I 

112TH CONGRESS 

1ST SESSION H. R. 2341 

To amend the Fair Labor Standards Act with regard to certain exemptions 

under that Act for direct care workers and to improve the systems 

for the collection and reporting of data relating to the direct care workforce, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 23, 2011 

Ms. LINDA T. SA ́NCHEZ of California (for herself, Mr. BRALEY of Iowa, Ms. 

DELAURO, Ms. EDWARDS, Mr. FILNER, Mr. GRIJALVA, Mr. GUTIERREZ, 

Mr. HASTINGS of Florida, Mr. HONDA, Mr. KILDEE, Mr. LANGEVIN, Mr. 

MCGOVERN, Mr. MICHAUD, Ms. MOORE, Mr. PASCRELL, Mr. PERLMUTTER, Ms. PINGREE of Maine, Ms. RICHARDSON, Ms. ROYBALALLARD, Ms. SCHAKOWSKY, Ms. SUTTON, and Mr. WU) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and the Workforce, for a period to be subsequently determined by the Speaker, in each 

case for consideration of such provisions as fall within the jurisdiction of 

the committee concerned 

A BILL 

To amend the Fair Labor Standards Act with regard to 

certain exemptions under that Act for direct care workers 

and to improve the systems for the collection and reporting of data relating to the direct care 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Direct Care Job Qual3 ity Improvement Act of 2011’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds that— 

6 (1) direct care workers are the linchpin of the 

7 Nation’s paid long-term care system, providing es8 sential care and daily living services to many of the 

9 approximately 10 million Americans who are elderly 

10 or live with disabilities; 

11 (2) over two-thirds of older adults will need 

12 some form of long-term care at some point in their 

13 lives and by 2020, 15 million Americans are ex14 pected to need such care; 

15 (3) the ability to meet the Nation’s need for 

16 long-term care services and supports depends largely 

17 on a strong, stable direct care workforce; 

18 (4) the United States faces an impending short19 age of qualified direct care workers to provide per20 sonal and long-term care and support services; 

21 (5) direct care work is demanding, working con22 ditions are often difficult, and turnover is high be23 cause of low pay, lack of access to health insurance 

24 and other benefits, inadequate training, limited op25 portunities for advancement, and lack of respect; 


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1 (6) direct care workers are often underpaid: 45 

2 percent of direct care workers live at or below the 

3 poverty level, and nearly half live in households that 

4 receive one or more public benefits (such as food 

5 stamps or Medicaid); 

6 (7) the average annual income for direct care 

7 workers is $17,000, and more than 1 in 4 of such 

8 workers lack health insurance; and 

9 (8) State management information systems are 

10 rarely designed to gather and report basic informa11 tion about the direct care workforce that could be 

12 used assess workforce challenges or monitor changes 

13 in the direct care workforce over time. 

14 SEC. 3. LIMITATION TO EXEMPTION UNDER THE FAIR 

15 LABOR STANDARDS ACT. 

16 (a) HOME CARE WORKERS.—Section 13(a)(15) of 

17 the Fair Labor Standards Act of 1938 (29 U.S.C. 

18 213(a)(15)) is amended to read as follows: 

19 ‘‘(15) any employee employed on a casual basis 

20 in domestic service employment to provide baby21 sitting services or any employee employed on a cas22 ual basis in domestic service employment to provide 

23 companionship services for individuals who (because 

24 of age, infirmity, or disability) are unable to care for 


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1 themselves (as such terms are defined and delimited 

2 by regulations of the Secretary);’’. 

3 (b) DEFINITION.—Section 3 of the Fair Labor 

4 Standards Act of 1938 (29 U.S.C. 203) is amended by 

5 adding at the end the following: 

6 ‘‘(z) The term ‘casual basis in domestic service em7 ployment to provide companionship services’ means em8 ployment which is irregular or intermittent, and which is 

9 not performed by an individual— 

10 ‘‘(1) whose vocation is the provision of compan11 ionship services; or 

12 ‘‘(2) who is employed by an employer or agency 

13 other than the family or household using their serv14 ices. 

15 Employment is not on a casual basis if any family or 

16 household employer employs an individual performing 

17 companionship services for more than five (5) hours per 

18 week or has employed the individual for a time period that 

19 has extended beyond twelve (12) weeks in a calendar 

20 year.’’. 

21 SEC. 4. LONG-TERM SERVICES AND SUPPORTS. 

22 (a) DIRECT CARE WORKFORCE MONITORING PRO23 GRAM.— 

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

25 Human Services, in cooperation with the heads of 


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1 other relevant departments, shall develop a program 

2 to monitor the capacity and adequacy of the direct 

3 care workforce in all relevant, as determined by the 

4 Secretary, Federal healthcare programs (as defined 

5 under section 1128B(f) of the Social Security Act 

6 (42 U.S.C. 1320a–7b(f)). 

7 (2) MONITORING AND EVALUATION.—Under 

8 the program under paragraph (1), the Secretary 

9 shall monitor and evaluate— 

10 (A) the quality of services provided by di11 rect care workers through Federal healthcare 

12 programs, including in home and community13 based settings and in long-term care settings; 

14 and 

15 (B) the adequacy of the direct care work16 force to provide services through such pro17 grams, including— 

18 (i) the stability of such workforce, in19 cluding turnover rates; 

20 (ii) an evaluation of geographic vari21 ation in the adequacy of such workforce; 

22 and 

23 (iii) the adequacy of such workforce to 

24 meet the current and future demand for 


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1 long-term services and supports under such 

2 programs. 

3 (3) DATA SHARING.—For purposes of improv4 ing the adequacy of the direct care workforce and 

5 quality of services provided by such workforce 

6 through Federal healthcare programs, the Secretary 

7 shall— 

8 (A) facilitate the sharing of data on such 

9 workforce between relevant Federal depart10 ments and between States; 

11 (B) prepare cross-State comparisons of 

12 such data and share such comparisons with 

13 States; and 

14 (C) share with States and Federal depart15 ments best practices for developing an adequate 

16 workforce that provides high quality direct care 

17 services. 

18 (b) REPORTING ON WORKFORCE ADEQUACY UNDER

19 MEDICAID.— 

20 (1) IN GENERAL.—Section 1902(a) of the So21 cial Security Act (42 U.S.C. 1396a(a)) is amend22 ed— 

23 (A) by striking ‘‘and’’ at the end of para24 graph (82); 


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1 (B) by striking the period at the end of 

2 paragraph (83) and inserting ‘‘; and’’; and 

3 (C) by inserting the following after para4 graph (83): 

5 ‘‘(84) provide that the State shall submit to the 

6 Secretary an annual report that, with respect to 

7 both the current and future needs of individuals who 

8 are enrolled in the State plan for long term care 

9 services and supports, details the capacity and ade10 quacy of the direct care workforce (as such term is 

11 defined in subsection (ll)) in the State (including 

12 specifying the number of full-time and part-time di13 rect care workers, the turnover rate for such work14 ers, the number of vacancies for such workers, the 

15 average wage for such workers; the typical benefits 

16 package offered to such workers, and any other 

17 types of data related to the direct care workforce in 

18 the State that the Secretary requires).’’. 

19 (2) DEFINITIONS AND EXCEPTION FROM WAIV20 ER.—Section 1902 of the Social Security Act is fur21 ther amended by adding at the end the following: 

22 ‘‘(ll) DIRECT CARE WORKERS.— 

23 ‘‘(1) DEFINITIONS.—For purposes of this sub24 section and subsection (a)(84): 


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1 ‘‘(A) DIRECT CARE WORKER.—The term 

2 ‘direct care worker’ has the meaning given each 

3 of the following terms in the 2010 Standard 

4 Occupational Classifications of the Department 

5 of Labor: Home Health Aides [31–1011], Psy6 chiatric Aides [31–1013], Nursing Assistants 

7 [31–1014], and Personal Care Aides [39– 

8 9021]. 

9 ‘‘(B) DIRECT CARE WORKFORCE.—The 

10 term ‘direct care workforce’ means the work11 force made up of direct care workers. 

12 ‘‘(2) EXEMPTION FROM WAIVER.—In the case 

13 of any State which is providing medical assistance to 

14 its residents under a waiver granted under section 

15 1115 or section 1915, the Secretary shall require the 

16 State submit the report required under subsection 

17 (a)(84) in the same manner as the State would be 

18 required to submit such report if the State had in 

19 effect a plan approved under this title.’’. 

20 (3) EFFECTIVE DATE.— 

21 (A) IN GENERAL.—Except as provided in 

22 subparagraph (B), the amendments made by 

23 this subsection shall take effect 6 months after 

24 the date of the enactment of this Act. 


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1 (B) RULE FOR CHANGES REQUIRING

2 STATE LEGISLATION.—In the case of a State 

3 plan for medical assistance under title XIX of 

4 the Social Security Act which the Secretary of 

5 Health and Human Services determines re6 quires State legislation (other than legislation 

7 appropriating funds) in order for the plan to 

8 meet the additional requirement imposed by the 

9 amendments made by this subsection, the State 

10 plan shall not be regarded as failing to comply 

11 with the requirements of such title solely on the 

12 basis of its failure to meet this additional re13 quirement before the first day of the first cal14 endar quarter beginning after the close of the 

15 first regular session of the State legislature that 

16 begins after the date of the enactment of this 

17 Act. For purposes of the previous sentence, in 

18 the case of a State that has a 2-year legislative 

19 session, each year of such session shall be 

20 deemed to be a separate regular session of the 

21 State legislature. 

22 SEC. 5. PRIORITIZING ANALYSIS BY NATIONAL HEALTH 

23 CARE WORKFORCE COMMISSION. 

24 (a) ADDITIONAL HIGH PRIORITY AREA.—Subpara25 graph (A) of section 5101(d)(4) of the Patient Protection 


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1 and Affordable Care Act (42 U.S.C. 294q(d)(4)) is 

2 amended by adding at the end the following: 

3 ‘‘(vi) With respect to the direct care 

4 workforce— 

5 ‘‘(I) a review of current and pro6 jected workforce supply and demand, 

7 including a review of workforce size, 

8 employment settings, turnover, com9 pensation, and benefits; 

10 ‘‘(II) an analysis of the adequacy 

11 of existing workforce data, data collec12 tion, and monitoring infrastructure; 

13 and 

14 ‘‘(III) recommendations for new 

15 or additional uniform data elements 

16 across regions and States that are 

17 necessary to track workforce supply, 

18 demand, and shortages.’’. 

19 (b) APPLICATION.—The amendment made by para20 graph (1) applies beginning with the reports required by 

21 section 5101(d)(2) of the Patient Protection and Afford22 able Care Act (42 U.S.C. 294q(d)(2)) for 2011. 


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1 SEC. 6. GRANTS AND TECHNICAL ASSISTANCE FOR DATA 

2 COLLECTION AND MONITORING. 

3 (a) IN GENERAL.—The Secretary of Health and 

4 Human Services shall award grants to States, Indian 

5 tribes, and tribal organizations for the purpose of devel6 oping comprehensive data collection and monitoring sys7 tems to assess the adequacy and stability of the direct care 

8 workforce of the State or Indian tribe, as applicable, to 

9 meet current and future demand for long-term services 

10 and supports. 

11 (b) USE OF FUNDS.—A State, Indian tribe, or tribal 

12 organization receiving a grant under subsection (a) shall 

13 use the grant for— 

14 (1) an assessment of current data sources and 

15 data gaps on the volume, stability, and compensation 

16 of the State or tribe’s direct care workforce across 

17 all settings and programs; 

18 (2) consultation with all agencies of the State, 

19 Indian tribe, or tribal organization that collect data 

20 on the direct care workforce, or data on programs 

21 under which services are provided in connection with 

22 the direct care workforce, in order to streamline 

23 data collection; 

24 (3) the development of an implementation plan 

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1 gram for monitoring the volume, stability, and com2 pensation of the direct care workforce; 

3 (4) the implementation of such program; 

4 (5) the sharing of information on best practices 

5 on data collection and monitoring with other States, 

6 Indian tribes, or tribal organizations; and 

7 (6) the formulation of recommendations for ap8 propriate steps to reduce State, local, or tribal bar9 riers to comprehensive direct care workforce data 

10 collection and monitoring systems, including any 

11 necessary changes in State, local, or tribal policies. 

12 (c) DISTRIBUTION OF GRANTS.— 

13 (1) NUMBER OF GRANTS.—In carrying out sub14 section (a) the Secretary shall award grants to not 

15 fewer than 5 States each year. 

16 (2) GEOGRAPHIC AND DEMOGRAPHIC DIVER17 SITY.—In selecting grant recipients under subsection 

18 (a), the Secretary shall ensure that grants are 

19 awarded to a diversity of grantees in terms of geog20 raphy and demographics. 

21 (3) PREFERENCE.—In selecting grant recipi22 ents under subsection (a), the Secretary shall give 

23 preference to States, Indian tribes, and tribal orga24 nizations with a relatively higher percentage of resiVerDate Mar 15 2010 23:10 Jun 29, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2341.IH H2341

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1 dents who require publicly financed long-term serv2 ices. 

3 (d) APPLICATION.—To apply for a grant under this 

4 section, an entity shall submit an application to the Sec5 retary in such form, in such manner, and containing such 

6 information as the Secretary may require. At a minimum, 

7 each such application shall include a description of the ac8 tivities for which funds are sought and a budget for use 

9 of the funds. 

10 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

11 provide technical assistance to States, Indian tribes, and 

12 tribal organizations to develop comprehensive data collec13 tion and monitoring systems to assess the adequacy and 

14 stability of the State’s direct care workforce under sub15 section (b)(1). 

16 (f) STATE DEFINED.—For purposes of this section: 

17 (1) Subject to paragraph (2), the term ‘‘State’’ 

18 means any of the 50 States, the District of Colum19 bia, Puerto Rico, Guam, the United States Virgin 

20 Islands, American Samoa, and the Commonwealth of 

21 the Northern Mariana Islands. 

22 (2) The term ‘‘State’’ includes, in lieu of any 

23 State listed in paragraph (1), an entity designated 

24 by such State to apply for a grant under this sec25 tion. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out this section for each of fiscal years 

4 2012 through 2016. 

5 SEC. 7. DIRECT CARE WORKER RECRUITMENT, RETENTION, 

6 AND EDUCATION GRANT PROGRAM. 

7 (a) IN GENERAL.—The Secretary shall award grants 

8 on a competitive basis to States and other eligible entities 

9 for the purpose of improving the recruitment, retention, 

10 and education of direct care workers. 

11 (b) USE OF FUNDS.—A State or other eligible entity 

12 receiving a grant under subsection (a) shall use the grant 

13 to— 

14 (1) establish, expand, or upgrade training pro15 grams and infrastructure for direct care workers; 

16 (2) establish or expand recruitment and reten17 tion programs for direct care workers, including ini18 tiatives which— 

19 (A) improve the wages and benefits offered 

20 to direct care workers; and 

21 (B) create and implement career ladders 

22 for such workers; and 

23 (3) develop or expand programs that— 

24 (A) promote the role of direct care workers 

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1 ices to persons with disabilities and to persons 

2 with chronic health conditions and other ex3 tended support needs; and 

4 (B) include approaches such as remote 

5 monitoring, wellness, and prevention. 

6 (c) DIVERSITY.—In selecting grant recipients under 

7 subsection (a), the Secretary shall ensure that grants are 

8 awarded to States or other eligible entities in a manner 

9 that ensures that grant funds are used to enhance the di10 rect care workforce— 

11 (1) in urban and rural communities; and 

12 (2) that serves a diverse patient population, in13 cluding with respect to— 

14 (A) age; 

15 (B) income level; 

16 (C) race and ethnicity; and 

17 (D) disability status. 

18 (d) GRANT PERIOD.—The Secretary— 

19 (1) may award grants under this section for pe20 riods of not more than 3 years; and 

21 (2) may extend the period of a grant under this 

22 section by not more than 3 years. 

23 (e) APPLICATION.—To apply for a grant under this 

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1 retary in such form, in such manner, and containing such 

2 information as the Secretary may require. 

3 (f) BASELINE MEASURES AND BENCHMARKS.—As a 

4 condition on the receipt of a grant under this section, the 

5 Secretary shall require each grantee to establish baseline 

6 measures and benchmarks (meeting such requirements as 

7 the Secretary may determine) in order to properly evaluate 

8 the impact of the work performed by the grantee through 

9 the grant. 

10 (g) SUPPLEMENT, NOT SUPPLANT.—The Secretary 

11 shall ensure that amounts provided to a grantee under this 

12 section are used to supplement and not supplant other 

13 Federal, State, or local public funds expended to improve 

14 the recruitment, retention, and education of the direct 

15 care workforce. 

16 (h) TERMINATION AUTHORITY.—The Secretary may 

17 terminate a grant agreement under this section for good 

18 cause. Such good cause shall include a determination that 

19 the grantee— 

20 (1) has misappropriated funds provided under 

21 this section; or 

22 (2) has failed to make adequate progress to23 ward accomplishing any benchmark established pur24 suant to subsection (f). 


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1 (i) REPORTS AND AUDITS.—As a condition on the re2 ceipt of a grant under this section, the Secretary shall re3 quire each grantee to agree— 

4 (1) to report to the Secretary on the activities 

5 carried out with the grant, including, at the request 

6 of the Secretary, periodic spending reports; and 

7 (2) to allow the Secretary to conduct periodic 

8 audits pertaining to funding received through the 

9 grant. 

10 (j) ELIGIBLE ENTITY.—For purposes of this section, 

11 the term ‘‘eligible entity’’ means— 

12 (1) a State or political subdivision of a State; 

13 or 

14 (2) any organization, including a labor-manage15 ment partnership, that is committed to carrying out 

16 the activities set forth in subsection (b), whether in 

17 cooperation with a State, on its own initiative, or in 

18 partnership with any other organization. 

19 SEC. 8. REPORTS BY SECRETARY. 

20 Not later than 3 years after the date of awarding the 

21 first grant under section 6 or section 7, the Secretary of 

22 Health and Human Services shall prepare and submit to 

23 the Congress a report that describes the effectiveness of 

24 grants awarded under such sections in achieving the pur25 poses of such grants, including the effectiveness of the 


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1 programs funded by such grants in reducing turnover 

2 rates in the direct care workforce. 

3 SEC. 9. DEFINITIONS. 

4 For purposes of this Act: 

5 (1) DIRECT CARE WORKER.—The term ‘‘direct 

6 care worker’’ has the meaning given each of the fol7 lowing terms in the 2010 Standard Occupational 

8 Classifications of the Department of Labor: Home 

9 Health Aides [31–1011], Psychiatric Aides [31– 

10 1013], Nursing Assistants [31–1014], and Personal 

11 Care Aides [39–9021]. 

12 (2) DIRECT CARE WORKFORCE.—The term ‘‘di13 rect care workforce’’ means the workforce made up 

14 of direct care workers. 

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

16 the Secretary of Health and Human Services. 

Æ 


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