II 

118TH CONGRESS 

1ST SESSION S. 3410 

To prohibit the Secretary of Health and Human Services from finalizing 

a proposed rule regarding minimum staffing for nursing facilities, and 

to establish an advisory panel on the nursing home workforce. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 5, 2023 

Mrs. FISCHER (for herself, Mr. TESTER, Mr. MARSHALL, Mr. LANKFORD, Mr. 

MANCHIN, Ms. SINEMA, Mr. WICKER, Ms. COLLINS, and Mr. KING) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To prohibit the Secretary of Health and Human Services 

from finalizing a proposed rule regarding minimum staffing for nursing facilities, and to establish an advisory 

panel on the nursing home workforce. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protecting Rural Sen5 iors’ Access to Care Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) According to the Bureau of Labor Statis2 tics, between February 2020 and August 2023, 

3 nursing homes in the United States lost nearly 

4 200,000 employees. 

5 (2) Forty-five percent of nursing home pro6 viders have reported a worsening workforce situation 

7 since May 2022. 

8 (3) Ninety-six percent of nursing home pro9 viders have reported difficulty in hiring staff. 

10 (4) More than ninety percent of nursing home 

11 providers have increased wages and bonuses to re12 cruit and retain staff. 

13 (5) Nearly eighty percent of nursing home pro14 viders have hired temporary staff, who are often 

15 much more expensive than permanent staff. 

16 (6) The Centers for Medicare & Medicaid Serv17 ices reported that 129 nursing homes closed in 

18 2022, threatening access for America’s seniors, espe19 cially in rural areas. 

20 (7) The minimum staffing mandate in the pro21 posed rule entitled ‘‘Medicare and Medicaid Pro22 grams; Minimum Staffing Standards for Long-Term 

23 Care Facilities and Medicaid Institutional Payment 

24 Transparency Reporting’’ published by the Depart25 ment of Health and Human Services on September 


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1 6, 2023 (88 Fed. Reg. 61352–61429), will result in 

2 nursing home closures, displacing an estimated 

3 450,000 nursing home residents, harming access to 

4 nursing home care, especially in rural areas (as de5 fined in the proposed rule). 

6 (8) The minimum staffing mandate in the pro7 posed rule may exacerbate workforce shortages, es8 pecially in rural areas (as defined in the rule). 

9 SEC. 3. PROHIBITION ON FINALIZING PROPOSED STAFFING 

10 RULE. 

11 The Secretary of Health and Human Services may 

12 not implement, enforce, or otherwise give effect to the pro13 posed rule entitled ‘‘Medicare and Medicaid Programs; 

14 Minimum Staffing Standards for Long-Term Care Facili15 ties and Medicaid Institutional Payment Transparency 

16 Reporting’’ published by the Department of Health and 

17 Human Services on September 6, 2023 (88 Fed. Reg. 

18 61352–61429), and may not promulgate any substantially 

19 similar rule. 

20 SEC. 4. ADVISORY PANEL ON NURSING HOME WORKFORCE. 

21 (a) IN GENERAL.—Not later than 60 days after the 

22 date of the enactment of this section, the Secretary of 

23 Health and Human Services (in this section referred to 

24 as the ‘‘Secretary’’) shall establish the Advisory Panel on 


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1 the Nursing Home Workforce (in this section referred to 

2 as the ‘‘Panel’’). 

3 (b) MEMBERSHIP.— 

4 (1) NUMBER AND APPOINTMENT.—The Panel 

5 shall be composed of 17 members representing var6 ious geographic areas, appointed by the Secretary as 

7 follows: 

8 (A) 1 representative of the Secretary, who 

9 shall serve as the chair of the Panel. 

10 (B) 2 registered nurses who actively fur11 nish services in a skilled nursing facility or 

12 nursing facility, one of whom shall represent a 

13 rural area. 

14 (C) 2 licensed professional nurses who ac15 tively furnish services in a skilled nursing facil16 ity or nursing facility, one of whom shall rep17 resent a rural area. 

18 (D) 2 nurse aides who actively furnish 

19 services in a skilled nursing facility or nursing 

20 facility, one of whom shall represent a rural 

21 area. 

22 (E) 2 physicians who actively furnish serv23 ices in a skilled nursing facility or nursing facil24 ity, one of whom shall represent a rural area. 


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1 (F) 1 representative of the Centers for 

2 Medicare & Medicaid Services. 

3 (G) 1 representative of the Health Re4 sources and Services Administration. 

5 (H) 2 individuals with professional exper6 tise related to the nursing home workforce, one 

7 of whom shall have experience with respect to 

8 the nursing home workforce in rural and under9 served areas. 

10 (I) 1 licensed administrator or representa11 tive of a rural not-for-profit skilled nursing fa12 cility. 

13 (J) 1 licensed administrator or representa14 tive of a rural for-profit skilled nursing facility. 

15 (K) 2 representatives of State boards of 

16 nursing. 

17 (2) TIMING OF APPOINTMENTS.—Each of the 

18 appointments under paragraph (1) shall be made not 

19 later than 60 days after the date of the enactment 

20 of this section. 

21 (3) TERMS; VACANCIES.—Each member shall be 

22 appointed for a term not to exceed 2 years, and a 

23 vacancy in the Panel shall be filled in the manner 

24 in which the original appointment was made. 


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1 (4) QUORUM.—13 members of the Panel shall 

2 constitute a quorum. 

3 (5) FEDERAL ADVISORY COMMITTEE ACT.— 

4 Chapter 10 of title 5, United States Code, shall 

5 apply to the Panel. 

6 (c) DUTIES.— 

7 (1) MEETINGS.— 

8 (A) FREQUENCY.—The Panel shall meet 

9 not later than 180 days after the date on which 

10 the appointments described in subsection (b) 

11 are made, and not less frequently than twice 

12 per year thereafter. 

13 (B) PUBLIC ACCESS.—The Panel shall 

14 make available on a public website of the De15 partment of Health and Human Services— 

16 (i) real-time virtual access to each 

17 meeting of the Panel; and 

18 (ii) not later than 30 days after each 

19 such meeting, a recording and transcript of 

20 the meeting. 

21 (2) REPORTS.— 

22 (A) INITIAL REPORT.—Not later than 60 

23 days after the initial meeting of the Panel 

24 under paragraph (1)(A), the Panel shall submit 

25 to the Secretary, the Committee on Ways and 


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1 Means and the Committee on Energy and Com2 merce of the House of Representatives, and the 

3 Committee on Finance of the Senate, and shall 

4 publish on a public website of the Centers for 

5 Medicare & Medicaid Services, a report on the 

6 state of the nursing home workforce, which 

7 shall include— 

8 (i) an assessment of the state of the 

9 nursing home workforce in rural and un10 derserved areas, including an analysis of— 

11 (I) workforce shortages; and 

12 (II) with respect to individuals 

13 entitled to benefits under part A of 

14 title XVIII of the Social Security Act 

15 (42 U.S.C. 1395 et seq.) and individ16 uals entitled to medical assistance 

17 under title XIX of such Act (42 

18 U.S.C. 1396 et seq.), barriers to ac19 cess to skilled nursing facilities and 

20 nursing facilities caused by such 

21 shortages; 

22 (ii) an analysis of regulations, sub23 regulatory guidance, and guidance to State 

24 survey agencies issued by the Secretary 

25 with respect to skilled nursing facilities 


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1 and nursing facilities, and the effects of 

2 such regulations and guidance on the nurs3 ing home workforce; 

4 (iii) recommendations for the Sec5 retary to strengthen the nursing home 

6 workforce, including recommendations for 

7 decreasing regulatory burdens for skilled 

8 nursing facilities and nursing facilities and 

9 making financial investments in training 

10 for health professionals; and 

11 (iv) other information as the Panel 

12 determines necessary. 

13 (B) SUBSEQUENT REPORTS.—Not later 

14 than 1 year after submitting the initial report 

15 under subparagraph (A), and annually there16 after, the Panel shall submit and publish an up17 dated report in the same manner as required 

18 under such subparagraph. 

19 (d) DEFINITIONS.—In this section, the following defi20 nitions apply: 

21 (1) NURSING FACILITY.—The term ‘‘nursing 

22 facility’’ has the meaning given such term in section 

23 1919(a) of the Social Security Act (42 U.S.C. 

24 1396r(a)). 


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1 (2) NURSING HOME WORKFORCE.—The term 

2 ‘‘nursing home workforce’’ means the workforce of 

3 health professionals that provide direct resident care 

4 in skilled nursing facilities and nursing facilities. 

5 (3) RURAL AREA.—The term ‘‘rural area’’ 

6 means any area outside a metropolitan statistical 

7 area. 

8 (4) SKILLED NURSING FACILITY.—The term 

9 ‘‘skilled nursing facility’’ has the meaning given such 

10 term in section 1819(a) of the Social Security Act 

11 (42 U.S.C. 1395i–3(a)). 

12 (5) UNDERSERVED AREA.—The term ‘‘under13 served area’’ means an area that is— 

14 (A) a health professional shortage area, as 

15 such term is defined in section 332(a)(1)(A) of 

16 the Public Health Service Act (42 U.S.C. 

17 254e(a)(1)(A)); or 

18 (B) designated as a medically underserved 

19 area pursuant to section 330(b)(3)(A) of such 

20 Act (42 U.S.C. 254b(b)(3)(A)). 

Æ 


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