U.S.C. 601 et seq.) or individuals who are eligi-
ble for such assistance; and 
(B) individuals with barriers to employ-
ment. 
(c) CONSIDERATIONS.—In selecting eligible entities 
to receive a grant under this title, the Secretary shall en-
sure— 
(1) equitable geographic diversity, including by 
selecting recipients serving rural areas and selecting 
recipients serving urban areas; and 
(2) that selected eligible entities will serve areas 
where the occupation of direct care professional, or 
a related occupation, is an in-demand industry sec-
tor or occupation. 
(d) USES
OF FUNDS; SUPPLEMENT, NOT SUP-
PLANT.— 
(1) USES OF FUNDS.— 
(A) IN GENERAL.—Each eligible entity re-
ceiving a grant under this title shall use the 
funds of such grant to carry out at least 1 
project described in section 303(a)(2). 
(B) ADMINISTRATIVE COSTS.—Each eligi-
ble entity receiving a grant under this title shall 
not use more than 5 percent of the funds of 
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such grant for costs associated with the admin-
istration of activities under this title. 
(C) DIRECT SUPPORT.—Each eligible enti-
ty receiving a grant under this title shall use 
not less than 5 percent of the funds of such 
grant to provide direct financial benefits or sup-
portive services to direct care professionals and 
paid or unpaid family caregivers to support the 
financial needs of such participants during the 
duration of the project activities. 
(2) SUPPLEMENT, NOT SUPPLANT.—An eligible 
entity receiving a grant under this title shall use 
such grant only to supplement, and not supplant, 
the amount of funds that, in the absence of such 
grant, would be available to address the recruitment, 
training and education, retention, and advancement 
of direct care professionals or provide support for 
family caregivers, in the State or region served by 
the eligible entity. 
(3) PROHIBITION.—No amounts made available 
under this title may be used for any activity that is 
subject to the reporting requirements set forth in 
section 203(a) of the Labor-Management Reporting 
and Disclosure Act of 1959 (29 U.S.C. 433(a)). 
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SEC. 305. EVALUATIONS AND REPORTS; TECHNICAL ASSIST-
ANCE. 
(a) REPORTING REQUIREMENTS BY GRANT RECIPI-
ENTS.— 
(1) IN GENERAL.—An eligible entity receiving a 
grant under this title shall cooperate with the Sec-
retary and annually provide a report to the Sec-
retary that includes any relevant data requested by 
the Secretary in a manner specified by the Sec-
retary. 
(2) CONTENTS.—The data requested by the 
Secretary for an annual report may include any of 
the following (as determined relevant by the Sec-
retary with respect to the category of the grant and 
each project supported through the grant): 
(A) The number of individuals and the de-
mographic categories (as defined in section 2) 
served by each project supported by the grant, 
including— 
(i) the number of individuals recruited 
through each such project to be employed 
as a direct care professional; 
(ii) the number of individuals who 
through each such project attained employ-
ment as a direct care professional; and 
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(iii) the number of individuals who en-
rolled in each such project and withdrew or 
were terminated from each such project 
without completing training or attaining 
employment as a direct care professional. 
(B) The number of family caregivers par-
ticipating in an education or training program 
through each project supported by the grant. 
(C) The number of project participants 
who through each such project participated in 
and completed— 
(i) work-based learning; 
(ii) on-the-job training; 
(iii) an apprenticeship program; or 
(iv) a professional development or 
mentoring program. 
(D)(i) Other services, benefits, or supports 
(other than the services, benefits, or supports 
described 
in 
subparagraph 
(C)) 
provided 
through each such project to assist in the re-
cruitment, retention, or advancement of direct 
care professionals (including through education 
or training for such professionals or individuals 
seeking to become such professionals); 
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(ii) the number of individuals who accessed 
such services, benefits, or supports; and 
(iii) the impact of such services, benefits, 
or supports. 
(E) The crude separation and vacancy 
rates of direct care professionals, and such 
rates for those professionals who are managers 
or supervisors, in the geographic region for a 
number of years before the grant was awarded, 
as determined by the Secretary, and annually 
thereafter for the duration of the grant period. 
(F) How each project supported by the 
grant assessed satisfaction with respect to— 
(i) project participants assisted by the 
project; 
(ii) individuals receiving services deliv-
ered by project participants, including— 
(I) any impact on the health or 
health outcomes of such individuals; 
and 
(II) any impact on the ability of 
individuals to transition to or remain 
in the community in an environment 
that meets the criteria established in 
the section 441.301(c)(4) of title 42, 
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Code of Federal Regulations (or suc-
cessor regulations); and 
(iii) employers of such project partici-
pants. 
(G) The performance of the eligible entity 
with respect to the indicators of performance on 
unsubsidized employment, median earnings, cre-
dential attainment, measurable skill gains, and 
employer satisfaction. 
(H) Any other information with respect to 
outcomes of the project as determined by the 
Secretary. 
(b) ANNUAL
REPORT
TO
CONGRESS
BY
SEC-
RETARY.—Not later than 2 years after the date of enact-
ment of this title, and each year thereafter until all 
projects supported through a grant under this title are 
completed, the Secretary shall prepare and submit to Con-
gress an annual report on the progress of each project 
supported through a grant under this title and the activi-
ties of the technical assistance center established under 
section 302. 
(c) GAO REPORT.—Not later than 1 year after the 
date on which all projects supported through a grant 
under this title are completed, the Comptroller General of 
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the United States shall conduct a study and submit to 
Congress a report including— 
(1) an assessment of how the technical assist-
ance center established under section 302 and the 
projects supported through a grant under this title 
assisted in the creation, recruitment, training and 
education, retention, and advancement of the direct 
care workforce or in providing support for family 
caregivers; and 
(2) recommendations for such legislative or ad-
ministrative actions needed for improving the assist-
ance described in paragraph (1), as the Comptroller 
General determines appropriate. 
(d) INDEPENDENT EVALUATIONS.—Not later than 6 
months after the date of enactment of this title, the Sec-
retary shall enter into a contract with an independent enti-
ty to provide independent evaluations of activities sup-
ported by grants under this title and activities of the tech-
nical assistance center established under section 302. 
SEC. 306. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—There are authorized to be appro-
priated— 
(1) for the establishment and activities of the 
technical assistance center under section 302, 
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$2,000,000 for each of fiscal years 2024 through 
2028; and 
(2) 
for 
grants 
under 
section 
303, 
$1,000,000,000 for fiscal year 2024. 
(b) AVAILABILITY.—Amounts made available under 
this title shall remain available until September 30, 2033. 
TITLE IV—EVALUATION 
SEC. 401. EVALUATION OF IMPACT ON ACCESS TO HCBS. 
(a) NATIONAL SURVEY ON EXPANDED HCBS AC-
CESS.—The Administrator of the Centers for Medicare & 
Medicaid Services, in coordination with the National Acad-
emy of Medicine, shall, not later than 7 years after the 
date of enactment of this Act, conduct or contract for a 
national survey of States, direct care professionals, family 
caregivers, and providers and recipients of home and com-
munity-based services, to determine the effects of the im-
plementation of this Act and the amendments made by 
this Act on— 
(1) the availability and access to home and 
community-based services under the Medicaid pro-
gram nationally and in each State; 
(2) the capacity of the direct service workforce 
to provide home and community-based services and 
information on the demographics (as defined in sec-
tion 2) of such workforce; 
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(3) the compensation and working conditions, 
including scheduling and benefits, of direct care 
workers; 
(4) the economic effects on beneficiaries and on 
families with a member receiving home and commu-
nity-based services through Medicaid; 
(5) the availability of direct care workers and 
services for people needing long-term services and 
supports who are not Medicaid eligible; 
(6) family caregivers; and 
(7) recommendations for measures to further 
expand and enhance access home and community- 
based services. 
(b) REPORT.—Not later than 9 years after the date 
of enactment of this Act, the Administrator of the Centers 
for Medicare & Medicaid Services shall publish a report 
containing the results of the survey conducted under sub-
section (a). 
(c) AMERICAN COMMUNITY SURVEY ADDITION.—The 
Secretary of Commerce, acting through the Bureau of the 
Census, shall add to the American Community Survey a 
question designed to identify the need for long-term serv-
ices and supports by residents of the United States. 
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(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary such 
sums as are necessary to carry out this section. 
Æ 
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