```

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3410 Introduced in Senate (IS)]

<DOC>

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Rural Seniors' Access to 
Care Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) According to the Bureau of Labor Statistics, between 
        February 2020 and August 2023, nursing homes in the United 
        States lost nearly 200,000 employees.
            (2) Forty-five percent of nursing home providers have 
        reported a worsening workforce situation since May 2022.
            (3) Ninety-six percent of nursing home providers have 
        reported difficulty in hiring staff.
            (4) More than ninety percent of nursing home providers have 
        increased wages and bonuses to recruit and retain staff.
            (5) Nearly eighty percent of nursing home providers have 
        hired temporary staff, who are often much more expensive than 
        permanent staff.
            (6) The Centers for Medicare & Medicaid Services reported 
        that 129 nursing homes closed in 2022, threatening access for 
        America's seniors, especially in rural areas.
            (7) The minimum staffing mandate in the proposed rule 
        entitled ``Medicare and Medicaid Programs; Minimum Staffing 
        Standards for Long-Term Care Facilities and Medicaid 
        Institutional Payment Transparency Reporting'' published by the 
        Department of Health and Human Services on September 6, 2023 
        (88 Fed. Reg. 61352-61429), will result in nursing home 
        closures, displacing an estimated 450,000 nursing home 
        residents, harming access to nursing home care, especially in 
        rural areas (as defined in the proposed rule).
            (8) The minimum staffing mandate in the proposed rule may 
        exacerbate workforce shortages, especially in rural areas (as 
        defined in the rule).

SEC. 3. PROHIBITION ON FINALIZING PROPOSED STAFFING RULE.

    The Secretary of Health and Human Services may not implement, 
enforce, or otherwise give effect to the proposed rule entitled 
``Medicare and Medicaid Programs; Minimum Staffing Standards for Long-
Term Care Facilities and Medicaid Institutional Payment Transparency 
Reporting'' published by the Department of Health and Human Services on 
September 6, 2023 (88 Fed. Reg. 61352-61429), and may not promulgate 
any substantially similar rule.

SEC. 4. ADVISORY PANEL ON NURSING HOME WORKFORCE.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this section, the Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') shall establish the 
Advisory Panel on the Nursing Home Workforce (in this section referred 
to as the ``Panel'').
    (b) Membership.--
            (1) Number and appointment.--The Panel shall be composed of 
        17 members representing various geographic areas, appointed by 
        the Secretary as follows:
                    (A) 1 representative of the Secretary, who shall 
                serve as the chair of the Panel.
                    (B) 2 registered nurses who actively furnish 
                services in a skilled nursing facility or nursing 
                facility, one of whom shall represent a rural area.
                    (C) 2 licensed professional nurses who actively 
                furnish services in a skilled nursing facility or 
                nursing facility, one of whom shall represent a rural 
                area.
                    (D) 2 nurse aides who actively furnish services in 
                a skilled nursing facility or nursing facility, one of 
                whom shall represent a rural area.
                    (E) 2 physicians who actively furnish services in a 
                skilled nursing facility or nursing facility, one of 
                whom shall represent a rural area.
                    (F) 1 representative of the Centers for Medicare & 
                Medicaid Services.
                    (G) 1 representative of the Health Resources and 
                Services Administration.
                    (H) 2 individuals with professional expertise 
                related to the nursing home workforce, one of whom 
                shall have experience with respect to the nursing home 
                workforce in rural and underserved areas.
                    (I) 1 licensed administrator or representative of a 
                rural not-for-profit skilled nursing facility.
                    (J) 1 licensed administrator or representative of a 
                rural for-profit skilled nursing facility.
                    (K) 2 representatives of State boards of nursing.
            (2) Timing of appointments.--Each of the appointments under 
        paragraph (1) shall be made not later than 60 days after the 
        date of the enactment of this section.
            (3) Terms; vacancies.--Each member shall be appointed for a 
        term not to exceed 2 years, and a vacancy in the Panel shall be 
        filled in the manner in which the original appointment was 
        made.
            (4) Quorum.--13 members of the Panel shall constitute a 
        quorum.
            (5) Federal advisory committee act.--Chapter 10 of title 5, 
        United States Code, shall apply to the Panel.
    (c) Duties.--
            (1) Meetings.--
                    (A) Frequency.--The Panel shall meet not later than 
                180 days after the date on which the appointments 
                described in subsection (b) are made, and not less 
                frequently than twice per year thereafter.
                    (B) Public access.--The Panel shall make available 
                on a public website of the Department of Health and 
                Human Services--
                            (i) real-time virtual access to each 
                        meeting of the Panel; and
                            (ii) not later than 30 days after each such 
                        meeting, a recording and transcript of the 
                        meeting.
            (2) Reports.--
                    (A) Initial report.--Not later than 60 days after 
                the initial meeting of the Panel under paragraph 
                (1)(A), the Panel shall submit to the Secretary, the 
                Committee on Ways and Means and the Committee on Energy 
                and Commerce of the House of Representatives, and the 
                Committee on Finance of the Senate, and shall publish 
                on a public website of the Centers for Medicare & 
                Medicaid Services, a report on the state of the nursing 
                home workforce, which shall include--
                            (i) an assessment of the state of the 
                        nursing home workforce in rural and underserved 
                        areas, including an analysis of--
                                    (I) workforce shortages; and
                                    (II) with respect to individuals 
                                entitled to benefits under part A of 
                                title XVIII of the Social Security Act 
                                (42 U.S.C. 1395 et seq.) and 
                                individuals entitled to medical 
                                assistance under title XIX of such Act 
                                (42 U.S.C. 1396 et seq.), barriers to 
                                access to skilled nursing facilities 
                                and nursing facilities caused by such 
                                shortages;
                            (ii) an analysis of regulations, sub-
                        regulatory guidance, and guidance to State 
                        survey agencies issued by the Secretary with 
                        respect to skilled nursing facilities and 
                        nursing facilities, and the effects of such 
                        regulations and guidance on the nursing home 
                        workforce;
                            (iii) recommendations for the Secretary to 
                        strengthen the nursing home workforce, 
                        including recommendations for decreasing 
                        regulatory burdens for skilled nursing 
                        facilities and nursing facilities and making 
                        financial investments in training for health 
                        professionals; and
                            (iv) other information as the Panel 
                        determines necessary.
                    (B) Subsequent reports.--Not later than 1 year 
                after submitting the initial report under subparagraph 
                (A), and annually thereafter, the Panel shall submit 
                and publish an updated report in the same manner as 
                required under such subparagraph.
    (d) Definitions.--In this section, the following definitions apply:
            (1) Nursing facility.--The term ``nursing facility'' has 
        the meaning given such term in section 1919(a) of the Social 
        Security Act (42 U.S.C. 1396r(a)).
            (2) Nursing home workforce.--The term ``nursing home 
        workforce'' means the workforce of health professionals that 
        provide direct resident care in skilled nursing facilities and 
        nursing facilities.
            (3) Rural area.--The term ``rural area'' means any area 
        outside a metropolitan statistical area.
            (4) Skilled nursing facility.--The term ``skilled nursing 
        facility'' has the meaning given such term in section 1819(a) 
        of the Social Security Act (42 U.S.C. 1395i-3(a)).
            (5) Underserved area.--The term ``underserved area'' means 
        an area that is--
                    (A) a health professional shortage area, as such 
                term is defined in section 332(a)(1)(A) of the Public 
                Health Service Act (42 U.S.C. 254e(a)(1)(A)); or
                    (B) designated as a medically underserved area 
                pursuant to section 330(b)(3)(A) of such Act (42 U.S.C. 
                254b(b)(3)(A)).
                                 <all>
```