I 
118TH CONGRESS 
1ST SESSION H. R. 5796 
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 HOUSE OF REPRESENTATIVES 
SEPTEMBER 28, 2023 
Mrs. FISCHBACH (for herself and Mr. PENCE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To prohibit the Secretary of Health and Human Services 
from finalizing a proposed rule regarding minimum staff-
ing for nursing facilities, and to establish an advisory 
panel on the nursing home workforce. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Rural Sen-
iors’ Access to Care Act’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) According to the Bureau of Labor Statis-
tics, between February 2020 and August 2023, 
nursing homes in the United States lost nearly 
200,000 employees. 
(2) Forty-five percent of nursing home pro-
viders have reported a worsening workforce situation 
since May 2022. 
(3) Ninety-six percent of nursing home pro-
viders have reported difficulty in hiring staff. 
(4) More than ninety percent of nursing home 
providers have increased wages and bonuses to re-
cruit and retain staff. 
(5) Nearly eighty percent of nursing home pro-
viders have hired temporary staff, who are often 
much more expensive than permanent staff. 
(6) The Centers for Medicare & Medicaid Serv-
ices reported that 129 nursing homes closed in 
2022, threatening access for America’s seniors, espe-
cially in rural areas. 
(7) The minimum staffing mandate in the pro-
posed rule entitled ‘‘Medicare and Medicaid Pro-
grams; Minimum Staffing Standards for Long-Term 
Care Facilities and Medicaid Institutional Payment 
Transparency Reporting’’ published by the Depart-
ment of Health and Human Services on September 
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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 de-
fined in the proposed rule). 
(8) The minimum staffing mandate in the pro-
posed rule may exacerbate workforce shortages, es-
pecially 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 pro-
posed rule entitled ‘‘Medicare and Medicaid Programs; 
Minimum Staffing Standards for Long-Term Care Facili-
ties 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 
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the Nursing Home Workforce (in this section referred to 
as the ‘‘Panel’’). 
(b) MEMBERSHIP.— 
(1) NUMBER AND APPOINTMENT.—The Panel 
shall be composed of 15 members representing var-
ious 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 fur-
nish services in a skilled nursing facility or 
nursing facility, one of whom shall represent a 
rural area. 
(C) 2 licensed professional nurses who ac-
tively furnish services in a skilled nursing facil-
ity or nursing facility, one of whom shall rep-
resent 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 serv-
ices in a skilled nursing facility or nursing facil-
ity, one of whom shall represent a rural area. 
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(F) 1 representative of the Centers for 
Medicare & Medicaid Services. 
(G) 1 representative of the Health Re-
sources and Services Administration. 
(H) 2 individuals with professional exper-
tise related to the nursing home workforce, one 
of whom shall have experience with respect to 
the nursing home workforce in rural and under-
served areas. 
(I) 1 representative of a not-for-profit 
skilled nursing facility. 
(J) 1 representative of a for-profit skilled 
nursing facility. 
(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. 
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(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 De-
partment 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 Com-
merce of the House of Representatives, and the 
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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 un-
derserved 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 individ-
uals entitled to medical assistance 
under title XIX of such Act (42 
U.S.C. 1396 et seq.), barriers to ac-
cess 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 
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such regulations and guidance on the nurs-
ing home workforce; 
(iii) recommendations for the Sec-
retary 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 there-
after, the Panel shall submit and publish an up-
dated report in the same manner as required 
under such subparagraph. 
(d) DEFINITIONS.—In this section, the following defi-
nitions 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 
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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 ‘‘under-
served 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)). 
Æ 
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