 


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1 (7) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Labor. 

3 (8) STRATEGIC ENFORCEMENT.—The term 

4 ‘‘strategic enforcement’’ means the process by which 

5 the Secretary— 

6 (A) targets highly noncompliant industries, 

7 as identified by the Secretary, using industry8 specific structures to influence, and ultimately 

9 reform, networks of interconnected employers; 

10 (B) analyzes regulatory regimes under 

11 which specific industries operate; and 

12 (C) modifies the enforcement approach of 

13 such regulatory regimes in order to ensure the 

14 greatest impact. 

15 (9) WAGE AND HOUR LAW.—The term ‘‘wage 

16 and hour law’’ means any Federal law enforced by 

17 the Wage and Hour Division of the Department of 

18 Labor, including any provision of this Act enforced 

19 by such division. 

20 (10) WAGE AND HOUR VIOLATION.—The term 

21 ‘‘wage and hour violation’’ refers to any violation of 

22 a Federal law enforced by the Wage and Hour Divi23 sion of the Department of Labor, including any pro24 vision of this Act enforced by such division. 


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1 SEC. 302. DIRECT CARE PROFESSIONAL WORKFORCE WAGE 

2 THEFT PREVENTION AND WAGE RECOVERY 

3 GRANT PROGRAM. 

4 (a) IN GENERAL.—The Secretary, acting through the 

5 Administrator, shall provide grants to eligible entities to 

6 assist such entities in enhancing the enforcement of wage 

7 and hour laws, in accordance with this section and con8 sistent with the purposes of this Act. 

9 (b) GRANTS.—A grant provided under this section 

10 shall be designed to— 

11 (1) support an eligible entity in establishing 

12 and supporting the activities described in subsection 

13 (c)(1); and 

14 (2) develop community partnerships to expand 

15 and improve cooperative efforts between enforcement 

16 agencies and members of the community to— 

17 (A) prevent and reduce wage and hour vio18 lations; and 

19 (B) assist covered employees in recovering 

20 back pay for any such violations. 

21 (c) USE OF FUNDS.— 

22 (1) PERMISSIBLE ACTIVITIES.—The grants de23 scribed in this section shall assist eligible entities in 

24 establishing and supporting activities that include— 

25 (A) disseminating information and con26 ducting outreach and training to educate covVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 ered employees about their rights under wage 

2 and hour laws; 

3 (B) conducting educational training for 

4 covered employers about their obligations under 

5 wage and hour laws; 

6 (C) conducting orientations and trainings 

7 jointly with officials of the Wage and Hour Di8 vision of the Department of Labor; 

9 (D) providing assistance to covered em10 ployees in filing claims of wage and hour viola11 tions; 

12 (E) assisting enforcement agencies in con13 ducting investigations, including in the collec14 tion of evidence and recovering back pay; 

15 (F) monitoring compliance with wage and 

16 hour laws; 

17 (G) performing joint visitations to work18 sites that violate wage and hour laws with offi19 cials from the Wage and Hour Division of the 

20 Department of Labor; 

21 (H) establishing networks for education, 

22 communication, and participation in the work23 place and community; 


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1 (I) evaluating the effectiveness of pro2 grams designed to prevent wage and hour viola3 tions and enforce wage and hour laws; 

4 (J) recruiting and hiring of staff and vol5 unteers; 

6 (K) production and dissemination of out7 reach and training materials; 

8 (L) creation of a phone, short message 

9 service, web, or other technology-based commu10 nication for reporting covered employee emer11 gencies, wage theft, or labor violations, seeking 

12 emergency services, or seeking support or guid13 ance in lieu of emergency services; and 

14 (M) any other activities as the Secretary 

15 may reasonably prescribe through notice and 

16 comment rulemaking. 

17 (2) PROHIBITED ACTIVITIES.—Notwithstanding 

18 paragraph (1), an eligible entity receiving a grant 

19 under this section may not use the grant funds for 

20 any purpose reasonably prohibited by the Secretary 

21 through notice and comment rulemaking. 

22 (d) TERM OF GRANTS.—Each grant made under this 

23 section shall be available for expenditure for a period that 

24 is not to exceed 3 years. 

25 (e) APPLICATIONS.— 


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1 (1) IN GENERAL.—An eligible entity seeking a 

2 grant under this section shall submit an application 

3 for such grant to the Secretary in accordance with 

4 this subsection. 

5 (2) PARTNERSHIPS.—In the case of an eligible 

6 entity that is a partnership described in section 

7 301(4)(E), the eligible entity may submit a joint ap8 plication that designates a single entity as the lead 

9 entity for purposes of receiving and disbursing 

10 funds. 

11 (3) CONTENTS.—An application under this sub12 section shall include— 

13 (A) a description of a plan for the program 

14 that the eligible entity proposes to carry out 

15 with a grant under this section, including a 

16 long-term strategy and detailed implementation 

17 plan that reflects expected participation of, and 

18 partnership with, community partners; 

19 (B) information on the prevalence of wage 

20 and hour violations in each community or State 

21 of the eligible entity; 

22 (C) information on any industry or geo23 graphic area targeted by the plan for such pro24 gram; 


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1 (D) information on the type of outreach 

2 and relationship building that will be conducted 

3 under such program; 

4 (E) information on the training and edu5 cation that will be provided to covered employ6 ees and covered employers under such program; 

7 and 

8 (F) the method by which the eligible entity 

9 will measure results of such program. 

10 (f) SELECTION.— 

11 (1) COMPETITIVE BASIS.—In accordance with 

12 this subsection, the Secretary shall, on a competitive 

13 basis, select grant recipients from among eligible en14 tities that have submitted an application under sub15 section (e). 

16 (2) PRIORITY.—In selecting grant recipients 

17 under paragraph (1), the Secretary shall give pri18 ority to eligible entities that— 

19 (A) serve covered employees in the long20 term care industry or geographic area that is 

21 most highly at risk for noncompliance with 

22 wage and hour violations, as identified by the 

23 Secretary; and 


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1 (B) demonstrate past and ongoing work to 

2 prevent wage and hour violations or to recover 

3 unpaid wages. 

4 (3) OTHER CONSIDERATIONS.—In selecting 

5 grant recipients under paragraph (1), the Secretary 

6 shall also consider— 

7 (A) the prevalence of ongoing community 

8 support for each eligible entity, including finan9 cial and other contributions; and 

10 (B) the eligible entity’s past and ongoing 

11 partnerships with other organizations. 

12 (g) MEMORANDA OF UNDERSTANDING.— 

13 (1) IN GENERAL.—Not later than 60 days after 

14 receiving a grant under this section, the grant recipi15 ent shall negotiate and finalize with the Secretary a 

16 memorandum of understanding that sets forth spe17 cific goals, objectives, strategies, and activities that 

18 will be carried out under the grant by such recipient 

19 through a community partnership. 

20 (2) SIGNATURES.—A representative of the 

21 grant recipient (or, in the case of a grant recipient 

22 that is an eligible entity described in section 

23 301(4)(E), a representative of each entity that 

24 composes the grant recipient) and the Secretary 


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1 shall sign the memorandum of understanding under 

2 this subsection. 

3 (3) REVISIONS.—The memorandum of under4 standing under this subsection shall be reviewed and 

5 revised by the grant recipient and the Secretary each 

6 year of the duration of the grant. 

7 (h) PERFORMANCE EVALUATIONS.— 

8 (1) IN GENERAL.—Each grant recipient under 

9 this section shall develop procedures for reporting, 

10 monitoring, measuring, and evaluating the activities 

11 of each program or project funded under this sec12 tion. 

13 (2) GUIDELINES.—The procedures required 

14 under paragraph (1) shall be in accordance with 

15 guidelines established by the Secretary. 

16 (i) REVOCATION OR SUSPENSION OF FUNDING.—If 

17 the Secretary determines that a recipient of a grant under 

18 this section is not in compliance with the terms and re19 quirements of the memorandum of understanding under 

20 subsection (g), the Secretary may revoke or suspend (in 

21 whole or in part) the funding of the grant. 

22 (j) USE OF COMPONENTS.— 

23 (1) IN GENERAL.—In addition to the Wage and 

24 Hour Division, the Secretary (acting through the 

25 Administrator) may use any division or agency of 


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1 the Department of Labor in carrying out this sub2 title. 

3 (2) CONSULTATION WITH HHS.—The Secretary 

4 may consult with the Secretary of Health and 

5 Human Services (acting through the Administrator 

6 for Community Living) to carry out this subtitle. 

7 (k) EVALUATION.—The Secretary of Health and 

8 Human Services, in conjunction with the Secretary of 

9 Labor, shall evaluate the implementation and outcomes of 

10 this section on the occurrence of wage and hour violations 

11 through a contract with an external evaluator who has ex12 perience with evaluation of labor regulations and long13 term care services. 

14 (l) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this subtitle 

16 $50,000,000 for each of fiscal years 2025 through 2029, 

17 to remain available until expended. 

18 Subtitle B—Direct Care 

19 Professional Rights 

20 SEC. 311. DEFINITIONS. 

21 (a) FAIR LABOR STANDARDS ACT DEFINITIONS.— 

22 In this subtitle— 

23 (1) the terms ‘‘enterprise’’, ‘‘enterprise engaged 

24 in commerce or in the production of goods for com25 merce’’, and ‘‘person’’ have the meanings given such 


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1 terms in section 3 of the Fair Labor Standards Act 

2 of 1938 (29 U.S.C. 203); and 

3 (2) the term ‘‘regular rate’’ has the meaning 

4 given such term in section 7(e) of such Act (29 

5 U.S.C. 207(e)). 

6 (b) OTHER DEFINITIONS.—In this subtitle: 

7 (1) CHILD.—The term ‘‘child’’— 

8 (A) means an individual who is under 18 

9 years of age; and 

10 (B) includes an individual described in 

11 subparagraph (A) who is— 

12 (i) a biological, foster, or adopted 

13 child; 

14 (ii) a stepchild; 

15 (iii) a child of a domestic partner; 

16 (iv) a legal ward; or 

17 (v) a child of a person standing in 

18 loco parentis. 

19 (2) COVERED ENTITY.—The term ‘‘covered en20 tity’’— 

21 (A) means any person or agency who pro22 vides compensation directly or indirectly to a di23 rect care professional for the performance of 

24 long-term care services; and 

25 (B) includes— 


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1 (i) a person acting directly or indi2 rectly in the interest of the entity in rela3 tion to a direct care professional; 

4 (ii) an employer of a direct care pro5 fessional; and 

6 (iii) an agency that contracts with an 

7 agency to provide direct care professionals. 

8 (3) MEDICAID HCBS-ELIGIBLE OLDER INDI9 VIDUAL.—The term ‘‘Medicaid HCBS-eligible older 

10 individual’’ means an individual who— 

11 (A) is 60 years of age or older; and 

12 (B) is eligible for and enrolled for medical 

13 assistance for any of the following services 

14 (whether provided on a fee-for-service, risk, or 

15 other basis) under a State Medicaid program, 

16 and includes an individual who becomes eligible 

17 for medical assistance under a State Medicaid 

18 program when removed from a waiting list: 

19 (i) Home health care services author20 ized under paragraph (7) of section 

21 1905(a) of the Social Security Act (42 

22 U.S.C. 1396d(a)). 

23 (ii) Personal care services authorized 

24 under paragraph (24) of such section. 


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1 (iii) PACE services authorized under 

2 paragraph (26) of such section. 

3 (iv) Home and community-based serv4 ices authorized under subsections (b), (c), 

5 (i), (j), and (k) of section 1915 of such Act 

6 (42 U.S.C. 1396n), such services author7 ized under a waiver under section 1115 of 

8 such Act (42 U.S.C. 1315), and such serv9 ices provided through coverage authorized 

10 under section 1937 of such Act (42 U.S.C. 

11 1396u–7). 

12 (v) Case management services author13 ized under section 1905(a)(19) of the So14 cial Security Act (42 U.S.C. 1396d(a)(19)) 

15 and section 1915(g) of such Act (42 

16 U.S.C. 1396n(g)). 

17 (vi) Rehabilitative services, including 

18 those related to behavioral health, de19 scribed in section 1905(a)(13) of such Act 

20 (42 U.S.C. 1396d(a)(13)). 

21 (vii) Such other services specified by 

22 the Secretary of Health and Human Serv23 ices. 


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1 (4) ON-CALL SHIFT.—The term ‘‘on-call shift’’ 

2 means any time a covered entity expects a direct 

3 care professional to— 

4 (A) be available to work; and 

5 (B) wait to contact, or be contacted by, the 

6 covered entity, or a designee of the entity, to 

7 determine whether the direct care professional 

8 shall report to work during such time. 

9 (5) PARENT.—The term ‘‘parent’’, with respect 

10 to a direct care professional, means— 

11 (A) a biological, foster, or adoptive parent 

12 of a direct care professional; 

13 (B) a stepparent of a direct care profes14 sional; 

15 (C) parent-in-law of a direct care profes16 sional; 

17 (D) parent of a domestic partner of a di18 rect care professional; or 

19 (E) a legal guardian or other person who 

20 stood in loco parentis to the direct care profes21 sional when the worker was a child. 

22 (6) SECRETARY.—The term ‘‘Secretary’’ means 

23 the Secretary of Labor. 


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1 (7) SHARED LIVING ARRANGEMENT.—The term 

2 ‘‘shared living arrangement’’ means a living arrange3 ment involving— 

4 (A) not more than 2 individuals who are a 

5 person with a disability or a Medicaid HCBS6 eligible older individual, except if 1 or more of 

7 the individuals are related to each other (by 

8 blood or a close association that is equivalent to 

9 a family relationship); 

10 (B) an individual providing services for 

11 compensation and living in the private home of 

12 the recipient of such services; 

13 (C) an individual receiving funding 

14 through a State Medicaid program or another 

15 publicly funded program; 

16 (D) a stipend or room and board as the 

17 primary form of payment for the individual pro18 viding such services; and 

19 (E) the individual receiving such services 

20 having the final decision regarding who is the 

21 provider of such services living with the indi22 vidual, through a consumer-driven matching 

23 process that includes relationship building, per24 son-centered planning as defined by the Admin25 istrator of the Centers for Medicare & Medicaid 


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1 Services, and an assessment of individual com2 patibility. 

3 (8) SPOUSE.—The term ‘‘spouse’’ has the 

4 meaning given such term by the marriage laws of 

5 the State in which the marriage was celebrated. 

6 SEC. 312. WRITTEN AGREEMENTS. 

7 (a) COVERED DIRECT CARE PROFESSIONAL.—In this 

8 section, the term ‘‘covered direct care professional’’ means 

9 any direct care professional to whom the covered entity 

10 expects to provide compensation for the performance of 

11 long-term care services by the covered direct care profes12 sional for not less than 8 hours per week. 

13 (b) REQUIREMENT.—Each covered entity shall pro14 vide a written agreement in accordance with this section 

15 to each covered direct care professional who is provided 

16 compensation, directly or indirectly, by the covered entity 

17 for the performance of long-term care services. 

18 (c) WRITTEN AGREEMENT REQUIREMENTS.— 

19 (1) IN GENERAL.—A written agreement re20 quired under this section shall— 

21 (A) be signed and dated by the covered di22 rect care professional and the covered entity; 

23 (B) be written in a language easily and 

24 fully understood by the covered direct care pro25 fessional and the covered entity, which may be 


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1 in multiple languages if the covered direct care 

2 professional and the entity do not easily and 

3 fully understand the same language; and 

4 (C) include the contents described in sub5 section (d). 

6 (2) COPY.—A copy of the written agreement re7 quired under this section shall be provided to the 

8 covered direct care professional not later than 5 cal9 endar days after the date on which the covered di10 rect care professional is hired by the covered entity. 

11 (d) CONTENTS OF THE WRITTEN AGREEMENT.— 

12 (1) IN GENERAL.—The contents described in 

13 this subsection shall include each of the following: 

14 (A) The full name, address, and contact 

15 information of the covered entity, including, as 

16 appropriate, any ‘‘doing business as’’ name of 

17 the entity and the name of each individual of 

18 the entity who will be doing business with the 

19 covered direct care professional. 

20 (B) The address for the location where the 

21 covered direct care professional will be pro22 viding long-term care services for the covered 

23 entity. 

24 (C) All responsibilities to be performed by 

25 the covered direct care professional for the covVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 ered entity, and the regularity in which such re2 sponsibilities are to be performed. 

3 (D) The regular rate of pay of the covered 

4 direct care professional for any work week, in5 cluding any overtime compensation due. 

6 (E) The day of the week when the covered 

7 direct care professional will be paid. 

8 (F) The required working hours for any 

9 work week, including— 

10 (i) the time of day and day of week 

11 the work of the covered direct care profes12 sional begins; 

13 (ii) meal and rest breaks described in 

14 section 316; 

15 (iii) time off; 

16 (iv) the work schedule of the covered 

17 direct care professional at the time of hire, 

18 including— 

19 (I) the time of day and the days 

20 of the week the covered direct care 

21 professional will be expected to work 

22 each week for the covered entity; or 

23 (II) if the time of day or the days 

24 of the week that the covered direct 

25 care professional will be expected to 


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1 work for the covered entity will vary 

2 from week to week, information re3 garding a good faith estimate of the 

4 days and hours for which the covered 

5 direct care professional will be ex6 pected to work for the entity each 

7 week, including, at minimum— 

8 (aa) the average number of 

9 hours the covered direct care pro10 fessional will be expected to work 

11 for the entity each week during a 

12 typical 90-day period; 

13 (bb) whether the covered di14 rect care professional can expect 

15 to work any on-call shifts for the 

16 entity; 

17 (cc) a subset of days the 

18 covered direct care professional 

19 can typically expect to work (or 

20 to be scheduled as off from work) 

21 for the entity; and 

22 (dd) the amount of notice 

23 that the entity will provide to the 

24 covered direct care professional 

25 in advance of scheduled work 


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1 hours (as defined in section 

2 313(a)), which shall not be less 

3 than 72 hours before such sched4 uled work hours are to begin (ex5 cept during a period described in 

6 subparagraph (A) of section 

7 313(e)(1), in a case described in 

8 subparagraph (B) of such sec9 tion, or in the case of a shared 

10 living arrangement), and the 

11 manner in which such notice 

12 shall be provided; 

13 (v) the reporting time pay policy de14 scribed in section 313(c); and 

15 (vi) the right to request and receive a 

16 change to scheduled work hours due to 

17 personal events as described in section 

18 314. 

19 (G) If applicable, any policies of the cov20 ered entity with respect to the covered direct 

21 care professional for paying for or providing re22 imbursement for— 

23 (i) health insurance; 

24 (ii) transportation, meals, or lodging; 

25 and 


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1 (iii) any fees or costs associated with 

2 the long-term care services provided by the 

3 covered direct care professional for the en4 tity. 

5 (H) If applicable, any policies of the cov6 ered entity with respect to the covered direct 

7 care professional for— 

8 (i) annual or other pay increases; 

9 (ii) severance pay; and 

10 (iii) providing materials or equipment 

11 related to the performance of long-term 

12 care services by the covered direct care 

13 professional, including (if applicable) any 

14 cleaning supplies provided by the entity. 

15 (I) Information about policies, procedures, 

16 and equipment related to safety and emer17 gencies. 

18 (J) The policy of the covered entity per19 taining to notice of termination of the covered 

20 direct care professional by the entity. 

21 (K) In the case of a covered direct care 

22 professional who resides in the household of the 

23 person for whom the covered direct care profes24 sional provides long-term care services— 


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1 (i) the circumstances under which the 

2 covered entity may enter the designated 

3 living space of the covered direct care pro4 fessional; 

5 (ii) the circumstances under which the 

6 covered direct care professional, in a 

7 shared living arrangement, may enter the 

8 designated living space of the covered enti9 ty; and 

10 (iii) a description of certain cir11 cumstances the covered entity determines 

12 as cause for— 

13 (I) immediate termination of the 

14 covered direct care professional; and 

15 (II) removal of the covered direct 

16 care professional from the household 

17 of the person for whom the covered 

18 direct care professional provides long19 term care services not later than 48 

20 hours after notice of the termination. 

21 (L) Any additional benefits afforded to the 

22 covered direct care professional by the covered 

23 entity. 

24 (M) The process for the covered direct care 

25 professional to raise or address grievances with 


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1 respect to, or breaches of, the written agree2 ment. 

3 (N) The process used by the covered entity 

4 to change any policy described in subpara5 graphs (A) through (M), including addressing 

6 additional compensation if responsibilities are 

7 added to those described in subparagraph (C), 

8 after the date on which the written agreement 

9 is provided to the covered direct care profes10 sional. 

11 (2) PROHIBITIONS.—A written agreement re12 quired under this section may not— 

13 (A) contain— 

14 (i) a mandatory pre-dispute arbitra15 tion agreement for claims made by a cov16 ered direct care professional against a cov17 ered entity regarding the legal rights of the 

18 covered direct care professional; or 

19 (ii) a non-disclosure agreement, non20 compete agreement, or non-disparagement 

21 agreement, limiting the ability of the cov22 ered direct care professional to seek com23 pensation for performing long-term care 

24 services after the covered direct care pro25 fessional ceases to receive compensation 


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1 from the covered entity for the perform2 ance of long-term care services; and 

3 (B) be construed to waive the rights or 

4 protections of a covered direct care professional 

5 under Federal, State, or local law. 

6 (e) TIMING.— 

7 (1) INITIAL AGREEMENT.—A covered entity 

8 shall provide a written agreement required under 

9 this section— 

10 (A) to each covered direct care professional 

11 hired after the date of enactment of this Act, 

12 prior to the first day the covered direct care 

13 professional performs long-term care services 

14 for the entity; and 

15 (B) to each covered direct care professional 

16 hired on or prior to the date of enactment of 

17 this Act, 90 days after such date of enactment. 

18 (2) SUBSEQUENT AGREEMENTS.—Not later 

19 than 30 calendar days after the date on which a cov20 ered entity makes a change to a written agreement 

21 provided to a covered direct care professional under 

22 this section, the entity shall provide the covered di23 rect care professional with an updated agreement in 

24 accordance with this section. 


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1 (f) RECORDS.—A covered entity that is required to 

2 provide a written agreement under this section to a cov3 ered direct care professional shall retain such agreement 

4 for a period of not less than 3 years from the date on 

5 which the covered direct care professional is no longer 

6 working for the entity. 

7 (g) MODEL WRITTEN AGREEMENTS.— 

8 (1) IN GENERAL.—Not later than 6 months 

9 after the date of enactment of this Act, the Sec10 retary shall establish and make available templates 

11 for model written agreements under this section. 

12 (2) REQUIREMENTS.—A model written agree13 ment required under paragraph (1) shall— 

14 (A) be available in multiple languages com15 monly understood by covered direct care profes16 sionals, including all languages in which the 

17 Secretary, acting through the Administrator of 

18 the Wage and Hour Division, translates the 

19 basic information fact sheet published by the 

20 Administrator; and 

21 (B) not include any agreement described in 

22 subsection (d)(2)(A). 

23 SEC. 313. FAIR SCHEDULING PRACTICES. 

24 (a) DEFINITIONS.—In this section: 


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1 (1) COVERED DIRECT CARE PROFESSIONAL.— 

2 The term ‘‘covered direct care professional’’ has the 

3 meaning given the term in section 312(a). 

4 (2) SCHEDULED WORK HOURS.—The term 

5 ‘‘scheduled work hours’’ means the hours on a speci6 fied day during which a direct care professional is, 

7 through a written agreement or schedule, required 

8 by a covered entity to perform long-term care serv9 ices for the entity and for which the direct care pro10 fessional will receive compensation for such services. 

11 (b) REQUIREMENT FOR NOTICE OF COVERED DI12 RECT CARE PROFESSIONAL.—In the case of a covered di13 rect care professional, the covered entity shall provide the 

14 covered direct care professional notice of the scheduled 

15 work hours of such covered direct care professional 

16 through— 

17 (1) a written agreement described in subclause 

18 (I) of section 312(d)(1)(F)(iv) regarding a schedule 

19 of the time of day and the days of the week the cov20 ered direct care professional is expected to work for 

21 the covered entity each week; or 

22 (2) a schedule agreed upon by the covered enti23 ty and the covered direct care professional provided 

24 in the amount of time specified in accordance with 

25 a written agreement described in subclause (II) of 


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•S 4120 IS

1 such section, regarding a good faith estimate of the 

2 time of day and the days of the week that the cov3 ered direct care professional is expected to work for 

4 the entity. 

5 (c) REQUIREMENTS FOR CHANGES TO SCHEDULED

6 WORK HOURS AND REPORTING TIME PAY.—A covered 

7 entity shall— 

8 (1) communicate in writing (which may be in 

9 an electronic form) any change to the scheduled 

10 work hours of a direct care professional, including 

11 any on-call shifts, not less than 72 hours before the 

12 direct care professional is scheduled to begin work; 

13 and 

14 (2) pay a direct care professional— 

15 (A) the regular rate of pay of the direct 

16 care professional for any scheduled work hours 

17 the direct care professional does not work due 

18 to the covered entity canceling or reducing the 

19 scheduled work hours of the direct care profes20 sional after the direct care professional arrives 

21 to work for the scheduled work hours; or 

(B) at a rate of 1 22 ⁄2 of the regular rate of 

23 pay of the direct care professional for any 

24 scheduled work hours the direct care profes25 sional does not work due to the covered entity 


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1 canceling or reducing the scheduled work hours 

2 of the direct care professional at a time that is 

3 less than 72 hours prior to the commencement 

4 of such scheduled work hours, unless the enti5 ty— 

6 (i) is an individual with a disability 

7 relying on the direct care professional for 

8 disability supports and services (or an enti9 ty supporting an individual with a dis10 ability); and 

11 (ii) requests the direct care profes12 sional to consent to work alternative, 

13 equivalent scheduled work hours within a 

14 7-day period and the direct care profes15 sional consents to work such alternative, 

16 equivalent hours. 

17 (d) RIGHT TO DECLINE SCHEDULE CHANGES.— 

18 (1) IN GENERAL.—In the case of a covered di19 rect care professional, if a covered entity wishes to 

20 include work hours in the scheduled work hours of 

21 such covered direct care professional that are identi22 fied as hours in which the covered direct care profes23 sional can typically expect to be scheduled as off 

24 from work in accordance with the written agreement 

25 under section 312(d)(1)(F)(iv)(I) or are identified as 


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•S 4120 IS

1 hours outside of the good faith estimate under sec2 tion 312(d)(1)(F)(iv)(II)(cc), the hiring entity shall 

3 obtain the written consent of the worker to work 

4 such hours prior to the commencement of such work. 

5 (2) CONSENT.—The consent required under 

6 paragraph (1) may be transmitted electronically to 

7 the covered entity. 

8 (e) EXCEPTIONS.— 

9 (1) IN GENERAL.—Notwithstanding any provi10 sion in this section, the requirements under sub11 section (c) shall not apply— 

12 (A) during any period in which the oper13 ations of the covered entity cannot begin or 

14 continue due to— 

15 (i) a fire, flood, or other natural dis16 aster; 

17 (ii) a major disaster or emergency de18 clared by the President under section 401 

19 or 501, respectively, of the Robert T. Staf20 ford Disaster Relief and Emergency Assist21 ance Act (42 U.S.C. 5170, 5191) or a 

22 state of emergency declared by a Governor 

23 of a State or chief official of a unit of local 

24 government; or 


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1 (iii) a severe weather condition that 

2 poses a threat to worker safety; or 

3 (B) in a case in which— 

4 (i) the direct care professional volun5 tarily requested in writing a change to the 

6 scheduled work hours of the direct care 

7 professional; or 

8 (ii) the covered entity changes the 

9 scheduled work hours of a direct care pro10 fessional due to— 

11 (I) a medical emergency requir12 ing emergency medical treatment or 

13 hospitalization; or 

14 (II) the risk of contagion or a 

15 quarantine requirement related to a 

16 public health emergency declared by 

17 the Secretary of Health and Human 

18 Services under section 319 of the 

19 Public Health Service Act (42 U.S.C. 

20 247d). 

21 (2) SHARED LIVING ARRANGEMENT.—Notwith22 standing any provision in this section, the require23 ments under this section shall not apply to a shared 

24 living arrangement. 


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1 (f) EFFECTIVE DATE.—This section shall take effect 

2 on the date that is 2 years after the date of enactment 

3 of this Act. 

4 SEC. 314. RIGHT TO REQUEST AND RECEIVE TEMPORARY 

5 CHANGES TO SCHEDULED WORK HOURS DUE 

6 TO PERSONAL EVENTS. 

7 (a) DEFINITIONS.—In this section: 

8 (1) COVERED DIRECT CARE PROFESSIONAL.— 

9 The term ‘‘covered direct care professional’’ has the 

10 meaning given the term in section 312(a). 

11 (2) DOMESTIC VIOLENCE.—The term ‘‘domestic 

12 violence’’ has the meaning given the term in section 

13 331. 

14 (3) PERSONAL EVENT.—The term ‘‘personal 

15 event’’, with respect to a covered direct care profes16 sional, means— 

17 (A) an event resulting in the need of the 

18 covered direct care professional to serve as a 

19 caregiver for an individual related to the cov20 ered direct care professional by blood or affinity 

21 or whose close association with the covered di22 rect care professional is the equivalent of a 

23 family relationship; 

24 (B) an event resulting from the obligation 

25 of a covered direct care professional to attend 


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•S 4120 IS

1 a legal proceeding or hearing for subsistence 

2 benefits, including benefits under the supple3 mental nutrition assistance program established 

4 under the Food and Nutrition Act of 2008 (7 

5 U.S.C. 2011 et seq.) or under a State program 

6 for temporary assistance for needy families es7 tablished under part A of title IV of the Social 

8 Security Act (42 U.S.C. 601 et seq.), to which 

9 the covered direct care professional, or an indi10 vidual related to the covered direct care profes11 sional as described in subparagraph (A), is a 

12 party or witness; or 

13 (C) any circumstance that would constitute 

14 a basis for permissible use of safe time, or fam15 ily, medical, or sick leave, as determined based 

16 on the policy of the covered entity. 

17 (4) SAFE TIME.—The term ‘‘safe time’’, with 

18 respect to a covered direct care professional, means 

19 an absence from work of the covered direct care pro20 fessional resulting from domestic violence, sexual as21 sault, or stalking, if the absence is to— 

22 (A) seek medical attention for the covered 

23 direct care professional or a child, parent, 

24 spouse, or domestic partner of the covered di25 rect care professional, or any other individual 


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•S 4120 IS

1 related to the covered direct care professional 

2 by blood or affinity whose close association with 

3 the covered direct care professional is the equiv4 alent of a family relationship, in order to re5 cover from physical or psychological injury or 

6 disability caused by domestic violence, sexual 

7 assault, or stalking; 

8 (B) obtain, or assist a child, parent, 

9 spouse, domestic partner, or other individual 

10 described in subparagraph (A) in obtaining, 

11 services from a victim services organization; 

12 (C) obtain, or assist a child, parent, 

13 spouse, domestic partner, or other individual 

14 described in subparagraph (A) in obtaining, 

15 psychological or other counseling; 

16 (D) seek relocation for the covered direct 

17 care professional or a child, parent, spouse, do18 mestic partner, or other individual described in 

19 subparagraph (A); or 

20 (E) take legal action, including preparing 

21 for or participating in any civil or criminal legal 

22 proceeding related to or resulting from domestic 

23 violence, sexual assault, or stalking, of the cov24 ered direct care professional or a child, parent, 


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•S 4120 IS

1 spouse, domestic partner, or other individual 

2 described in subparagraph (A). 

3 (5) SCHEDULED WORK HOURS.—The term 

4 ‘‘scheduled work hours’’ has the meaning given such 

5 term in section 313(a), except that references in 

6 such section to the term ‘‘direct care professional’’ 

7 shall be deemed to be a reference to the term ‘‘cov8 ered direct care professional’’. 

9 (6) SEXUAL ASSAULT; STALKING.—The terms 

10 ‘‘sexual assault’’ and ‘‘stalking’’ have the meanings 

11 given such terms in section 331. 

12 (7) TEMPORARY CHANGE.—The term ‘‘tem13 porary change’’, with respect to a change in the 

14 scheduled work hours of a covered direct care pro15 fessional, means a limited alteration in the hours or 

16 dates that, or locations where, a covered direct care 

17 professional is scheduled to work, including through 

18 using paid time off, trading or shifting work hours, 

19 or using short-term unpaid leave. 

20 (b) REQUEST.— 

21 (1) IN GENERAL.—In accordance with this sub22 section, for each calendar year, a covered entity 

23 shall, upon request of a covered direct care profes24 sional, grant to the covered direct care professional 

25 not less than— 


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1 (A) 2 requests for a temporary change, 

2 covering not more than 1 business day per re3 quest, to the scheduled work hours of the cov4 ered direct care professional due to a personal 

5 event; or 

6 (B) 1 request for a temporary change, cov7 ering not more than 2 business days, to the 

8 scheduled work hours of the covered direct care 

9 professional due to a personal event. 

10 (2) NOTIFICATION OF REQUEST.— 

11 (A) IN GENERAL.—A covered direct care 

12 professional who requests a temporary change 

13 to the scheduled work hours of the covered di14 rect care professional due to a personal event 

15 under this subsection shall— 

16 (i) notify the covered entity, or direct 

17 supervisor, of such covered direct care pro18 fessional, as soon as the covered direct 

19 care professional becomes aware of the 

20 need for the temporary change and inform 

21 the entity or supervisor that the change is 

22 due to a personal event; 

23 (ii) make a proposal for the temporary 

24 change to the scheduled work hours of the 

25 covered direct care professional, unless the 


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•S 4120 IS

1 covered direct care professional seeks leave 

2 without pay; and 

3 (iii) subject to subparagraph (B), not 

4 be required to initially submit the request 

5 in writing. 

6 (B) WRITTEN RECORD.— 

7 (i) IN GENERAL.—A covered direct 

8 care professional that requests a temporary 

9 change to the scheduled work hours of the 

10 covered direct care professional under this 

11 subsection and does not initially submit a 

12 request for such change in writing shall, as 

13 soon as practicable and not later than 2 

14 business days after date on which the cov15 ered direct care professional returns to 

16 work following the conclusion of the tem17 porary change to the scheduled work 

18 hours, submit a written record of such re19 quest indicating— 

20 (I) the date for which the change 

21 was requested; and 

22 (II) that the request was made 

23 due to a personal event. 

24 (ii) ELECTRONIC MEANS.—A covered 

25 entity may require that a record under this 


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•S 4120 IS

1 subparagraph be submitted in electronic 

2 form if covered direct care professionals of 

3 the entity commonly use an electronic form 

4 to request and manage leave and schedule 

5 changes. 

6 (c) RESPONSE.—A covered entity who receives a re7 quest under subsection (b) for a temporary change to the 

8 scheduled work hours of a covered direct care professional 

9 due to a personal event shall respond as soon as prac10 ticable. Such entity shall not be initially required to re11 spond to such request in writing. If such entity does not 

12 initially respond to the requested schedule change in writ13 ing, the entity shall, as soon as practicable and not later 

14 than 1 week after the requested schedule change, provide 

15 the direct care professional with a written record of the 

16 response to the requested schedule change. 

17 (d) EFFECTIVE DATE.—This section shall take effect 

18 on the date that is 2 years after the date of enactment 

19 of this Act. 

20 SEC. 315. PRIVACY. 

21 (a) IN GENERAL.—A covered entity shall not— 

22 (1) monitor or record a direct care professional 

23 while such direct care professional is— 

24 (A) using restroom or bathing facilities; 


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1 (B) in the private living quarters of the di2 rect care professional; or 

3 (C) engaging in any activities associated 

4 with the dressing, undressing, or changing of 

5 clothes of the direct care professional; 

6 (2) subject to subsection (b), restrict or inter7 fere with, or monitor, the private communications of 

8 such direct care professional; or 

9 (3) take possession of any documents or other 

10 personal effects of such direct care professional. 

11 (b) PRIVATE COMMUNICATIONS.—A covered entity 

12 may— 

13 (1) restrict, interfere with, or monitor the pri14 vate communications of a direct care professional if 

15 the entity has a reasonable belief that such commu16 nications significantly interfere with the direct care 

17 professional’s performance of expected duties; and 

18 (2) establish reasonable restrictions on the pri19 vate communications of a direct care professional 

20 while such direct care professional is performing 

21 work for the entity. 

22 (c) RELATION TO OTHER LAWS.—This section shall 

23 not preclude liability under any other law. 

24 (d) DEFINITION OF PRIVATE COMMUNICATIONS.—In 

25 this section, the term ‘‘private communications’’ means 


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1 any communication through telephone or internet services, 

2 including sending and receiving communications by text 

3 message, social media, electronic mail, and telephone, with 

4 an entity or individual other than the covered entity. 

5 SEC. 316. BREAKS FOR MEALS AND REST. 

6 (a) MEAL BREAKS.— 

7 (1) IN GENERAL.—Except as provided in sub8 section (c), a covered entity shall not require a direct 

9 care professional to work more than 5 hours for 

10 such hiring entity without an uninterrupted meal 

11 break of not less than 30 minutes. The number of 

12 hours worked by a direct care professional for pur13 poses of this paragraph shall be calculated without 

14 regard to any rest break the direct care professional 

15 takes and to which the direct care professional has 

16 a right under subsection (b). 

17 (2) RATE OF PAY.—A covered entity shall pay 

18 a direct care professional for a meal break under 

19 paragraph (1) at the regular rate of pay of the di20 rect care professional, unless the direct care profes21 sional is relieved of all duty for not less than 30 

22 minutes during the meal break and is permitted to 

23 leave the work site during such break. 


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1 (3) PAID MEAL BREAK.—Except as provided in 

2 subsection (c), for any paid meal break required 

3 under paragraph (2), a covered entity— 

4 (A) shall provide a reasonable opportunity 

5 for a direct care professional to take such break 

6 for a period of uninterrupted time that is not 

7 less than 30 minutes; and 

8 (B) shall not impede or discourage a direct 

9 care professional from taking such meal break. 

10 (b) REST BREAKS.— 

11 (1) IN GENERAL.—Except as provided in sub12 section (c), for every 4 hours of work that a direct 

13 care professional is scheduled to perform for a cov14 ered entity, the entity shall allow the direct care pro15 fessional a rest break of not less than 10 uninter16 rupted minutes in which the direct care professional 

17 is relieved of all duties related to providing long18 term care services to the entity. The entity shall 

19 allow such rest break to occur during the first 3 

20 hours of consecutive work performed by the direct 

21 care professional for the entity. 

22 (2) RATE OF PAY.—A covered entity shall pay 

23 a direct care professional for the times spent by the 

24 direct care professional for a rest break under para25 graph (1) at the regular rate of pay of the direct 


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1 care professional. The hiring entity shall not impede 

2 or discourage a direct care professional from taking 

3 such break. 

4 (c) EXCEPTIONS.— 

5 (1) IN GENERAL.—Subject to paragraph (2), a 

6 direct care professional may not have the right to a 

7 meal break under subsection (a), or a rest break 

8 under subsection (b), in a case in which the safety 

9 of an individual under the care of the direct care 

10 professional prevents the direct care professional 

11 from taking such break. 

12 (2) ON-DUTY BREAKS.— 

13 (A) DEFINITION OF ON-DUTY.—In this 

14 subsection, the term ‘‘on-duty’’, with respect to 

15 a meal break under subsection (a) or a rest 

16 break under subsection (b), means such a break 

17 in which the direct care professional— 

18 (i) is not relieved of all duties of the 

19 direct care professional for the covered en20 tity; and 

21 (ii) may, to the extent possible given 

22 the duties of the direct care professional 

23 for the covered entity, engage in personal 

24 activities, such as resting, eating a meal, 

25 drinking a beverage, making a personal 


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1 telephone call, or making other personal 

2 choices. 

3 (B) AUTHORIZATION.— 

4 (i) IN GENERAL.—In a case described 

5 in paragraph (1), the direct care profes6 sional may still take an on-duty meal or 

7 rest break under subsection (a) or (b), re8 spectively, if— 

9 (I) the nature of the work pre10 vents a direct care professional from 

11 being relieved of all duties required of 

12 the direct care professional for the 

13 covered entity; and 

14 (II) the direct care professional 

15 and the covered entity agree to such 

16 an on-duty meal or rest break in a 

17 written agreement described in clause 

18 (ii). 

19 (ii) WRITTEN AGREEMENT.—The 

20 written agreement under clause (i)(II) 

21 shall include a provision allowing the direct 

22 care professional to, in writing, revoke the 

23 agreement at any time. 

24 (C) RATE OF PAY.—A covered entity shall 

25 compensate a direct care professional for the 


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1 time of an on-duty meal or rest break under 

2 this paragraph at the regular rate of pay of the 

3 direct care professional for the entity. 

4 (3) SHARED LIVING ARRANGEMENT.—The re5 quirements under this section shall not apply in the 

6 case of a shared living arrangement. 

7 SEC. 317. PROHIBITED ACTS. 

8 (a) INTERFERENCE WITH RIGHTS.—It shall be un9 lawful for any person to interfere with, restrain, or deny 

10 the exercise of, or the attempt to exercise, any right pro11 vided under this subtitle, including— 

12 (1) discharging or in any manner discrimi13 nating against (including retaliating against) any di14 rect care professional for— 

15 (A) exercising, or attempting to exercise, 

16 any right provided under this subtitle; or 

17 (B) engaging in concerted activities for the 

18 purpose of collective bargaining or mutual aid 

19 or protection, regardless of whether such activi20 ties are with direct care professionals of dif21 ferent employers or direct care professionals at 

22 different worksites; and 

23 (2) discriminating against any direct care pro24 fessional by using the exercise of a right provided 

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1 ment action, such as an action involving hiring, pro2 motion, or changing work hours or number of shifts, 

3 or a disciplinary action. 

4 (b) RETALIATION PROTECTION.—It shall be unlawful 

5 for any covered entity to discharge, demote, suspend, re6 duce the work hours of, take any other adverse employ7 ment action against, threaten to take an adverse employ8 ment action against, or in any other manner discriminate 

9 against a direct care professional with respect to com10 pensation, terms, conditions, or privileges of employment 

11 because the direct care professional (or any person acting 

12 pursuant to the request of the direct care professional), 

13 whether at the initiative of the direct care professional or 

14 in the ordinary course of the direct care professional’s du15 ties— 

16 (1) opposes any practice made unlawful under 

17 this subtitle; 

18 (2) asserts any claim or right under this sub19 title; 

20 (3) assists a direct care professional in assert21 ing such claim or right; 

22 (4) informs any direct care professional about 

23 this subtitle; 

24 (5) requests a change to the written agreement 

25 described in section 312; 


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1 (6) requests a change in scheduled work hours 

2 described in section 314, or any other schedule 

3 change, without regard to the eligibility of such di4 rect care professional to receive any such change; 

5 (7)(A) files an action, or institutes or causes to 

6 be instituted any proceeding, under or related to this 

7 subtitle; 

8 (B) gives, or is about to give, any information 

9 in connection with any inquiry or proceeding relating 

10 to any right provided under this subtitle; or 

11 (C) testifies, or is about to testify, in any in12 quiry or proceeding relating to any right provided 

13 under this subtitle; and 

14 (8) engages in concerted activities for the pur15 pose of collective bargaining or mutual aid or protec16 tion, regardless of whether such activities are with 

17 direct care professionals of different employers or di18 rect care professionals at different worksites. 

19 (c) IMMIGRATION-RELATED ACTIONS AS DISCRIMI20 NATION.—For purposes of subsections (a) and (b), dis21 crimination with respect to compensation, terms, condi22 tions, or privileges of employment occurs if a person un23 dertakes any of the following activities (unless such activ24 ity is legal conduct undertaken at the express and specific 

25 direction or request of the Federal Government): 


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1 (1) Reporting, or threatening to report, the citi2 zenship or immigration status of a direct care pro3 fessional, or the suspected citizenship or immigration 

4 status of a family member of such an individual, to 

5 a Federal, State, or local agency. 

6 (2) Requesting more or different documents 

7 than those required under section 274A(b) of the 

8 Immigration and Nationality Act (8 U.S.C. 

9 1324a(b)), or refusing to honor documents that on 

10 their face appear to be genuine. 

11 (3) Using the Federal E-Verify system to check 

12 employment status in a manner not required under 

13 section 274A(b) of the Immigration and Nationality 

14 Act (8 U.S.C. 1324a(b)) or any memorandum gov15 erning use of the E-Verify system. 

16 (4) Filing, or threatening to file, a false police 

17 report relating to the immigration status of a direct 

18 care professional, or a family member of a direct 

19 care professional. 

20 (5) Contacting, or threatening to contact, immi21 gration authorities relating to the immigration sta22 tus of a direct care professional, or a family member 

23 of a direct care professional. 

24 (d) PRESUMPTION OF RETALIATION.— 


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1 (1) IN GENERAL.—For the purposes of sub2 sections (a) and (b), proof that a person discharged 

3 an individual, or discriminated against an individual 

4 with respect to compensation, terms, conditions, or 

5 privileges of employment, within 90 days of the indi6 vidual involved asserting any claim or right under 

7 this subtitle, or assisting any other individual in as8 serting such a claim or right, shall raise a presump9 tion that the discharge or discrimination was in re10 taliation as prohibited under subsection (a) or (b), 

11 as the case may be. 

12 (2) REBUTTAL.—The presumption under para13 graph (1) may be rebutted by clear and convincing 

14 evidence that such discharge or discrimination was 

15 taken for another permissible reason. 

16 SEC. 318. ENFORCEMENT AUTHORITY. 

17 (a) IN GENERAL.— 

18 (1) APPLICATION.—In this subsection— 

19 (A) the term ‘‘covered entity’’ means a 

20 covered entity described in subsection (e)(1)(A); 

21 and 

22 (B) the term ‘‘direct care professional’’ 

23 means a direct care professional described in 

24 subsection (e)(4)(A). 

25 (2) INVESTIGATIVE AUTHORITY.— 


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1 (A) IN GENERAL.—To ensure compliance 

2 with the provisions of this subtitle, or any regu3 lation or order issued under this subtitle, the 

4 Secretary shall have the investigative authority 

5 provided under section 11(a) of the Fair Labor 

6 Standards Act of 1938 (29 U.S.C. 211(a)), 

7 with respect to covered entities, direct care pro8 fessionals, and other individuals affected. 

9 (B) OBLIGATION TO KEEP AND PRESERVE

10 RECORDS.—A covered entity shall make, keep, 

11 and preserve records pertaining to compliance 

12 with this subtitle in accordance with section 

13 11(c) of the Fair Labor Standards Act of 1938 

14 (29 U.S.C. 211(c)) and in accordance with reg15 ulations prescribed by the Secretary. 

16 (C) REQUIRED SUBMISSIONS GENERALLY

17 LIMITED TO AN ANNUAL BASIS.—The Secretary 

18 shall not require under this paragraph a cov19 ered entity to submit to the Secretary any 

20 books or records more than once during any 12- 

21 month period, unless the Secretary— 

22 (i) has reasonable cause to believe 

23 there may exist a violation of this subtitle, 

24 including any regulation or order issued 

25 under this subtitle; or 


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1 (ii) is investigating a charge under 

2 paragraph (4). 

3 (D) SUBPOENA AUTHORITY.—For the pur4 poses of any investigation under this paragraph, 

5 the Secretary shall have the subpoena authority 

6 provided under section 9 of the Fair Labor 

7 Standards Act of 1938 (29 U.S.C. 209). 

8 (3) CIVIL ACTION BY DIRECT CARE PROFES9 SIONALS.— 

10 (A) RIGHT OF ACTION.—An action to re11 cover the damages or equitable relief prescribed 

12 in subparagraph (B) may be maintained 

13 against a covered entity by one or more direct 

14 care professionals, or a representative for and 

15 on behalf of the direct care professionals and 

16 any other direct care professionals that may be 

17 similarly situated. 

18 (B) LIABILITY.—A covered entity that vio19 lates this subtitle shall be liable to a direct care 

20 professional aggrieved by the violation, except 

21 as provided in subparagraphs (C) and (D), 

22 for— 

23 (i) damages equal to— 

24 (I) the amount of— 


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1 (aa) any wages, salary, em2 ployment benefits, or other com3 pensation denied or lost by rea4 son of the violation; or 

5 (bb) in a case in which 

6 wages, salary, employment bene7 fits, or other compensation have 

8 not been denied or lost, any ac9 tual monetary losses sustained, 

10 or the costs reasonably related to 

11 damage to or loss of property, or 

12 any other injury to the person, 

13 reputation, character, or feelings, 

14 sustained by a direct care profes15 sional as a direct result of the 

16 violation, or any injury to an17 other person sustained as a di18 rect result of the violation, by the 

19 covered entity; 

20 (II) the interest on the amount 

21 described in subclause (I) calculated 

22 at the prevailing rate; 

23 (III) an additional amount as liq24 uidated damages; and 


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1 (IV) such other legal relief as 

2 may be appropriate; 

3 (ii) such equitable relief as may be ap4 propriate, including employment, reinstate5 ment, and promotion; and 

6 (iii) a reasonable attorney’s fee, rea7 sonable expert witness fees, and other costs 

8 of the action. 

9 (C) MEAL AND REST BREAKS.—In the case 

10 of a violation of section 316, the covered entity 

11 involved shall be liable under subparagraph 

12 (B)— 

13 (i) for the amount of damages de14 scribed in subclauses (I), (II), and (III) of 

15 subparagraph (B)(i); and 

16 (ii) under subparagraph (B)(i)(IV), 

17 for each such violation, for an amount 

18 equal to 1 hour of pay at the direct care 

19 professional’s regular rate of compensation 

20 (but not more than 2 hours of such pay for 

21 each workday for which the covered entity 

22 is in violation of such section). 

23 (D) WRITTEN AGREEMENTS.—In the case 

24 of a violation of section 312, the covered entity 


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1 involved shall be liable, under subparagraph 

2 (B)(i)(I), for an amount equal to $5,000. 

3 (E) VENUE.—An action under this para4 graph may be maintained in any Federal or 

5 State court of competent jurisdiction. 

6 (4) ACTION BY THE SECRETARY.— 

7 (A) ADMINISTRATIVE ACTION.— 

8 (i) IN GENERAL.—Subject to clause 

9 (ii), and subparagraphs (C) and (D) of 

10 paragraph (3), the Secretary shall receive, 

11 investigate, and attempt to resolve com12 plaints of violations of this subtitle in the 

13 same manner that the Secretary receives, 

14 investigates, and attempts to resolve com15 plaints of violations of sections 6, 7, and 

16 15(a)(3) of the Fair Labor Standards Act 

17 of 1938 (29 U.S.C. 206, 207, and 

18 215(a)(3)), including the Secretary’s au19 thority to supervise payment of wages and 

20 compensation under section 16(c) of the 

21 Fair Labor Standards Act of 1938 (29 

22 U.S.C. 216(c)). 

23 (ii) VIOLATIONS GENERALLY.—The 

24 Secretary may assess a civil penalty 


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1 against a covered entity that violates any 

2 section of this subtitle— 

3 (I) of not more than $15,000 for 

4 any first violation of any such section 

5 by such covered entity; and 

6 (II) of not more than $25,000 

7 for any subsequent violation of any 

8 such section by such covered entity. 

9 (B) ADMINISTRATIVE REVIEW.—Any ag10 grieved direct care professional who takes ex11 ception to an order issued by the Secretary 

12 under subparagraph (A) may request review of 

13 and a decision regarding such order by an ad14 ministrative law judge. In reviewing the order, 

15 the administrative law judge may hold an ad16 ministrative hearing concerning the order, in 

17 accordance with the requirements of sections 

18 554, 556, and 557 of title 5, United States 

19 Code. Such hearing shall be conducted expedi20 tiously. If no aggrieved direct care professional 

21 requests such review within 60 days after the 

22 order is issued under subparagraph (A), the 

23 order shall be considered to be a final order 

24 that is not subject to judicial review. 


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1 (C) CIVIL ACTION.—The Secretary may 

2 bring an action in any court of competent juris3 diction to recover amounts described in para4 graph (3)(B) on behalf of a direct care profes5 sional aggrieved by a violation of this subtitle. 

6 (D) SUMS RECOVERED.— 

7 (i) IN GENERAL.—Any sums recovered 

8 by the Secretary under subparagraph (C) 

9 shall be held in a special deposit account 

10 and shall be paid, on order of the Sec11 retary, directly to each direct care profes12 sional aggrieved by the violation for which 

13 the action was brought. Any such sums not 

14 paid to a direct care professional because 

15 of inability to do so within a period of 3 

16 years shall be deposited into the Treasury 

17 of the United States as a miscellaneous re18 ceipt. 

19 (ii) CIVIL PENALTY.—Any sums re20 covered by the Secretary under subpara21 graph (A)(ii) shall be deposited into the 

22 general fund of the Treasury of the United 

23 States as a miscellaneous receipt. 

24 (5) LIMITATION.— 


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1 (A) IN GENERAL.—Except as provided in 

2 subparagraph (B), an action may be brought 

3 under paragraph (3), (4), or (6) not later than 

4 2 years after the date of the last event consti5 tuting the alleged violation for which the action 

6 is brought. 

7 (B) WILLFUL VIOLATION.—In the case of 

8 an action brought for a willful violation of this 

9 subtitle, such action may be brought not later 

10 than 3 years after the date of the last event 

11 constituting the alleged violation for which such 

12 action is brought. 

13 (C) COMMENCEMENT.—An action shall be 

14 considered commenced under paragraph (3), 

15 (4), or (6) for the purposes of this paragraph 

16 on the date on which the complaint is filed 

17 under such paragraph (3), (4), or (6). 

18 (6) ACTION FOR INJUNCTION.—The district 

19 courts of the United States together with the Dis20 trict Court of the Virgin Islands and the District 

21 Court of Guam shall have jurisdiction, for cause 

22 shown, in an action brought by a direct care profes23 sional or the Secretary— 

24 (A) to restrain violations of this subtitle, 

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1 ment from a direct care professional as required 

2 under section 312, or of any withholding of 

3 payment of wages, salary, employment benefits, 

4 or other compensation, plus interest, found by 

5 the court to be due to a direct care professional 

6 under this subtitle; or 

7 (B) to award such other equitable relief as 

8 may be appropriate, including employment, re9 instatement, and promotion, for a violation of 

10 this subtitle. 

11 (7) SOLICITOR OF LABOR.—The Solicitor of 

12 Labor may appear for and represent the Secretary 

13 on any litigation brought under paragraph (4) or 

14 (6). 

15 (8) GOVERNMENT ACCOUNTABILITY OFFICE

16 AND LIBRARY OF CONGRESS.—Notwithstanding any 

17 other provision of this subsection, in the case of the 

18 Government Accountability Office and the Library of 

19 Congress, the authority of the Secretary of Labor 

20 under this subsection shall be exercised respectively 

21 by the Comptroller General of the United States and 

22 the Librarian of Congress. 

23 (b) EMPLOYEES COVERED BY CONGRESSIONAL AC24 COUNTABILITY ACT OF 1995.—The powers, remedies, and 

25 procedures provided in the Congressional Accountability 


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1 Act of 1995 (2 U.S.C. 1301 et seq.) to the Board (as de2 fined in section 101 of that Act (2 U.S.C. 1301)), or any 

3 person, alleging a violation of section 202(a)(1) of that 

4 Act (2 U.S.C. 1312(a)(1)) shall be the powers, remedies, 

5 and procedures this Act provides to that Board, or any 

6 person, alleging an unlawful employment practice in viola7 tion of this subtitle against a direct care professional de8 scribed in subsection (e)(4)(B). 

9 (c) EMPLOYEES COVERED BY CHAPTER 5 OF TITLE

10 3, UNITED STATES CODE.—The powers, remedies, and 

11 procedures provided in chapter 5 of title 3, United States 

12 Code, to the President, the Merit Systems Protection 

13 Board, or any person, alleging a violation of section 

14 412(a)(1) of that title, shall be the powers, remedies, and 

15 procedures this Act provides to the President, that Board, 

16 or any person, respectively, alleging an unlawful employ17 ment practice in violation of this subtitle against a direct 

18 care professional described in subsection (e)(4)(C). 

19 (d) EMPLOYEES COVERED BY CHAPTER 63 OF TITLE

20 5, UNITED STATES CODE.—The powers, remedies, and 

21 procedures provided in title 5, United States Code, to an 

22 employing agency, provided in chapter 12 of that title to 

23 the Merit Systems Protection Board, or provided in that 

24 title to any person, alleging a violation of chapter 63 of 

25 that title, shall be the powers, remedies, and procedures 


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1 this Act provides to that agency, that Board, or any per2 son, respectively, alleging an unlawful employment prac3 tice in violation of this subtitle against a direct care pro4 fessional described in subsection (e)(4)(D). 

5 (e) DEFINITION.—In section 317 and this section, ex6 cept as otherwise provided in this subsection: 

7 (1) COVERED ENTITY.—Notwithstanding sec8 tion 311, the term ‘‘covered entity’’ means a covered 

9 entity— 

10 (A) as defined in section 311(b) except 

11 that a reference in that section to a person or 

12 an employer shall be considered to be a ref13 erence to an employer described in clause (i) or 

14 (ii) of subparagraph (A), and subparagraph 

15 (B), of paragraph (2); 

16 (B) as defined in section 311(b) except 

17 that a reference in that section to a person or 

18 an employer shall be considered to be a ref19 erence to an employer described in subpara20 graphs (A)(iii) and (B) of paragraph (2); 

21 (C) as defined in section 311(b) except 

22 that a reference in that section to a person or 

23 an employer shall be considered to be a ref24 erence to an employer described in subpara25 graphs (A)(iv) and (B) of paragraph (2); and 


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1 (D) as defined in section 311(b) except 

2 that a reference in that section to a person or 

3 an employer shall be considered to be a ref4 erence to an employer described in subpara5 graphs (A)(v) and (B) of paragraph (2). 

6 (2) EMPLOYER.—Notwithstanding section 311, 

7 for purposes of paragraph (1), the term ‘‘employer’’ 

8 means a person who is— 

9 (A)(i) any person who is not covered under 

10 another clause of this subparagraph; 

11 (ii) an entity employing a State employee 

12 described in section 304(a) of the Government 

13 Employee Rights Act of 1991; 

14 (iii) an employing office, as defined in sec15 tion 101 of the Congressional Accountability 

16 Act of 1995; 

17 (iv) an employing office, as defined in sec18 tion 411(c) of title 3, United States Code; or 

19 (v) an employing agency covered under 

20 subchapter V of chapter 63 of title 5, United 

21 States Code; and 

22 (B) engaged in commerce or the produc23 tion of goods for commerce or is an enterprise 

24 engaged in commerce or in the production of 

25 goods for commerce. 


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1 (3) EMPLOYMENT.—Notwithstanding section 3, 

2 the term ‘‘employment’’ includes work as a direct 

3 care professional. 

4 (4) DIRECT CARE PROFESSIONAL.—Notwith5 standing section 3, the term ‘‘direct care profes6 sional’’ means— 

7 (A) direct care professional (as defined in 

8 such section) who is compensated for the per9 formance of long-term care services by an entity 

10 described in paragraph (1)(A); 

11 (B) direct care professional (as defined in 

12 such section) who is compensated for the per13 formance of long-term care services by an entity 

14 described in paragraph (1)(B); 

15 (C) direct care professional (as defined in 

16 such section) who is compensated for the per17 formance of long-term care services by an entity 

18 described in paragraph (1)(C); and 

19 (D) direct care professional (as defined in 

20 such section) who is compensated for the per21 formance of long-term care services by an entity 

22 described in paragraph (1)(D). 

23 SEC. 319. EFFECT ON EXISTING EMPLOYMENT BENEFITS 

24 AND OTHER LAWS. 

25 (a) IN GENERAL.—Nothing in this subtitle shall— 


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1 (1) supersede a provision in a collective bar2 gaining agreement; 

3 (2) be construed to diminish the obligation of a 

4 covered entity to comply with any contract, collective 

5 bargaining agreement, or employment benefit pro6 gram or plan that provides greater rights or benefits 

7 to direct care professionals than the rights estab8 lished under this subtitle; or 

9 (3) be construed to discourage or prevent a cov10 ered entity from adopting a contract, collective bar11 gaining agreement, or employment benefit program 

12 or plan that provides greater rights or benefits to di13 rect care professionals than the rights established 

14 under this subtitle. 

15 (b) OTHER LAWS.—Nothing in this subtitle shall— 

16 (1) affect the obligation of a covered entity to 

17 provide a reasonable accommodation in the form of 

18 a change to the work schedule of a direct care pro19 fessional required under any other law, or to other20 wise comply with any other law; 

21 (2) preempt, limit, or otherwise affect the appli22 cability of any State or local law that provides com23 parable or superior benefits for direct care profes24 sionals to the requirements under this subtitle; or 


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1 (3) diminish the rights, privileges, or remedies 

2 of any direct care professional under any Federal or 

3 State law or under any collective bargaining agree4 ment. 

5 (c) NO WAIVERS.—The rights and remedies in this 

6 subtitle may not be waived by a direct care professional 

7 through any agreement, policy, or form, or as a condition 

8 of employment. 

9 Subtitle C—Workplace Violence 

10 Prevention for Health Care and 

11 Social Services Workers Act 

12 SEC. 321. WORKPLACE VIOLENCE PREVENTION STANDARD. 

13 (a) INTERIM FINAL STANDARD.— 

14 (1) IN GENERAL.—Not later than 1 year after 

15 the date of enactment of this Act, the Secretary of 

16 Labor shall issue an interim final standard on work17 place violence prevention— 

18 (A) to require certain employers in the 

19 health care and social service sectors, and cer20 tain employers in sectors that conduct activities 

21 similar to the activities in the health care and 

22 social service sectors, to develop and implement 

23 a comprehensive workplace violence prevention 

24 plan and carry out other activities or require25 ments described in section 323 to protect health 


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1 care workers, social service workers, and other 

2 personnel from workplace violence; 

3 (B) that shall, at a minimum, be based on 

4 the Guidelines for Preventing Workplace Vio5 lence for Healthcare and Social Service Work6 ers published by the Occupational Safety and 

7 Health Administration of the Department of 

8 Labor in 2015 and adhere to the requirements 

9 of this subtitle; and 

10 (C) that provides for a period determined 

11 appropriate by the Secretary, not to exceed 1 

12 year, during which the Secretary shall prioritize 

13 technical assistance and advice consistent with 

14 section 21(d) of the Occupational Safety and 

15 Health Act of 1970 (29 U.S.C. 670(d)) to em16 ployers subject to the standard with respect to 

17 compliance with the standard. 

18 (2) INAPPLICABLE PROVISIONS OF LAW AND

19 EXECUTIVE ORDER.—The following provisions of law 

20 and Executive orders shall not apply to the issuance 

21 of the interim final standard under this subsection: 

22 (A) The requirements applicable to occupa23 tional safety and health standards under section 

24 6(b) of the Occupational Safety and Health Act 

25 of 1970 (29 U.S.C. 655(b)). 


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1 (B) The requirements of chapters 5 and 6 

2 of title 5, United States Code. 

3 (C) Subchapter I of chapter 35 of title 44, 

4 United States Code (commonly referred to as 

5 the ‘‘Paperwork Reduction Act’’). 

6 (D) Executive Order No. 12866 (58 Fed. 

7 Reg. 51735; relating to regulatory planning and 

8 review), as amended. 

9 (3) NOTICE AND COMMENT.—Notwithstanding 

10 paragraph (2)(B), the Secretary shall, prior to 

11 issuing the interim final standard under this sub12 section, provide notice in the Federal Register of the 

13 interim final standard and a 30-day period for pub14 lic comment. 

15 (4) EFFECTIVE DATE OF INTERIM STAND16 ARD.—The interim final standard shall— 

17 (A) take effect on a date that is not later 

18 than 30 days after issuance, except that such 

19 interim final standard may include a reasonable 

20 phase-in period for the implementation of re21 quired engineering controls that take effect 

22 after such date; 

23 (B) be enforced in the same manner and 

24 to the same extent as any standard promul25 gated under section 6(b) of the Occupational 


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1 Safety and Health Act of 1970 (29 U.S.C. 

2 655(b)); and 

3 (C) be in effect until the final standard de4 scribed in subsection (b) becomes effective and 

5 enforceable. 

6 (5) FAILURE TO PROMULGATE.—If an interim 

7 final standard described in paragraph (1) is not 

8 issued not later than 1 year of the date of enactment 

9 of this Act, the provisions of section 323 shall be in 

10 effect and enforced in the same manner and to the 

11 same extent as any standard promulgated under sec12 tion 6(b) of the Occupational Safety and Health Act 

13 of 1970 (29 U.S.C. 655(b)) until such provisions are 

14 superseded in whole by an interim final standard 

15 issued by the Secretary that meets the requirements 

16 of paragraph (1). 

17 (b) FINAL STANDARD.— 

18 (1) PROPOSED STANDARD.—Not later than 2 

19 years after the date of enactment of this Act, the 

20 Secretary of Labor shall, pursuant to section 6 of 

21 the Occupational Safety and Health Act of 1970 (29 

22 U.S.C. 655), promulgate a proposed standard on 

23 workplace violence prevention— 

24 (A) for the purposes described in sub25 section (a)(1)(A); and 


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1 (B) that shall include, at a minimum, re2 quirements contained in the interim final stand3 ard required under subsection (a). 

4 (2) FINAL STANDARD.—Not later than 42 

5 months after the date of enactment of this Act, the 

6 Secretary shall issue a final standard on such pro7 posed standard that shall— 

8 (A) provide no less protection than any 

9 workplace violence standard adopted by a State 

10 plan that has been approved by the Secretary 

11 under section 18 of the Occupational Safety 

12 and Health Act of 1970 (29 U.S.C. 667), pro13 vided the Secretary finds that the final stand14 ard is feasible on the basis of the best available 

15 evidence; and 

16 (B) be effective and enforceable in the 

17 same manner and to the same extent as any 

18 standard promulgated under section 6(b) of the 

19 Occupational Safety and Health Act of 1970 

20 (29 U.S.C. 655(b)). 

21 SEC. 322. SCOPE AND APPLICATION. 

22 In this subtitle: 

23 (1) COVERED FACILITY.— 

24 (A) IN GENERAL.—The term ‘‘covered fa25 cility’’ means the following: 


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1 (i) Any hospital, including any spe2 cialty hospital, in-patient or outpatient set3 ting, or clinic operating within a hospital 

4 license, or any setting that provides out5 patient services. 

6 (ii) Any residential treatment facility, 

7 including any nursing home, skilled nurs8 ing facility, hospice facility, Alzheimer’s 

9 and dementia care facility, or other long10 term care facility. 

11 (iii) Any nonresidential treatment or 

12 service setting. 

13 (iv) Any medical treatment or social 

14 service setting or clinic at a correctional or 

15 detention facility. 

16 (v) Any community care setting, in17 cluding a community-based residential fa18 cility, group home, and mental health clin19 ic. 

20 (vi) Any psychiatric treatment facility. 

21 (vii) Any drug abuse or substance use 

22 disorder treatment center. 

23 (viii) Any independent freestanding 

24 emergency center. 

25 (ix) Any assisted living facility. 


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1 (x) Any provider of home and commu2 nity-based services. 

3 (xi) Any facility described in clauses 

4 (i) through (x) operated by a Federal Gov5 ernment agency and required to comply 

6 with occupational safety and health stand7 ards pursuant to part 1960 of title 29, 

8 Code of Federal Regulations (as such part 

9 is in effect on the date of enactment of this 

10 Act). 

11 (xii) Any other facility the Secretary 

12 determines should be covered under the 

13 standards promulgated under section 321. 

14 (B) EXCLUSION.—The term ‘‘covered facil15 ity’’ does not include an office of a physician, 

16 dentist, podiatrist, or any other health practi17 tioner that is not physically located within a 

18 covered facility described in clauses (i) through 

19 (xi) of subparagraph (A). 

20 (2) COVERED SERVICES.— 

21 (A) IN GENERAL.—The term ‘‘covered 

22 service’’ means the following services and oper23 ations: 

24 (i) Any services and operations pro25 vided in any field work setting, including 


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1 home health care, home-based hospice, and 

2 home-based social work. 

3 (ii) Any emergency services and trans4 port, including such services provided by 

5 firefighters and emergency responders. 

6 (iii) Any services described in clauses 

7 (i) and (ii) performed by a Federal Gov8 ernment agency and required to comply 

9 with occupational safety and health stand10 ards pursuant to part 1960 of title 29, 

11 Code of Federal Regulations (as such part 

12 is in effect on the date of enactment of this 

13 Act). 

14 (iv) Any other services and operations 

15 the Secretary determines should be covered 

16 under the standards promulgated under 

17 section 321. 

18 (B) EXCLUSION.—The term ‘‘covered serv19 ice’’ does not include child day care services. 

20 (3) COVERED EMPLOYER.— 

21 (A) IN GENERAL.—The term ‘‘covered em22 ployer’’ includes a person (including a con23 tractor, a subcontractor, a temporary service 

24 firm, or an employee leasing entity) that emVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 ploys an individual to work at a covered facility 

2 or to perform covered services. 

3 (B) EXCLUSION.—The term ‘‘covered em4 ployer’’ does not include an individual who pri5 vately employs, in the individual’s residence, a 

6 person to perform covered services for the indi7 vidual or a family member of the individual or 

8 an individual who receives home and commu9 nity-based services through a self-directed or 

10 participant-directed Medicaid waiver. 

11 (4) COVERED EMPLOYEE.—The term ‘‘covered 

12 employee’’ includes an individual employed by a cov13 ered employer to work at a covered facility or to per14 form covered services. 

15 SEC. 323. REQUIREMENTS FOR WORKPLACE VIOLENCE 

16 PREVENTION STANDARD. 

17 Each standard described in section 321 shall include, 

18 at a minimum, the following: 

19 (1) WORKPLACE VIOLENCE PREVENTION

20 PLAN.—Not later than 6 months after the date of 

21 promulgation of the interim final standard under 

22 section 321(a), or 18 months after the date of enact23 ment of this Act in a case described in section 

24 321(a)(5), a covered employer shall develop, imple25 ment, and maintain an effective written workplace 


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1 violence prevention plan (in this section referred to 

2 as the ‘‘Plan’’) for covered employees at each cov3 ered facility and for covered employees performing a 

4 covered service on behalf of such employer, which 

5 meets the following: 

6 (A) PLAN DEVELOPMENT.—Each Plan— 

7 (i) shall be developed and imple8 mented with the meaningful participation 

9 of direct care professionals, other employ10 ees, and employee representatives, for all 

11 aspects of the Plan; 

12 (ii) shall be tailored and specific to 

13 conditions and hazards for the covered fa14 cility or the covered service, including pa15 tient-specific risk factors and risk factors 

16 specific to each work area or unit; 

17 (iii) shall be suitable for the size, com18 plexity, and type of operations at the cov19 ered facility or for the covered service, and 

20 remain in effect at all times; and 

21 (iv) may be in consultation with stake22 holders or experts who specialize in work23 place violence prevention, emergency re24 sponse, or other related areas of expertise 

25 for all relevant aspects of the Plan. 


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1 (B) PLAN CONTENT.—Each Plan shall in2 clude procedures and methods for the following: 

3 (i) Identification of the individual (in4 cluding the individual’s role with respect to 

5 the covered employer) responsible for im6 plementation of the Plan. 

7 (ii) With respect to each work area 

8 and unit at the covered facility or while 

9 covered employees are performing the cov10 ered service, risk assessment and identi11 fication of workplace violence risks and 

12 hazards to employees exposed to such risks 

13 and hazards (including environmental risk 

14 factors and patient-specific risk factors), 

15 which shall be— 

16 (I) informed by past violent inci17 dents specific to such covered facility 

18 or such covered service; and 

19 (II) conducted with, at a min20 imum— 

21 (aa) direct care profes22 sionals; 

23 (bb) where applicable, the 

24 representatives of such workers; 

25 and 


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1 (cc) the employer. 

2 (iii) Hazard prevention, engineering 

3 controls, or work practice controls to cor4 rect hazards, in a timely manner, applying 

5 industrial hygiene principles of the hier6 archy of controls, which— 

7 (I) may include security and 

8 alarm systems, adequate exit routes, 

9 monitoring systems, barrier protec10 tion, established areas for patients 

11 and clients, lighting, entry procedures, 

12 staffing and working in teams, and 

13 systems to identify and flag clients 

14 with a history of violence; and 

15 (II) shall ensure that employers 

16 correct, in a timely manner, hazards 

17 identified in any violent incident in18 vestigation described in paragraph (2) 

19 and any annual report described in 

20 paragraph (5). 

21 (iv) Reporting, incident response, and 

22 post-incident investigation procedures, in23 cluding procedures— 


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1 (I) for employees to report work2 place violence risks, hazards, and inci3 dents; 

4 (II) for employers to respond to 

5 reports of workplace violence; 

6 (III) for employers to perform a 

7 post-incident investigation and de8 briefing of all reports of workplace vi9 olence with the participation of em10 ployees and their representatives; 

11 (IV) to provide medical care or 

12 first aid to affected employees; and 

13 (V) to provide employees with in14 formation about available trauma and 

15 related counseling. 

16 (v) Procedures for emergency re17 sponse, including procedures for threats of 

18 mass casualties and procedures for inci19 dents involving a firearm or a dangerous 

20 weapon. 

21 (vi) Procedures for communicating 

22 with and training the covered employees on 

23 workplace violence hazards, threats, and 

24 work practice controls, the employer’s plan, 

25 and procedures for confronting, responding 


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1 to, and reporting workplace violence 

2 threats, incidents, and concerns, and em3 ployee rights. 

4 (vii) Procedures for— 

5 (I) ensuring the coordination of 

6 risk assessment efforts, Plan develop7 ment, and implementation of the Plan 

8 with other employers who have em9 ployees who work at the covered facil10 ity or who are performing the covered 

11 service; and 

12 (II) determining which covered 

13 employer or covered employers shall 

14 be responsible for implementing and 

15 complying with the provisions of the 

16 standard applicable to the working 

17 conditions over which such employers 

18 have control. 

19 (viii) Procedures for conducting the 

20 annual evaluation under paragraph (6). 

21 (C) AVAILABILITY OF PLAN.—Each Plan 

22 shall be made available at all times to the cov23 ered employees who are covered under such 

24 Plan. 

25 (2) VIOLENT INCIDENT INVESTIGATION.— 


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1 (A) IN GENERAL.—As soon as practicable 

2 after a workplace violence incident, risk, or haz3 ard of which a covered employer has knowledge, 

4 the employer shall conduct an investigation of 

5 such incident, risk, or hazard under which the 

6 employer shall— 

7 (i) review the circumstances of the in8 cident, risk, or hazard, and whether any 

9 controls or measures implemented pursu10 ant to the Plan of the employer were effec11 tive; and 

12 (ii) solicit input from involved employ13 ees, their representatives, and supervisors 

14 about the cause of the incident, risk, or 

15 hazard, and whether further corrective 

16 measures (including system-level factors) 

17 could have prevented the incident, risk, or 

18 hazard. 

19 (B) DOCUMENTATION.—A covered em20 ployer shall document the findings, rec21 ommendations, and corrective measures taken 

22 for each investigation conducted under this 

23 paragraph. 

24 (3) TRAINING AND EDUCATION.—With respect 

25 to the covered employees covered under a Plan of a 


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1 covered employer, the employer shall provide train2 ing and education to such employees who may be ex3 posed to workplace violence hazards and risks, which 

4 meet the following requirements: 

5 (A) Annual training and education shall 

6 include information on the Plan, including iden7 tified workplace violence hazards, work practice 

8 control measures, reporting procedures, record9 keeping requirements, response procedures, 

10 anti-retaliation policies, and employee rights. 

11 (B) Additional hazard recognition training 

12 shall be provided for supervisors and managers 

13 to ensure they— 

14 (i) can recognize high-risk situations; 

15 and 

16 (ii) do not assign employees to situa17 tions that predictably compromise the safe18 ty of such employees. 

19 (C) Additional training shall be provided 

20 for each such covered employee whose job cir21 cumstances have changed, within a reasonable 

22 timeframe after such change. 

23 (D) Additional training shall be provided 

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1 cumstances require working with victims of tor2 ture, trafficking, or domestic violence. 

3 (E) Applicable training shall be provided 

4 under this paragraph for each new covered em5 ployee prior to the employee’s job assignment. 

6 (F) All training shall provide such employ7 ees opportunities to ask questions, give feed8 back on training, and request additional in9 struction, clarification, or other follow-up. 

10 (G) All training shall be provided in-person 

11 and by an individual with knowledge of work12 place violence prevention and of the Plan, ex13 cept that any annual training described in sub14 paragraph (A) provided to an employee after 

15 the first year such training is provided to such 

16 employee may be conducted by live video if in17 person training is impracticable. 

18 (H) All training shall be appropriate in 

19 content and vocabulary to the language, edu20 cational level, and literacy of such covered em21 ployees. 

22 (4) RECORDKEEPING AND ACCESS TO PLAN

23 RECORDS.— 

24 (A) IN GENERAL.—Each covered employer 

25 shall— 


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1 (i) maintain for not less than 5 

2 years— 

3 (I) records related to each Plan 

4 of the employer, including workplace 

5 violence risk and hazard assessments, 

6 and identification, evaluation, correc7 tion, and training procedures; 

8 (II) a violent incident log de9 scribed in subparagraph (B) for re10 cording all workplace violence inci11 dents; and 

12 (III) records of all incident inves13 tigations as required under paragraph 

14 (2)(B); and 

15 (ii)(I) make such records and logs 

16 available, upon request, to covered employ17 ees and their representatives for examina18 tion and copying in accordance with sec19 tion 1910.1020 of title 29, Code of Federal 

20 Regulations (as such section is in effect on 

21 the date of enactment of this Act), and in 

22 a manner consistent with HIPAA privacy 

23 regulations (defined in section 1180(b)(3) 

24 of the Social Security Act (42 U.S.C. 

25 1320d–9(b)(3))) and part 2 of title 42, 


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1 Code of Federal Regulations (as such part 

2 is in effect on the date of enactment of this 

3 Act); and 

4 (II) ensure that any such records and 

5 logs that may be copied, transmitted elec6 tronically, or otherwise removed from the 

7 employer’s control for purposes of this 

8 clause omit any element of personal identi9 fying information sufficient to allow identi10 fication of any patient, resident, client, or 

11 other individual alleged to have committed 

12 a violent incident (including the individ13 ual’s name, address, electronic mail ad14 dress, telephone number, or social security 

15 number, or other information that, alone 

16 or in combination with other publicly avail17 able information, reveals such individual’s 

18 identity). 

19 (B) VIOLENT INCIDENT LOG DESCRIP20 TION.—Each violent incident log shall— 

21 (i) be maintained by a covered em22 ployer for each covered facility controlled 

23 by the employer and for each covered serv24 ice being performed by a covered employee 

25 on behalf of such employer; 


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1 (ii) be based on a template developed 

2 by the Secretary not later than 1 year 

3 after the date of enactment of this Act; 

4 (iii) include, at a minimum, a descrip5 tion of— 

6 (I) the violent incident (including 

7 environmental risk factors present at 

8 the time of the incident); 

9 (II) the date, time, and location 

10 of the incident, and the names and 

11 job titles of involved employees; 

12 (III) the nature and extent of in13 juries to covered employees; 

14 (IV) a classification of the perpe15 trator who committed the violence, in16 cluding whether the perpetrator was— 

17 (aa) a patient, client, resi18 dent, or customer of a covered 

19 employer; 

20 (bb) a family or friend of a 

21 patient, client, resident, or cus22 tomer of a covered employer; 

23 (cc) a stranger; 


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1 (dd) a coworker, supervisor, 

2 or manager of a covered em3 ployee; 

4 (ee) a partner, spouse, par5 ent, or relative of a covered em6 ployee; or 

7 (ff) any other appropriate 

8 classification; 

9 (V) the type of violent incident 

10 (such as type 1 violence, type 2 vio11 lence, type 3 violence, or type 4 vio12 lence); and 

13 (VI) how the incident was 

14 abated; 

15 (iv) not later than 7 days after the 

16 employer learns of such incident, contain a 

17 record of each violent incident, which is 

18 updated to ensure completeness of such 

19 record; 

20 (v) be maintained for not less than 5 

21 years; and 

22 (vi) in the case of a violent incident 

23 involving a privacy concern case, protect 

24 the identity of employees in a manner con25 sistent with section 1904.29(b) of title 29, 


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1 Code of Federal Regulations (as such sec2 tion is in effect on the date of enactment 

3 of this Act). 

4 (C) ANNUAL SUMMARY.— 

5 (i) COVERED EMPLOYERS.—Each cov6 ered employer shall prepare and submit to 

7 the Secretary an annual summary of each 

8 violent incident log for the preceding cal9 endar year that shall— 

10 (I) with respect to each covered 

11 facility, and each covered service, for 

12 which such a log has been maintained, 

13 include— 

14 (aa) the total number of vio15 lent incidents; 

16 (bb) the number of record17 able injuries related to such inci18 dents; and 

19 (cc) the total number of 

20 hours worked by the covered em21 ployees for such preceding year; 

22 (II) be completed on a form pro23 vided by the Secretary; 

24 (III) be posted for 90 days begin25 ning February 1 of each year in a 


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1 manner consistent with the require2 ments of part 1904 of title 29, Code 

3 of Federal Regulations (as such part 

4 is in effect on the date of enactment 

5 of this Act), relating to the posting of 

6 summaries of injury and illness logs; 

7 (IV) be located in a conspicuous 

8 place or places where notices to em9 ployees are customarily posted; and 

10 (V) not be altered, defaced, or 

11 covered by other material. 

12 (ii) SECRETARY.—Not later than 1 

13 year after the promulgation of the interim 

14 final standard under section 321(a), or 2 

15 years after the date of enactment of this 

16 Act in a case described in section 

17 321(a)(5), the Secretary shall make avail18 able a platform for the electronic submis19 sion of annual summaries required under 

20 this subparagraph. 

21 (5) ANNUAL REPORT.— 

22 (A) REPORT TO SECRETARY.—Not later 

23 than February 15 of each year, each covered 

24 employer shall report to the Secretary, on a 

25 form provided by the Secretary, the frequency, 


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1 quantity, and severity of workplace violence, 

2 and any incident response and post-incident in3 vestigation (including abatement measures) for 

4 the incidents set forth in the annual summary 

5 of the violent incident log described in para6 graph (4)(C). 

7 (B) REPORT TO CONGRESS.—Not later 

8 than 180 days after February 15 of each year, 

9 the Secretary shall submit to Congress a sum10 mary of the reports received under subpara11 graph (A). The contents of the summary of the 

12 Secretary to Congress shall not disclose any 

13 confidential information. 

14 (6) ANNUAL EVALUATION.—Each covered em15 ployer shall conduct an annual written evaluation, 

16 conducted with the full, active participation of cov17 ered employees and employee representatives, of— 

18 (A) the implementation and effectiveness 

19 of the Plan, including a review of the violent in20 cident log; and 

21 (B) compliance with training required by 

22 each standard described in section 321, and 

23 specified in the Plan. 

24 (7) PLAN UPDATES.—Each covered employer 

25 shall incorporate changes to the Plan, in a manner 


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1 consistent with paragraph (1)(A)(i) and based on 

2 findings from the most recent annual evaluation con3 ducted under paragraph (6), as appropriate. 

4 (8) ANTI-RETALIATION.— 

5 (A) POLICY.—Each covered employer shall 

6 adopt a policy prohibiting any person (including 

7 an agent of the employer) from the discrimina8 tion or retaliation described in subparagraph 

9 (B). 

10 (B) PROHIBITION.—No covered employer 

11 shall discriminate or retaliate against any em12 ployee for— 

13 (i) reporting a workplace violence inci14 dent, threat, or concern to, or seeking as15 sistance or intervention with respect to 

16 such incident, threat, or concern from, the 

17 employer, law enforcement, local emer18 gency services, or a local, State, or Federal 

19 government agency; or 

20 (ii) exercising any other rights under 

21 this section. 

22 (C) ENFORCEMENT.—This paragraph shall 

23 be enforced in the same manner and to the 

24 same extent as any standard promulgated 


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1 under section 6(b) of the Occupational Safety 

2 and Health Act of 1970 (29 U.S.C. 655(b)). 

3 SEC. 324. RULES OF CONSTRUCTION. 

4 Notwithstanding section 18 of the Occupational Safe5 ty and Health Act of 1970 (29 U.S.C. 667)— 

6 (1) nothing in this subtitle shall be construed to 

7 curtail or limit authority of the Secretary under any 

8 other provision of the law; 

9 (2) the rights, privileges, or remedies of covered 

10 employees shall be in addition to the rights, privi11 leges, or remedies provided under any Federal or 

12 State law, or any collective bargaining agreement; 

13 (3) nothing in this subtitle shall be construed to 

14 limit or prevent health care workers, social service 

15 workers, and other personnel from reporting violent 

16 incidents to appropriate law enforcement; and 

17 (4) nothing in this Act shall be construed to 

18 limit or diminish any protections in relevant Federal, 

19 State, or local law related to— 

20 (A) domestic violence; 

21 (B) stalking; 

22 (C) dating violence; or 

23 (D) sexual assault. 

24 SEC. 325. DEFINITIONS. 

25 In this subtitle: 


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1 (1) ALARM.—The term ‘‘alarm’’ means a me2 chanical, electrical, or electronic device that does not 

3 rely upon an employee’s vocalization in order to alert 

4 others. 

5 (2) DANGEROUS WEAPON.—The term ‘‘dan6 gerous weapon’’ means an instrument capable of in7 flicting death or serious bodily injury, without re8 gard to whether such instrument was designed for 

9 that purpose. 

10 (3) ENGINEERING CONTROLS.— 

11 (A) IN GENERAL.—The term ‘‘engineering 

12 controls’’ means an aspect of the built space or 

13 a device that removes a hazard from the work14 place or creates a barrier between a covered 

15 employee and the hazard. 

16 (B) INCLUSIONS.—For purposes of reduc17 ing workplace violence hazards, the term ‘‘engi18 neering controls’’ includes electronic access con19 trols to employee occupied areas, weapon detec20 tors (installed or handheld), enclosed 

21 workstations with shatter-resistant glass, deep 

22 service counters, separate rooms or areas for 

23 high-risk patients, locks on doors, removing ac24 cess to or securing items that could be used as 

25 weapons, furniture affixed to the floor, opaque 


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1 glass in patient rooms (which protects privacy, 

2 but allows the health care provider to see where 

3 the patient is before entering the room), closed4 circuit television monitoring and video record5 ing, sight-aids, and personal alarm devices. 

6 (4) ENVIRONMENTAL RISK FACTORS.— 

7 (A) IN GENERAL.—The term ‘‘environ8 mental risk factors’’ means factors in the cov9 ered facility or area in which a covered service 

10 is performed that may contribute to the likeli11 hood or severity of a workplace violence inci12 dent. 

13 (B) CLARIFICATION.—Environmental risk 

14 factors may be associated with the specific task 

15 being performed or the work area, such as 

16 working in an isolated area, poor illumination 

17 or blocked visibility, and lack of physical bar18 riers between individuals and persons at risk of 

19 committing workplace violence. 

20 (5) PATIENT-SPECIFIC RISK FACTORS.—The 

21 term ‘‘patient-specific risk factors’’ means factors 

22 specific to a patient that may increase the likelihood 

23 or severity of a workplace violence incident, includ24 ing— 


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1 (A) a patient’s treatment and medication 

2 status, and history of violence and use of drugs 

3 or alcohol; and 

4 (B) any conditions or disease processes of 

5 the patient that may cause the patient to expe6 rience confusion or disorientation, be non7 responsive to instruction, behave unpredictably, 

8 or engage in disruptive, threatening, or violent 

9 behavior. 

10 (6) SECRETARY.—The term ‘‘Secretary’’ means 

11 the Secretary of Labor. 

12 (7) THREAT OF VIOLENCE.—The term ‘‘threat 

13 of violence’’ means a statement or conduct that— 

14 (A) causes an individual to fear for such 

15 individual’s safety because there is a reasonable 

16 possibility the individual might be physically in17 jured; and 

18 (B) serves no legitimate purpose. 

19 (8) TYPE 1 VIOLENCE.—The term ‘‘type 1 vio20 lence’’— 

21 (A) means workplace violence directed at a 

22 covered employee at a covered facility or while 

23 performing a covered service by an individual 

24 who has no legitimate business at the covered 


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1 facility or with respect to such covered service; 

2 and 

3 (B) includes violent acts by any individual 

4 who enters the covered facility or worksite 

5 where a covered service is being performed with 

6 the intent to commit a crime. 

7 (9) TYPE 2 VIOLENCE.—The term ‘‘type 2 vio8 lence’’ means workplace violence directed at a cov9 ered employee by customers, clients, patients, stu10 dents, inmates, or any individual for whom a covered 

11 facility provides services or for whom the employee 

12 performs covered services. 

13 (10) TYPE 3 VIOLENCE.—The term ‘‘type 3 vio14 lence’’ means workplace violence directed at a cov15 ered employee by a present or former employee, su16 pervisor, or manager. 

17 (11) TYPE 4 VIOLENCE.—The term ‘‘type 4 vio18 lence’’ means workplace violence directed at a cov19 ered employee by an individual who is not an em20 ployee, but has or is known to have had a personal 

21 relationship with such employee, or with a customer, 

22 client, patient, student, inmate, or any individual for 

23 whom a covered facility provides services or for 

24 whom the employee performs covered services. 

25 (12) WORK PRACTICE CONTROLS.— 


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1 (A) IN GENERAL.—The term ‘‘work prac2 tice controls’’ means procedures and rules that 

3 are used to effectively reduce workplace violence 

4 hazards. 

5 (B) INCLUSIONS.—The term ‘‘work prac6 tice controls’’ includes— 

7 (i) assigning and placing sufficient 

8 numbers of staff to reduce patient-specific 

9 type 2 violence hazards; 

10 (ii) provision of dedicated and avail11 able safety personnel such as security 

12 guards; 

13 (iii) employee training on workplace 

14 violence prevention methods and tech15 niques to de-escalate and minimize violent 

16 behavior; and 

17 (iv) employee training on procedures 

18 for response in the event of a workplace vi19 olence incident and for post-incident re20 sponse. 

21 (13) WORKPLACE VIOLENCE.— 

22 (A) IN GENERAL.—The term ‘‘workplace 

23 violence’’ means any act of violence or threat of 

24 violence, without regard to intent, that occurs 


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1 at a covered facility or while a covered employee 

2 performs a covered service. 

3 (B) EXCLUSIONS.—The term ‘‘workplace 

4 violence’’ does not include lawful acts of self-de5 fense or lawful acts of defense of others. 

6 (C) INCLUSIONS.—The term ‘‘workplace 

7 violence’’ includes— 

8 (i) the threat or use of physical force 

9 against a covered employee that results in 

10 or has a high likelihood of resulting in in11 jury, psychological trauma, or stress, with12 out regard to whether the covered em13 ployee sustains an injury, psychological 

14 trauma, or stress; and 

15 (ii) an incident involving the threat or 

16 use of a firearm or a dangerous weapon, 

17 including the use of common objects as 

18 weapons, without regard to whether the 

19 employee sustains an injury, psychological 

20 trauma, or stress. 

21 SEC. 326. APPLICATION OF THE WORKPLACE VIOLENCE 

22 PREVENTION STANDARD TO CERTAIN FACILI23 TIES RECEIVING MEDICARE FUNDS. 

24 (a) IN GENERAL.—Section 1866 of the Social Secu25 rity Act (42 U.S.C. 1395cc) is amended— 


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•S 4120 IS

1 (1) in subsection (a)(1)— 

2 (A) in subparagraph (X), by striking 

3 ‘‘and’’ at the end; 

4 (B) in subparagraph (Y), by striking the 

5 period at the end and inserting ‘‘, and’’; and 

6 (C) by inserting after subparagraph (Y) 

7 the following new subparagraph: 

8 ‘‘(Z) in the case of hospitals that are not 

9 otherwise subject to the Occupational Safety 

10 and Health Act of 1970 (or a State occupa11 tional safety and health plan that is approved 

12 under section 18(b) of such Act) and skilled 

13 nursing facilities that are not otherwise subject 

14 to such Act (or such a State occupational safety 

15 and health plan), to comply with the Workplace 

16 Violence Prevention Standard (as promulgated 

17 under section 321 of the Long-Term Care 

18 Workforce Support Act).’’; and 

19 (2) in subsection (b)(4)— 

20 (A) in subparagraph (A), by inserting 

21 ‘‘and a hospital or skilled nursing facility that 

22 fails to comply with the requirement of sub23 section (a)(1)(Z) (relating to the Workplace Vi24 olence Prevention Standard)’’ after 

25 ‘‘Bloodborne Pathogens standard)’’; and 


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•S 4120 IS

1 (B) in subparagraph (B)— 

2 (i) by striking ‘‘(a)(1)(U)’’ and insert3 ing ‘‘(a)(1)(V)’’; and 

4 (ii) by inserting ‘‘(or, in the case of a 

5 failure to comply with the requirement of 

6 subsection (a)(1)(Z), for a violation of the 

7 Workplace Violence Prevention standard 

8 referred to in such subsection by a hospital 

9 or skilled nursing facility, as applicable, 

10 that is subject to the provisions of such 

11 Act)’’ before the period at the end. 

12 (b) EFFECTIVE DATE.—The amendments made by 

13 subsection (a) shall apply beginning on the date that is 

14 1 year after the date of issuance of the interim final stand15 ard on workplace violence prevention required under sec16 tion 321. 

17 Subtitle D—Improving Access to 

18 Job Benefits 

19 SEC. 331. DEFINITIONS. 

20 In this subtitle: 

21 (1) CHILD.—The term ‘‘child’’ means a biologi22 cal, foster, or adopted child, a stepchild, a child of 

23 a domestic partner, a legal ward, or a child of a per24 son standing in loco parentis. 


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1 (2) COMMERCE; INDUSTRY OR ACTIVITY AF2 FECTING COMMERCE.—The terms ‘‘commerce’’ and 

3 ‘‘industry or activity affecting commerce’’ mean any 

4 activity, business, or industry in commerce or in 

5 which a labor dispute would hinder or obstruct com6 merce or the free flow of commerce, and include 

7 ‘‘commerce’’ and any ‘‘industry affecting com8 merce’’, as defined in paragraphs (1) and (3) of sec9 tion 501 of the Labor Management Relations Act, 

10 1947 (29 U.S.C. 142 (1) and (3)). 

11 (3) COVERED DIRECT CARE PROFESSIONAL.— 

12 The term ‘‘covered direct care professional’’ means 

13 an employee who is employed as a direct care profes14 sional by an employer. 

15 (4) DOMESTIC VIOLENCE.—The term ‘‘domestic 

16 violence’’ has the meaning given the term in section 

17 40002(a) of the Violence Against Women Act of 

18 1994 (34 U.S.C. 12291(a)), except that the ref19 erence in such section to the term ‘‘jurisdiction re20 ceiving grant funding’’ shall be deemed to mean the 

21 jurisdiction in which the victim lives or the jurisdic22 tion in which the employer involved is located. Such 

23 term also includes dating violence, as that term is 

24 defined in such section. 


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1 (5) EMPLOYEE.—The term ‘‘employee’’ means 

2 an individual who is an employee, as defined in sec3 tion 3(e) of the Fair Labor Standards Act of 1938 

4 (29 U.S.C. 203(e)), except that a reference in such 

5 section to an employer shall be considered to be a 

6 reference to an employer described in paragraph (6). 

7 (6) EMPLOYER.— 

8 (A) IN GENERAL.—The term ‘‘em9 ployer’’— 

10 (i) means a person who is engaged in 

11 commerce or in any industry or activity af12 fecting commerce who employs 1 or more 

13 employees; 

14 (ii) includes— 

15 (I) any person who acts, directly 

16 or indirectly, in the interest of an em17 ployer to any of the employees of such 

18 employer; and 

19 (II) any successor in interest of 

20 such an employer; and 

21 (iii) does not include any public agen22 cy. 

23 (B) DEFINITIONS.—For purposes of this 

24 subparagraph: 


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1 (i) EMPLOYEE.—The term ‘‘em2 ployee’’ has the meaning given such term 

3 in section 3 of the Fair Labor Standards 

4 Act of 1938 (29 U.S.C. 203). 

5 (ii) PERSON.—The term ‘‘person’’ has 

6 the meaning given such term in section 3 

7 of the Fair Labor Standards Act of 1938 

8 (29 U.S.C. 203). 

9 (iii) PUBLIC AGENCY.—The term 

10 ‘‘public agency’’ has the meaning given 

11 such term in section 3 of the Fair Labor 

12 Standards Act of 1938 (29 U.S.C. 203). 

13 (C) PREDECESSORS.—Any reference in 

14 this paragraph to an employer shall include a 

15 reference to any predecessor of such employer. 

16 (7) EMPLOYMENT BENEFITS.—The term ‘‘em17 ployment benefits’’ means all benefits provided or 

18 made available to employees by an employer, includ19 ing group life insurance, health insurance, disability 

20 insurance, sick leave, annual leave, educational bene21 fits, and pensions, regardless of whether such bene22 fits are provided by a practice or written policy of 

23 an employer or through an ‘‘employee benefit plan’’, 

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1 ment Income Security Act of 1974 (29 U.S.C. 

2 1002(3)). 

3 (8) HEALTH CARE PROVIDER.—The term 

4 ‘‘health care provider’’ means a provider who— 

5 (A)(i) is a doctor of medicine or osteopathy 

6 who is authorized to practice medicine or sur7 gery (as appropriate) by the State in which the 

8 doctor practices; or 

9 (ii) is any other person determined by the 

10 Secretary to be capable of providing health care 

11 services; and 

12 (B) is not employed by an employer for 

13 whom the provider issues certification under 

14 this subtitle. 

15 (9) PAID SICK TIME.—The term ‘‘paid sick 

16 time’’ means an increment of compensated leave 

17 that— 

18 (A) can be— 

19 (i) earned by an employee for use dur20 ing an absence from employment for a rea21 son described in any paragraph of section 

22 332(b); or 

23 (ii) provided by an employer during a 

24 public health emergency for use during an 

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1 scribed in any paragraph of section 332(b); 

2 and 

3 (B) is compensated at a rate that is not 

4 less than the greatest of— 

5 (i) the employee’s regular rate of pay; 

6 (ii) the wage rate described in section 

7 6(a)(1) of the Fair Labor Standards Act 

8 of 1938 (29 U.S.C. 206(a)(1)); or 

9 (iii) the minimum wage rate provided 

10 for in the applicable State or local law for 

11 the State or locality in which the employee 

12 is employed. 

13 (10) PARENT.—The term ‘‘parent’’ means a bi14 ological, foster, or adoptive parent of an employee, 

15 a stepparent of an employee, parent-in-law, parent 

16 of a domestic partner, or a legal guardian or other 

17 person who stood in loco parentis to an employee 

18 when the employee was a child. 

19 (11) PUBLIC HEALTH EMERGENCY.—The term 

20 ‘‘public health emergency’’ means a public health 

21 emergency declared by the Secretary of Health and 

22 Human Services for a jurisdiction, or by a State 

23 public health official with authority to declare such 

24 an emergency for the State or jurisdiction within the 

25 State. 


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1 (12) SECRETARY.—The term ‘‘Secretary’’ 

2 means the Secretary of Labor. 

3 (13) SEXUAL ASSAULT.—The term ‘‘sexual as4 sault’’ has the meaning given the term in section 

5 40002(a) of the Violence Against Women Act of 

6 1994 (34 U.S.C. 12291(a)). 

7 (14) SPOUSE.—The term ‘‘spouse’’, with re8 spect to an employee, has the meaning given such 

9 term by the marriage laws of the State in which the 

10 marriage was celebrated. 

11 (15) STALKING.—The term ‘‘stalking’’ has the 

12 meaning given the term in section 40002(a) of the 

13 Violence Against Women Act of 1994 (34 U.S.C. 

14 12291(a)). 

15 (16) VICTIM SERVICES ORGANIZATION.—The 

16 term ‘‘victim services organization’’ means a non17 profit, nongovernmental organization that provides 

18 assistance to victims of domestic violence, sexual as19 sault, or stalking or advocates for such victims, in20 cluding a rape crisis center, an organization carrying 

21 out a domestic violence, sexual assault, or stalking 

22 prevention or treatment program, an organization 

23 operating a shelter or providing counseling services, 

24 or a legal services organization or other organization 

25 providing assistance through the legal process. 


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1 SEC. 332. PAID SICK TIME. 

2 (a) EARNING OF PAID SICK TIME.— 

3 (1) IN GENERAL.—Subject to subsection (c), an 

4 employer shall provide each covered direct care pro5 fessional employed by the employer not less than 1 

6 hour of earned paid sick time for every 30 hours 

7 worked, to be used as described in subsection (b). 

8 An employer shall not be required to permit a cov9 ered direct care professional to earn, under this sub10 section, more than 56 hours of paid sick time in a 

11 year, unless the employer chooses to set a higher 

12 limit. 

13 (2) EXEMPT COVERED DIRECT CARE PROFES14 SIONALS.— 

15 (A) IN GENERAL.—Except as provided in 

16 subparagraph (B), for purposes of this sub17 section, a covered direct care professional who 

18 is exempt from overtime requirements under 

19 section 13(a)(1) of the Fair Labor Standards 

20 Act of 1938 (29 U.S.C. 213(a)(1)) shall be 

21 deemed to work 40 hours in each workweek. 

22 (B) SHORTER NORMAL WORKWEEK.—If 

23 the normal workweek of such a covered direct 

24 care professional is less than 40 hours, the cov25 ered direct care professional shall earn paid sick 


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1 time under this subsection based upon that nor2 mal workweek. 

3 (3) DATES FOR BEGINNING TO EARN PAID SICK

4 TIME AND USE.— 

5 (A) IN GENERAL.—Except as provided in 

6 subparagraph (B) and the second sentence of 

7 paragraph (8), covered direct care professionals 

8 shall begin to earn paid sick time under this 

9 section at the commencement of their employ10 ment. Except as provided in such subparagraph 

11 and such sentence, a covered direct care profes12 sional shall be entitled to use the earned paid 

13 sick time beginning on the 60th calendar day 

14 following commencement of the covered direct 

15 care professional’s employment. After that 60th 

16 calendar day, the covered direct care profes17 sional may use the paid sick time as the time 

18 is earned. An employer may, at the discretion 

19 of the employer, loan paid sick time to a cov20 ered direct care professional for use by such 

21 covered direct care professional in advance of 

22 the covered direct care professional earning 

23 such sick time as provided in this section and 

24 may permit use before the 60th day of employ25 ment. 


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1 (B) PUBLIC HEALTH EMERGENCY.—Sub2 paragraph (A) shall not apply with respect to 

3 additional paid sick time provided under sub4 section (c). In the event of a public health 

5 emergency, a covered direct care professional 

6 may immediately use the additional or accrued 

7 paid sick time described in subsection (c), re8 gardless of how long the covered direct care 

9 professional has been employed by an employer. 

10 (4) CARRYOVER.— 

11 (A) IN GENERAL.—Except as provided in 

12 subparagraph (B), paid sick time earned under 

13 this section shall carry over from 1 year to the 

14 next. 

15 (B) CONSTRUCTION.—Except as provided 

16 in subsection (c), this subtitle shall not be con17 strued to require an employer to permit a cov18 ered direct care professional to earn more than 

19 56 hours of earned paid sick time at a given 

20 time. 

21 (5) EMPLOYERS WITH EXISTING POLICIES.— 

22 Any employer with a paid leave policy who makes 

23 available an amount of paid leave that is sufficient 

24 to meet the requirements of this section and that 

25 may be used for the same purposes and under the 


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•S 4120 IS

1 same conditions as the purposes and conditions de2 scribed in this section shall not be required to per3 mit a covered direct care professional to earn addi4 tional paid sick time under this section. 

5 (6) CONSTRUCTION.—Nothing in this section 

6 shall be construed as requiring financial or other re7 imbursement to a covered direct care professional 

8 from an employer upon the covered direct care pro9 fessional’s termination, resignation, retirement, or 

10 other separation from employment for earned paid 

11 sick time that has not been used. 

12 (7) REINSTATEMENT.—If a covered direct care 

13 professional is separated from employment with an 

14 employer and is rehired, within 12 months after that 

15 separation, by the same employer, the employer shall 

16 reinstate the covered direct care professional’s pre17 viously earned paid sick time. The covered direct 

18 care professional shall be entitled to use the earned 

19 paid sick time and earn additional paid sick time at 

20 the recommencement of employment with the em21 ployer. 

22 (8) PROHIBITION.—An employer may not re23 quire, as a condition of providing paid sick time 

24 under this subtitle, that the covered direct care pro25 fessional involved search for or find a replacement to 


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•S 4120 IS

1 cover the hours during which the covered direct care 

2 professional is using paid sick time. 

3 (b) USES.—Paid sick time earned under this section 

4 may be used by a covered direct care professional for any 

5 of the following: 

6 (1) An absence resulting from a physical or 

7 mental illness, injury, or medical condition of the 

8 covered direct care professional. 

9 (2) An absence resulting from obtaining profes10 sional medical diagnosis or care, or preventive med11 ical care, for the covered direct care professional. 

12 (3) An absence resulting from the closure of a 

13 covered direct care professional’s place of employ14 ment by order of a Federal or State public official 

15 with jurisdiction, or at the employer’s discretion, due 

16 to a public health emergency. 

17 (4) An absence because a Federal or State pub18 lic official with jurisdiction or a health care provider 

19 has determined that the covered direct care profes20 sional’s presence in the community may jeopardize 

21 the health of others because of the covered direct 

22 care professional’s exposure to a communicable dis23 ease during a public health emergency, regardless of 

24 whether the covered direct care professional has ac25 tually contracted the communicable disease. 


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1 (5) An absence for the purpose of caring for a 

2 child, a parent, a spouse, a domestic partner, or any 

3 other individual related by blood or affinity whose 

4 close association with the covered direct care profes5 sional is the equivalent of a family relationship— 

6 (A) who is a child, if the child’s school or 

7 place of care has been closed by order of a Fed8 eral or State public official with jurisdiction or 

9 at the discretion of the school or place of care 

10 due to a public health emergency, including if 

11 a school or entity operating the place of care is 

12 physically closed but is providing education or 

13 care to the child remotely; or 

14 (B) because a Federal or State public offi15 cial with jurisdiction or a health care provider 

16 has determined that the presence in the com17 munity of the person receiving care may jeop18 ardize the health of others because of the per19 son’s exposure to a communicable disease dur20 ing a public health emergency, regardless of 

21 whether the person has actually contracted the 

22 communicable disease. 

23 (6) An absence for the purpose of caring for a 

24 child, a parent, a spouse, a domestic partner, or any 

25 other individual related by blood or affinity whose 


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1 close association with the covered direct care profes2 sional is the equivalent of a family relationship— 

3 (A) who has any of the conditions or needs 

4 for diagnosis or care described in paragraph (1) 

5 or (2); 

6 (B) who is a child, if the covered direct 

7 care professional is required to attend a school 

8 meeting or a meeting at a place where the child 

9 is receiving care necessitated by the child’s 

10 health condition or disability; or 

11 (C) who is otherwise in need of care. 

12 (7) An absence resulting from domestic vio13 lence, sexual assault, or stalking, if the time is to— 

14 (A) seek medical attention for the covered 

15 direct care professional or the covered direct 

16 care professional’s child, parent, spouse, domes17 tic partner, or an individual related to the cov18 ered direct care professional as described in 

19 paragraph (6), to recover from physical or psy20 chological injury or disability caused by domes21 tic violence, sexual assault, or stalking; 

22 (B) obtain or assist a related person de23 scribed in paragraph (6) in obtaining services 

24 from a victim services organization; 


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1 (C) obtain or assist a related person de2 scribed in paragraph (6) in obtaining psycho3 logical or other counseling; 

4 (D) seek relocation; or 

5 (E) take legal action, including preparing 

6 for or participating in any civil or criminal legal 

7 proceeding related to or resulting from domestic 

8 violence, sexual assault, or stalking. 

9 (c) ADDITIONAL PAID SICK TIME FOR PUBLIC

10 HEALTH EMERGENCY.— 

11 (1) ADDITIONAL PAID SICK TIME.—On the date 

12 of a declaration of a public health emergency by the 

13 Secretary of Health and Human Services under sec14 tion 319 of the Public Health Service Act (42 

15 U.S.C. 247d) or a major disaster or emergency de16 clared by the President under section 401 or 501, 

17 respectively, of the Robert T. Stafford Disaster Re18 lief and Emergency Assistance Act (42 U.S.C. 5170, 

19 5191), an employer in the jurisdiction involved shall 

20 provide each covered direct care professional of the 

21 employer in that jurisdiction with additional paid 

22 sick time, in addition to any amount of paid sick 

23 time accrued by the covered direct care professional 

24 under subsection (a) (including paid leave referred 

25 to in subsection (a)(4)). 


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1 (2) AMOUNT OF PAID SICK TIME.—In receiving 

2 additional paid sick time under paragraph (1), the 

3 covered direct care professional shall receive— 

4 (A) for a full-time salaried covered direct 

5 care professional, a specified amount of paid 

6 sick time that is sufficient to provide the cov7 ered direct care professional with 14 continuous 

8 days away from work without a reduction in 

9 pay; and 

10 (B) for a part-time or hourly covered di11 rect care professional, a specified amount of 

12 paid sick time equal to the number of hours 

13 that the covered direct care professional was 

14 scheduled to work or, if not so scheduled, regu15 larly works in a 14-day period. 

16 (3) USE OF LEAVE.—The additional sick time 

17 and accrued sick time described in this subsection 

18 shall be available for immediate use by the covered 

19 direct care professional for the purposes described in 

20 any paragraph of subsection (b) beginning on the 

21 date a public health emergency is declared, regard22 less of how long the covered direct care professional 

23 has been employed by an employer. 

24 (4) SEQUENCING.—During the public health 

25 emergency, a covered direct care professional may 


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•S 4120 IS

1 first use the additional sick time for those purposes. 

2 The covered direct care professional may then use 

3 the accrued sick time during the public health emer4 gency, or retain the accrued sick time for use after 

5 the public health emergency. An employer may not 

6 require a covered direct care professional to use the 

7 accrued sick time, or any other paid leave provided 

8 by the employer to the covered direct care profes9 sional, before using the additional sick time. 

10 (5) PERIODS.—A covered direct care profes11 sional may take the additional sick time on the 

12 schedule that meets the covered direct care profes13 sional’s needs, consistent with subsection (b), includ14 ing taking the additional sick time intermittently or 

15 on a reduced leave schedule, and an employer may 

16 not require a covered direct care professional to take 

17 the additional sick time in a single period or on any 

18 other schedule specified by the employer. 

19 (d) SCHEDULING.—A covered direct care professional 

20 shall make a reasonable effort to schedule a period of paid 

21 sick time under subsection (a) in a manner that does not 

22 unduly disrupt the operations of the employer. 

23 (e) PROCEDURES.— 


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1 (1) IN GENERAL.—Paid sick time shall be pro2 vided upon the oral or written request of a covered 

3 direct care professional. Such request shall— 

4 (A) include the expected duration of the 

5 period of such time; and 

6 (B)(i) in a case in which the need for such 

7 period of time is foreseeable at least 7 days in 

8 advance of such period, be provided at least 7 

9 days in advance of such period; and 

10 (ii) otherwise, be provided as soon as prac11 ticable after the covered direct care professional 

12 is aware of the need for such period. 

13 (2) CERTIFICATION IN GENERAL.— 

14 (A) PROVISION.— 

15 (i) IN GENERAL.—Subject to subpara16 graphs (C) and (D), an employer may re17 quire that a request for paid sick time 

18 under this section for a purpose described 

19 in paragraph (1), (2), or (6) of subsection 

20 (b) be supported by a certification issued 

21 by the health care provider of the covered 

22 direct care professional or of an individual 

23 described in subsection (b)(6), as appro24 priate, if the period of such time covers 

25 more than 3 consecutive workdays. 


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1 (ii) TIMELINESS.—The covered direct 

2 care professional shall provide a copy of 

3 such certification to the employer in a 

4 timely manner, not later than 30 days 

5 after the first day of the period of time. 

6 The employer shall not delay the com7 mencement of the period of time on the 

8 basis that the employer has not yet re9 ceived the certification. 

10 (B) SUFFICIENT CERTIFICATION.— 

11 (i) IN GENERAL.—A certification pro12 vided under subparagraph (A) shall be suf13 ficient if it states— 

14 (I) the date on which the period 

15 of time will be needed; 

16 (II) the probable duration of the 

17 period of time; 

18 (III) the appropriate medical 

19 facts within the knowledge of the 

20 health care provider regarding the 

21 condition involved, subject to clause 

22 (ii); and 

23 (IV)(aa) for purposes of paid sick 

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•S 4120 IS

1 ment that absence from work is medi2 cally necessary; 

3 (bb) for purposes of such time 

4 under subsection (b)(2), the dates on 

5 which testing for a medical diagnosis 

6 or care is expected to be given and the 

7 duration of such testing or care; and 

8 (cc) for purposes of such time 

9 under subsection (b)(6), in the case of 

10 time to care for someone who is not a 

11 child, a statement that care is needed 

12 for an individual described in such 

13 subsection, and an estimate of the 

14 amount of time that such care is 

15 needed for such individual. 

16 (ii) LIMITATION.—In issuing a certifi17 cation under subparagraph (A), a health 

18 care provider shall make reasonable efforts 

19 to limit the medical facts described in 

20 clause (i)(III) that are disclosed in the cer21 tification to the minimum necessary to es22 tablish a need for the covered direct care 

23 professional to use paid sick time. 

24 (C) PUBLIC HEALTH EMERGENCIES.—No 

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1 quired under this subtitle by an employer dur2 ing any public health emergency. 

3 (D) REGULATIONS.—Regulations pre4 scribed under section 339 shall specify the man5 ner in which a covered direct care professional 

6 who does not have health insurance shall pro7 vide a certification for purposes of this para8 graph. 

9 (E) CONFIDENTIALITY AND NONDISCLO10 SURE.— 

11 (i) PROTECTED HEALTH INFORMA12 TION.—Nothing in this subtitle shall be 

13 construed to require a health care provider 

14 to disclose information in violation of sec15 tion 1177 of the Social Security Act (42 

16 U.S.C. 1320d–6) or the regulations pro17 mulgated pursuant to section 264(c) of the 

18 Health Insurance Portability and Account19 ability Act of 1996 (42 U.S.C. 1320d–2 

20 note). 

21 (ii) HEALTH INFORMATION

22 RECORDS.—If an employer possesses 

23 health information about a covered direct 

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1 tic partner, or an individual related to the 

2 covered direct care professional as de3 scribed in subsection (b)(6), such informa4 tion shall— 

5 (I) be maintained on a separate 

6 form and in a separate file from other 

7 personnel information; 

8 (II) be treated as a confidential 

9 medical record; and 

10 (III) not be disclosed except to 

11 the affected covered direct care pro12 fessional or with the permission of the 

13 affected covered direct care profes14 sional. 

15 (3) CERTIFICATION IN THE CASE OF DOMESTIC

16 VIOLENCE, SEXUAL ASSAULT, OR STALKING.— 

17 (A) IN GENERAL.—An employer may re18 quire that a request for paid sick time under 

19 this section for a purpose described in sub20 section (b)(7) be supported by any one of the 

21 following: 

22 (i) A police report indicating that the 

23 covered direct care professional, or a mem24 ber of the covered direct care professional’s 

25 family described in subsection (b)(7), was 


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•S 4120 IS

1 a victim of domestic violence, sexual as2 sault, or stalking. 

3 (ii) A court order protecting or sepa4 rating the covered direct care professional 

5 or a member of the covered direct care 

6 professional’s family described in sub7 section (b)(7) from the perpetrator of an 

8 act of domestic violence, sexual assault, or 

9 stalking, or other evidence from the court 

10 or prosecuting attorney that the covered 

11 direct care professional or a member of the 

12 covered direct care professional’s family 

13 described in subsection (b)(7) has ap14 peared in court or is scheduled to appear 

15 in court in a proceeding related to domes16 tic violence, sexual assault, or stalking. 

17 (iii) Other documentation signed by a 

18 covered direct care professional or volun19 teer working for a victim services organiza20 tion, an attorney, a police officer, a med21 ical professional, a social worker, an 

22 antiviolence counselor, or a member of the 

23 clergy, affirming that the covered direct 

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1 scribed in subsection (b)(7) is a victim of 

2 domestic violence, sexual assault, or stalk3 ing. 

4 (B) REQUIREMENTS.—The requirements 

5 of paragraph (2) shall apply to certifications 

6 under this paragraph, except that— 

7 (i) subclauses (III) and (IV) of sub8 paragraph (B)(i) and subparagraph (B)(ii) 

9 of such paragraph shall not apply; 

10 (ii) the certification shall state the 

11 reason that the leave is required with the 

12 facts to be disclosed limited to the min13 imum necessary to establish a need for the 

14 covered direct care professional to be ab15 sent from work, and the covered direct 

16 care professional shall not be required to 

17 explain the details of the domestic violence, 

18 sexual assault, or stalking involved; and 

19 (iii) with respect to confidentiality 

20 under subparagraph (E) of such para21 graph, any information provided to the em22 ployer under this paragraph shall be con23 fidential, except to the extent that any dis24 closure of such information is— 


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1 (I) requested or consented to in 

2 writing by the covered direct care pro3 fessional; or 

4 (II) otherwise required by appli5 cable Federal or State law. 

6 (C) SPECIFICATION OF DOCUMENTA7 TION.—An employer may not specify which of 

8 the forms of documentation described in clause 

9 (i), (ii), or (iii) of subparagraph (A) is required 

10 to be provided in order to satisfy the require11 ment under such subparagraph. 

12 SEC. 333. NOTICE REQUIREMENT. 

13 (a) IN GENERAL.—Each employer shall notify each 

14 covered direct care professional employed by the employer 

15 and include in any employee handbook the information— 

16 (1) describing paid sick time available to cov17 ered direct care professionals under this subtitle; 

18 (2) pertaining to the filing of an action under 

19 this subtitle; 

20 (3) on the details of the notice requirement for 

21 a foreseeable period of time under section 

22 332(e)(1)(B)(i); and 

23 (4) that describes— 


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1 (A) the protections that a covered direct 

2 care professional has in exercising rights under 

3 this subtitle; and 

4 (B) how the covered direct care profes5 sional can contact the Secretary if any of the 

6 rights are violated. 

7 (b) POSTING OF NOTICE.—Each employer shall post 

8 and keep posted a notice, to be prepared or approved in 

9 accordance with procedures specified in regulations pre10 scribed under section 339, setting forth excerpts from, or 

11 summaries of, the pertinent provisions of this subtitle in12 cluding the information described in paragraphs (1) 

13 through (4) of subsection (a). 

14 (c) LOCATION.—The notice described under sub15 section (b) shall be posted— 

16 (1) in conspicuous places on the premises of the 

17 employer, where notices to employees (including ap18 plicants) are customarily posted; or 

19 (2) in employee handbooks. 

20 (d) VIOLATION; PENALTY.—Any employer who will21 fully violates the posting requirements of this section shall 

22 be subject to a civil fine in an amount not to exceed $100 

23 for each separate offense. 

24 SEC. 334. PROHIBITED ACTS. 

25 (a) INTERFERENCE WITH RIGHTS.— 


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1 (1) EXERCISE OF RIGHTS.—It shall be unlawful 

2 for any employer to interfere with, restrain, or deny 

3 the exercise of, or the attempt to exercise, any right 

4 provided under this subtitle, including— 

5 (A) discharging or discriminating against 

6 (including retaliating against) any individual, 

7 including a job applicant, for exercising, or at8 tempting to exercise, any right provided under 

9 this subtitle; 

10 (B) using the taking of paid sick time 

11 under this subtitle as a negative factor in an 

12 employment action, such as hiring, promotion, 

13 reducing hours or number of shifts, or a dis14 ciplinary action; or 

15 (C) counting the paid sick time under a 

16 no-fault attendance policy or any other absence17 control policy. 

18 (2) DISCRIMINATION.—It shall be unlawful for 

19 any employer to discharge or in any other manner 

20 discriminate against (including retaliating against) 

21 any individual, including a job applicant, for oppos22 ing any practice made unlawful by this subtitle. 

23 (b) INTERFERENCE WITH PROCEEDINGS OR INQUIR24 IES.—It shall be unlawful for any person to discharge or 

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1 ating against) any individual, including a job applicant, 

2 because such individual— 

3 (1) has filed an action, or has instituted or 

4 caused to be instituted any proceeding, under or re5 lated to this subtitle; 

6 (2) has given, or is about to give, any informa7 tion in connection with any inquiry or proceeding re8 lating to any right provided under this subtitle; or 

9 (3) has testified, or is about to testify, in any 

10 inquiry or proceeding relating to any right provided 

11 under this subtitle. 

12 (c) CONSTRUCTION.—Nothing in this section shall be 

13 construed to state or imply that the scope of the activities 

14 prohibited by section 105 of the Family and Medical Leave 

15 Act of 1993 (29 U.S.C. 2615) is less than the scope of 

16 the activities prohibited by this section. 

17 SEC. 335. ENFORCEMENT AUTHORITY. 

18 (a) INVESTIGATIVE AUTHORITY.— 

19 (1) IN GENERAL.—To ensure compliance with 

20 the provisions of this subtitle, or any regulation or 

21 order issued under this subtitle, the Secretary shall 

22 have, subject to paragraph (3), the investigative au23 thority provided under section 11(a) of the Fair 

24 Labor Standards Act of 1938 (29 U.S.C. 211(a)), 

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1 sionals, and other individuals affected by an em2 ployer. 

3 (2) OBLIGATION TO KEEP AND PRESERVE

4 RECORDS.—An employer shall make, keep, and pre5 serve records pertaining to compliance with this sub6 title in accordance with section 11(c) of the Fair 

7 Labor Standards Act of 1938 (29 U.S.C. 211(c)) 

8 and in accordance with regulations prescribed by the 

9 Secretary. 

10 (3) REQUIRED SUBMISSIONS GENERALLY LIM11 ITED TO AN ANNUAL BASIS.—The Secretary shall 

12 not require, under the authority of this subsection, 

13 an employer to submit to the Secretary any books or 

14 records more than once during any 12-month period, 

15 unless the Secretary has reasonable cause to believe 

16 there may exist a violation of this subtitle or any 

17 regulation or order issued pursuant to this subtitle, 

18 or is investigating a charge pursuant to subsection 

19 (c). 

20 (4) SUBPOENA AUTHORITY.—For the purposes 

21 of any investigation provided for in this subsection, 

22 the Secretary shall have the subpoena authority pro23 vided for under section 9 of the Fair Labor Stand24 ards Act of 1938 (29 U.S.C. 209). 


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1 (b) CIVIL ACTION BY COVERED DIRECT CARE PRO2 FESSIONALS OR INDIVIDUALS.— 

3 (1) RIGHT OF ACTION.—An action to recover 

4 the damages or equitable relief prescribed in para5 graph (1) may be maintained against any employer 

6 in any Federal or State court of competent jurisdic7 tion by a covered direct care professional or indi8 vidual or a representative for and on behalf of— 

9 (A) the covered direct care professional or 

10 individual; or 

11 (B) the covered direct care professional or 

12 individual and others similarly situated. 

13 (2) LIABILITY.—Any employer who violates sec14 tion 334 (including a violation relating to rights pro15 vided under section 332) shall be liable to any cov16 ered direct care professional or individual affected— 

17 (A) for damages equal to— 

18 (i) the amount of— 

19 (I) any wages, salary, employ20 ment benefits, or other compensation 

21 denied or lost by reason of the viola22 tion; or 

23 (II) in a case in which wages, 

24 salary, employment benefits, or other 

25 compensation have not been denied or 


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1 lost, any actual monetary losses sus2 tained as a direct result of the viola3 tion up to a sum equal to 56 hours of 

4 wages or salary for the covered direct 

5 care professional or individual, or the 

6 specified period described in section 

7 332(c)(3), or a combination of those 

8 hours and that period, as the case 

9 may be; 

10 (ii) the interest on the amount de11 scribed in clause (i) calculated at the pre12 vailing rate; and 

13 (iii) an additional amount as liq14 uidated damages; and 

15 (B) for such equitable relief as may be ap16 propriate, including employment, reinstatement, 

17 and promotion. 

18 (3) FEES AND COSTS.—The court in an action 

19 under this subsection shall, in addition to any judg20 ment awarded to the plaintiff, allow a reasonable at21 torney’s fee, reasonable expert witness fees, and 

22 other costs of the action to be paid by the defendant. 

23 (c) ACTION BY THE SECRETARY.— 

24 (1) ADMINISTRATIVE ACTION.—The Secretary 

25 shall receive, investigate, and attempt to resolve 


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1 complaints of violations of section 334 (including a 

2 violation relating to rights provided under section 

3 332) in the same manner that the Secretary re4 ceives, investigates, and attempts to resolve com5 plaints of violations of sections 6 and 7 of the Fair 

6 Labor Standards Act of 1938 (29 U.S.C. 206 and 

7 207). 

8 (2) CIVIL ACTION.—The Secretary may bring 

9 an action in any court of competent jurisdiction to 

10 recover the damages described in subsection 

11 (b)(2)(A). 

12 (3) SUMS RECOVERED.—Any sums recovered by 

13 the Secretary pursuant to paragraph (2) shall be 

14 held in a special deposit account and shall be paid, 

15 on order of the Secretary, directly to each covered 

16 direct care professional or individual affected. Any 

17 such sums not paid to a covered direct care profes18 sional or individual affected because of inability to 

19 do so within a period of 3 years shall be deposited 

20 into the Treasury of the United States as miscella21 neous receipts. 

22 (d) LIMITATION.— 

23 (1) IN GENERAL.—Except as provided in para24 graph (2), an action may be brought under sub25 section (b), (c), or (e) not later than 2 years after 


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1 the date of the last event constituting the alleged 

2 violation for which the action is brought. 

3 (2) WILLFUL VIOLATION.—In the case of an 

4 action brought for a willful violation of section 334 

5 (including a willful violation relating to rights pro6 vided under section 332), such action may be 

7 brought not later than 3 years after the last event 

8 constituting the alleged violation for which such ac9 tion is brought. 

10 (3) COMMENCEMENT.—In determining when an 

11 action is commenced under subsection (b), (c), or (e) 

12 for the purposes of this subsection, it shall be con13 sidered to be commenced on the date when the com14 plaint is filed. 

15 (e) ACTION FOR INJUNCTION BY SECRETARY.—The 

16 district courts of the United States shall have jurisdiction, 

17 for cause shown, in an action brought by the Secretary— 

18 (1) to restrain violations of section 334 (includ19 ing a violation relating to rights provided under sec20 tion 332), including the restraint of any withholding 

21 of payment of wages, salary, employment benefits, or 

22 other compensation, plus interest, found by the court 

23 to be due to covered direct care professionals or indi24 viduals eligible under this subtitle; or 


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1 (2) to award such other equitable relief as may 

2 be appropriate, including employment, reinstate3 ment, and promotion. 

4 (f) SOLICITOR OF LABOR.—The Solicitor of Labor 

5 may appear for and represent the Secretary on any litiga6 tion brought under subsection (c) or (e). 

7 SEC. 336. EDUCATION AND OUTREACH. 

8 (a) IN GENERAL.—The Secretary may conduct a 

9 public awareness campaign to educate and inform the pub10 lic of the requirements for paid sick time required by this 

11 subtitle. 

12 (b) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to the Secretary 

14 $20,000,000 to carry out such campaign. 

15 SEC. 337. EFFECT ON EXISTING EMPLOYMENT BENEFITS. 

16 (a) MORE PROTECTIVE.—Nothing in this subtitle 

17 shall be construed to diminish the obligation of an em18 ployer to comply with any contract, collective bargaining 

19 agreement, or any employment benefit program or plan 

20 that provides greater paid sick leave or other leave rights 

21 to covered direct care professionals or individuals than the 

22 rights established under this subtitle. 

23 (b) LESS PROTECTIVE.—The rights established for 

24 covered direct care professionals under this subtitle shall 


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1 not be diminished by any contract, collective bargaining 

2 agreement, or any employment benefit program or plan. 

3 SEC. 338. ENCOURAGEMENT OF MORE GENEROUS LEAVE 

4 POLICIES. 

5 Nothing in this subtitle shall be construed— 

6 (1) to discourage employers from adopting or 

7 retaining leave policies more generous than policies 

8 that comply with the requirements of this subtitle; 

9 or 

10 (2) to discourage or prevent an employer from 

11 adopting a contract, collective bargaining agreement, 

12 or employment benefit program or plan that pro13 vides greater right or benefits to covered direct care 

14 professionals than the rights established under this 

15 subtitle. 

16 SEC. 339. REGULATIONS. 

17 (a) IN GENERAL.—Subject to subsection (b), not 

18 later than 180 days after the date of enactment of this 

19 Act, the Secretary shall prescribe such regulations as are 

20 necessary to carry out this subtitle. 

21 (b) IMMEDIATE COMPLIANCE.—The rights and re22 sponsibilities specified in this subtitle shall take effect on 

23 the date of enactment of this Act and employers and other 

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1 mediately, without regard whether regulations have been 

2 prescribed under this section. 

3 SEC. 339A. EFFECTIVE DATE. 

4 If a public health emergency was declared before and 

5 remains in effect on the date of enactment of this Act, 

6 for purposes of this subtitle, including section 332(c), the 

7 public health emergency shall be considered to have been 

8 declared on the date of enactment of this Act. 

9 SEC. 339B. COLLECTION OF DATA AND FURTHER STUDY. 

10 (a) COMPILATION OF INFORMATION.—The Commis11 sioner of the Bureau of Labor Statistics shall— 

12 (1) collect data on— 

13 (A) the amount of paid and unpaid sick 

14 time available to covered direct care profes15 sionals by occupation and type of employment 

16 establishment; and 

17 (B) an estimate of the average sick time 

18 used by covered direct care professionals ac19 cording to occupation and the type of covered 

20 direct care professional; and 

21 (2) annually report that data to the Comp22 troller General of the United States. 

23 (b) GAO STUDY.—The Comptroller General of the 

24 United States shall— 


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1 (1) conduct a study to evaluate the implementa2 tion of this subtitle— 

3 (A) that includes an estimation of the ac4 cess of covered direct care professionals to paid 

5 sick time, the awareness of covered direct care 

6 professionals of rights under this Act, and the 

7 experiences of employers in complying with this 

8 subtitle; and 

9 (B) that takes into account access, aware10 ness, and experiences of covered direct care pro11 fessionals by race, ethnicity, gender, disability, 

12 occupation, and any other characteristic deter13 mined by the Secretary; and 

14 (2) not later than 5 years after the date of en15 actment of this Act, submit the report to the Com16 mittee on Health, Education, Labor, and Pensions 

17 and the Special Committee on Aging of the Senate 

18 and the Committee on Education and the Workforce 

19 of the House of Representatives. 

20 TITLE IV—NATIONAL DIRECT 

21 CARE PROFESSIONAL COM22 PENSATION STRATEGY 

23 SEC. 401. DEFINITIONS. 

24 In this title: 


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1 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 

2 Council’’ means the National Direct Care Profes3 sional Compensation Advisory Council convened 

4 under section 403. 

5 (2) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Health and Human Services. 

7 (3) STRATEGY.—The term ‘‘Strategy’’ means 

8 the National Direct Care Professional Compensation 

9 Strategy set forth under section 402. 

10 SEC. 402. NATIONAL DIRECT CARE PROFESSIONAL COM11 PENSATION STRATEGY. 

12 (a) IN GENERAL.—The Secretary, in consultation 

13 with the heads of other appropriate Federal agencies, shall 

14 develop jointly with the Advisory Council and submit to 

15 the appropriate committees of Congress, and the State 

16 agencies responsible for carrying out direct care profes17 sional programs, and make publicly available on the inter18 net website of the Department of Health and Human 

19 Services, a National Direct Care Professional Compensa20 tion Strategy. 

21 (b) CONTENTS.— 

22 (1) IN GENERAL.—The Strategy shall identify 

23 recommended actions that the Federal Government 

24 (under existing Federal programs), State and local 

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1 cluding direct care professionals and others, are tak2 ing, or may take, to provide direct care professionals 

3 a livable wage, including recommendations on— 

4 (A) how to calculate the fair cost of labor 

5 provided by direct care professionals; 

6 (B) how State Medicaid agencies, managed 

7 care organizations, and other public payers 

8 should establish policies and procedures to en9 sure the direct care professional workforce is 

10 compensated at the full cost of their labor; 

11 (C) how to set clear expectations for em12 ployers of direct care professionals with respect 

13 to compensation for such professionals; and 

14 (D) how to ensure additional training and 

15 certification is tied to increased compensation 

16 for such professionals. 

17 (2) CONSIDERATIONS.—The recommendations 

18 under paragraph (1) shall take into account— 

19 (A) the particular challenges of the direct 

20 care professional workforce, including— 

21 (i) the largely part-time nature of the 

22 work; 

23 (ii) the mobile or transient nature of 

24 positions in the direct care professional 

25 workforce; 


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1 (iii) precarity due to race, ethnicity, 

2 sexual orientation, gender identity, and im3 migration status; and 

4 (iv) any decrease in public benefits 

5 that direct care professionals may experi6 ence following an increase in wages; and 

7 (B) strategies for wage enhancement for 

8 direct care professionals. 

9 (c) DUTIES OF THE SECRETARY.—The Secretary, in 

10 carrying out subsection (a), shall oversee the following: 

11 (1) Collecting and making publicly available in12 formation submitted by the Advisory Council under 

13 section 403(e) to the appropriate committees of Con14 gress, and the State agencies responsible for car15 rying out direct care professional programs, includ16 ing evidence-based or promising practices and inno17 vative models (both domestic and foreign) regarding 

18 compensation for direct care professionals. 

19 (2) Coordinating and assessing existing Federal 

20 Government programs and activities to compensate 

21 direct care professionals while ensuring maximum ef22 fectiveness and avoiding unnecessary duplication. 

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1 vided under section 403(e), to State or local efforts 

2 to compensate direct care professionals. 

3 (d) INITIAL STRATEGY; UPDATES.—The Secretary 

4 shall— 

5 (1) not later than 18 months after the date of 

6 enactment of this Act, develop, publish, and submit 

7 to the appropriate committees of Congress, and the 

8 State agencies responsible for carrying out direct 

9 care professional programs, an initial Strategy incor10 porating the items addressed in the Advisory Coun11 cil’s initial report under section 403(e) and other 

12 relevant information, including best practices, for 

13 compensating direct care professionals; and 

14 (2) biennially update, republish, and submit to 

15 the appropriate committees of Congress and the 

16 State agencies responsible for carrying out direct 

17 care professional programs the Strategy, taking into 

18 account the most recent annual report submitted 

19 under section 403(e)(1)— 

20 (A) to reflect new developments, chal21 lenges, opportunities, and solutions; and 

22 (B) to review progress based on rec23 ommendations for compensating direct care 

24 professionals in the Strategy and, based on the 

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1 tions for improving the implementation of such 

2 recommendations, as appropriate. 

3 (e) PROCESS FOR PUBLIC INPUT.—The Secretary 

4 shall establish a process for public input to inform the de5 velopment of, and updates to, the Strategy, including a 

6 process for the public to submit recommendations to the 

7 Advisory Council and an opportunity for public comment 

8 on the proposed Strategy. 

9 (f) NO PREEMPTION.—Nothing in this title preempts 

10 any authority of a State or local government to com11 pensate direct care professionals. 

12 (g) RULE OF CONSTRUCTION.—Nothing in this title 

13 shall be construed to permit the Secretary (through regu14 lation, guidance, grant criteria, or otherwise) to— 

15 (1) mandate, direct, or control the allocation of 

16 State or local resources; 

17 (2) mandate the use of any of the best practices 

18 identified in the reports required under this title; or 

19 (3) otherwise expand the authority of the Sec20 retary beyond that expressly provided to the Sec21 retary in this title. 

22 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated for the advisory committee 

24 $100,000 for each of years 2025 through 2029. 


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1 SEC. 403. NATIONAL DIRECT CARE PROFESSIONAL COM2 PENSATION ADVISORY COUNCIL. 

3 (a) CONVENING.—The Secretary shall convene a Na4 tional Direct Care Professional Compensation Advisory 

5 Council to advise and provide recommendations, including 

6 identified best practices, to the Secretary on compensating 

7 direct care professionals. 

8 (b) MEMBERSHIP.— 

9 (1) IN GENERAL.—The members of the Advi10 sory Council shall consist of— 

11 (A) the appointed members under para12 graph (2); and 

13 (B) the Federal members under paragraph 

14 (3). 

15 (2) APPOINTED MEMBERS.—In addition to the 

16 Federal members under paragraph (3), the Sec17 retary shall appoint not more than 15 voting mem18 bers of the Advisory Council who are not representa19 tives of Federal departments or agencies and who 

20 shall include at least 1 representative of each of the 

21 following: 

22 (A) Direct care professionals. 

23 (B) Older individuals eligible for long-term 

24 care services under a State Medicaid program. 

25 (C) People with disabilities. 


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1 (D) Health care and social service pro2 viders. 

3 (E) Employers of direct care professionals. 

4 (F) State and local officials responsible for 

5 direct care professional policies in their jurisdic6 tions. 

7 (G) Accreditation bodies responsible for ac8 crediting direct care professionals. 

9 (H) Veterans who are older individuals or 

10 people with disabilities. 

11 (I) Organizations representing workers, in12 cluding labor organizations. 

13 (J) As appropriate, other experts in direct 

14 care and advocacy organizations for the direct 

15 care professional workforce. 

16 (3) FEDERAL MEMBERS.—The Federal mem17 bers of the Advisory Council, who shall be nonvoting 

18 members, shall consist of the following: 

19 (A) The Administrator of the Centers for 

20 Medicare & Medicaid Services (or the Adminis21 trator’s designee). 

22 (B) The Administrator of the Administra23 tion for Community Living (or the Administra24 tor’s designee who has experience in both aging 

25 and disability). 


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1 (C) The Secretary of Veterans Affairs (or 

2 the Secretary’s designee). 

3 (D) The Secretary of Labor (or the Sec4 retary’s designee). 

5 (E) The Administrator of the Health Re6 sources and Services Administration (or the Ad7 ministrator’s designee). 

8 (F) The heads of other Federal depart9 ments or agencies (or their designees), includ10 ing relevant departments or agencies that over11 see labor and workforce, economic, government 

12 financial policies, community service, and other 

13 impacted populations, as appointed by the Sec14 retary or the Chair of the Advisory Council. 

15 (4) DIVERSE REPRESENTATION.—The Sec16 retary shall ensure that the membership of the Advi17 sory Council reflects the diversity of direct care pro18 fessionals and individuals eligible for long-term care 

19 services under a State Medicaid program. 

20 (c) MEETINGS.—The Advisory Council shall meet 

21 quarterly during the 1-year period beginning on the date 

22 of enactment of this Act and at least 3 times during each 

23 year thereafter. Meetings of the Advisory Council shall be 

24 open to the public. 

25 (d) NON-FEDERAL MEMBER COMPENSATION.— 


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1 (1) COMPENSATION OF MEMBERS.—A member 

2 of the Advisory Council who is not an officer or em3 ployee of the Federal Government shall be com4 pensated at a rate equal to the daily equivalent of 

5 the annual rate of basic pay prescribed for level IV 

6 of the Executive Schedule under section 5315 of title 

7 5, United States Code, for each day (including travel 

8 time) during which the member is engaged in the 

9 performance of the duties of the Commission. 

10 (2) TRAVEL EXPENSES.—A member of the Ad11 visory Council who is not an officer or employee of 

12 the Federal Government shall be allowed travel ex13 penses, including per diem in lieu of subsistence, at 

14 rates authorized for employees of agencies under 

15 subchapter I of chapter 57 of title 5, United States 

16 Code, while away from their homes or regular places 

17 of business in the performance of services for the 

18 Commission. 

19 (3) CHILD CARE.—A member of the Advisory 

20 Council who is not an officer or employee of the 

21 Federal Government shall be permitted expenses for 

22 child care during the period for which they are re23 quired to meet with the Advisory Council or travel 

24 to and from meetings of the Advisory Council. 


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1 (4) TECHNOLOGY SUPPORT.—A member of the 

2 Advisory Council who is not an officer or employee 

3 of the Federal Government shall be permitted ex4 penses for technology necessary to participate in ac5 tivities of the Advisory Council. 

6 (e) ADVISORY COUNCIL ANNUAL REPORTS.— 

7 (1) IN GENERAL.—Not later than 12 months 

8 after the date of enactment of this Act, and annually 

9 thereafter, the Advisory Council shall submit to the 

10 Secretary, the appropriate committees of Congress, 

11 and the State agencies responsible for carrying out 

12 direct care professional programs, and make publicly 

13 available on the internet website of the Department 

14 of Health and Human Services, a report concerning 

15 the development, maintenance, and updating of the 

16 Strategy, including a description of the outcomes of 

17 the recommendations and any priorities included in 

18 the initial report pursuant to paragraph (2), as ap19 propriate. 

20 (2) INITIAL REPORT.—The Advisory Council’s 

21 initial report under paragraph (1) shall include— 

22 (A) an inventory and assessment of all fed23 erally funded efforts to compensate direct care 

24 professionals and the outcomes of such efforts, 

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1 ally funded efforts are reaching direct care pro2 fessionals and gaps in such efforts; 

3 (B) recommendations— 

4 (i) to improve and better coordinate 

5 Federal programs and activities to com6 pensate direct care professionals, as well as 

7 opportunities to improve the coordination 

8 of such Federal programs and activities 

9 with State programs; and 

10 (ii) to effectively deliver services based 

11 on the performance, mission, and purpose 

12 of a program while eliminating 

13 redundancies, avoiding unnecessary dupli14 cation and overlap, and ensuring the needs 

15 of direct care professionals are met; 

16 (C) the identification of challenges faced 

17 by direct care professionals, including financial, 

18 health, and other challenges, and existing ap19 proaches to address such challenges; and 

20 (D) an evaluation of how the status of the 

21 direct care professional workforce affects the 

22 Medicare program, the Medicaid program, and 

23 other Federal programs. 


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1 (f) NONAPPLICABILITY OF FEDERAL ADVISORY COM2 MITTEE ACT.—Chapter 10 of title 5, United States Code, 

3 shall not apply to the Advisory Council. 

4 SEC. 404. SUNSET PROVISION. 

5 The authority and obligations established by this title 

6 shall terminate on the date that is 10 years after the date 

7 of enactment of this Act. 

8 TITLE V—IMPROVING OVER9 SIGHT AND ACCOUNTABILITY 

10 SEC. 501. EVALUATION OF IMPLEMENTATION AND OUT11 COMES. 

12 (a) IN GENERAL.—The Secretary of Health and 

13 Human Services, in conjunction with the Secretary of 

14 Labor, shall evaluate the implementation and outcomes of 

15 this Act in the aggregate through a contract with an exter16 nal evaluator who has experience in evaluating— 

17 (1) home and community-based services; 

18 (2) disability programs; 

19 (3) programs for older individuals; 

20 (4) nursing homes and intermediate care facili21 ties; and 

22 (5) health care workforce programs, including 

23 direct care professional workforce programs. 

24 (b) EVALUATION CRITERIA.—The external evaluator 

25 shall document and evaluate the implementation and outVerDate Sep 11 2014 21:05 Apr 23, 2024 Jkt 049200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\S4120.IS S4120

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1 comes of this Act, and the amendments made by this Act, 

2 including outcomes based on— 

3 (1) the impact on workforce creation, training, 

4 education, recruitment, retention, professional devel5 opment, and advancement of the direct care profes6 sional workforce, including direct care professionals 

7 from low-income families; 

8 (2) the economic effects, including the impact 

9 on compensation and benefits, on the direct care 

10 professional workforce; 

11 (3) the impact on working conditions, including 

12 scheduling flexibility and stability, for direct care 

13 professionals; 

14 (4) the impact of workforce investment activi15 ties, including supportive services, on recruitment, 

16 wages, benefits, and advancement of direct care pro17 fessionals; 

18 (5) the impact on burnout, attrition, and sta19 bility of the direct care professional workforce; 

20 (6) the impact on vacancy rates and crude sep21 aration rates of the direct care professional work22 force; 

23 (7) the economic effects on— 

24 (A) individuals enrolled for medical assist25 ance under a State Medicaid program; 


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1 (B) people with disabilities and older indi2 viduals receiving long-term care services, includ3 ing home and community-based services; and 

4 (C) the families of any such individuals or 

5 persons described in subparagraph (A) or (B); 

6 (8) the impact on the capacity of States to en7 sure the delivery of long-term care services and on 

8 the costs to the Medicare and Medicaid programs; 

9 (9) the capacity of the direct care professional 

10 workforce to provide services for individuals needing 

11 long-term care services or changes in access, avail12 ability, and quality of long-term care services; 

13 (10) the impact on State waiting lists for home 

14 and community-based services; 

15 (11) the impact on mental health outcomes, in16 cluding substance use disorders and suicidality, 

17 among direct care professionals; 

18 (12) promising practices identified by activities 

19 authorized or conducted pursuant to this Act, or the 

20 amendments made by this Act; and 

21 (13) any other factor as determined appropriate 

22 by the Secretary of Health and Human Services. 

23 (c) FISCAL ANALYSIS.—The Secretary of Health and 

24 Human Services, in conjunction with the Secretary of 

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1 uator to track spending by States and providers of funding 

2 provided to States under sections 101 and 102 (including 

3 the amendments made by such sections). The evaluator 

4 shall— 

5 (1) collect spending data from each State re6 ceiving funds under such sections; 

7 (2) analyze the data to determine what percent8 age of funding under such sections was expended to 

9 improve wages and benefits of direct care profes10 sionals, disaggregated by subcategories of direct care 

11 professionals described in section 3(11); 

12 (3) beginning 2 years after the date of enact13 ment of this Act, and every year thereafter through 

14 fiscal year 2039— 

15 (A) publish an annual report of State 

16 spending and the analyses conducted under 

17 paragraph (2); and 

18 (B) provide all such reports to the appro19 priate committees of Congress; and 

20 (4) share the data described in paragraph (1) 

21 with researchers to encourage further analysis. 

22 (d) DISSEMINATION OF EVALUATION FINDINGS.— 

23 The Secretary of Health and Human Services shall— 

24 (1) disseminate the findings from the evalua25 tions conducted under this section, and from any 


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1 other evaluation conducted under this Act or an 

2 amendment made by this Act, to— 

3 (A) all State Medicaid agencies; and 

4 (B) the appropriate committees of Con5 gress; and 

6 (2) make all such findings publicly available in 

7 an accessible electronic format and any other acces8 sible format determined appropriate by the Sec9 retary. 

Æ 


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