SEC. 2. GRANTS TO DEVELOP SMALL-HOUSE NURSING FA-
CILITIES. 
(a) ESTABLISHMENT.—For the purpose described in 
subsection (b), the Secretary of Health and Human Serv-
ices (in this section referred to as the ‘‘Secretary’’), acting 
through the Administrator of the Centers for Medicare & 
Medicaid Services, and in coordination with State health 
departments, shall establish a grant program to award 
grants to nursing facilities to convert traditional nursing 
facilities to small-house nursing facilities. 
(b) PURPOSE.—The purpose of the grant program 
under subsection (a) shall be to replace beds used for long- 
term care in nursing facilities with beds used for long- 
term care in small-house nursing facilities, including by— 
(1) increasing the total number of such beds 
available in small-house nursing facilities as of the 
date of enactment of this Act by 250,000 by Janu-
ary 1, 2028; and 
(2) with respect to each State in which a nurs-
ing facility that receives a grant under this Act is 
located, increasing the number of— 
(A) small-house nursing facilities in oper-
ation in the State by not fewer than five sites; 
and 
(B) beds available at such nursing facilities 
in the State by not fewer than 250. 
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(c) USE OF FUNDS.—A nursing facility receiving a 
grant under this section shall use the grant— 
(1) exclusively for converting traditional nurs-
ing facilities to small-house nursing facilities; and 
(2) not for operation of the converted facilities. 
(d) REQUIREMENTS.—As a condition on receipt of a 
grant under this section, a nursing facility shall agree to 
each of the following: 
(1) CONSULTATION IN PLANNING AND DESIGN 
PROCESS.—The nursing facility will consult with 
residents, families, a long-term care ombudsman, di-
rect care nursing home workers, and a certified med-
ical director from the American Board of Post-Acute 
and Long-Term Care Medicine as part of— 
(A) the planning and design process for 
converting traditional nursing facilities to small- 
house nursing facilities pursuant to the grant; 
and 
(B) obtaining any necessary regulatory ap-
provals for such facilities. 
(2) PERSON-CENTERED CARE.— 
(A) IN GENERAL.—Sites that receive fund-
ing shall agree to demonstrate person-centered 
care upon completion of construction. Person- 
centered care should be measured prior to start-
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ing construction, 3 months following move-in at 
the new small-house nursing facilities, and an-
nually thereafter for 5 years. 
(B) MEASUREMENT.—The measurement 
described in subparagraph (A) shall be done 
through a partnership established between each 
site awarded the funding, a quality improve-
ment organization, the Department of Health 
and Human Services Office of the Inspector 
General, and the Department of Housing and 
Urban Development. The quality improvement 
organization may be a Quality Innovation Net-
work/Quality Improvement Organization (QIN/ 
QIO). 
Quality 
improvement 
organizations 
should provide technical assistance for nursing 
home sites and advise sites in their continuous 
quality improvement efforts. 
(C) 
PRACTICES.—Person-centered 
care 
shall be measured via at least the following 
practices: food and drink are available 24/7; 
residents are able to choose when to go to bed 
and when to wake up; residents are able to eas-
ily and regularly access outdoor spaces; resi-
dents have opportunities to engage in activities 
promoting relationship building that include dif-
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ferent ages and abilities; person-centered care 
training is required as part of on-boarding for 
new staff and is required as part of continuing 
education for all staff; residents have opportuni-
ties for spontaneous and meaningful enjoyment 
of simple daily pleasures; there is consistent as-
signment of staff to residents; and staff learn 
about residents’ interests, memberships, and re-
lationships, and provide opportunities to con-
tinue these. 
(D) ELIGIBILITY.—If person-centered care 
improvement is not demonstrated within 2 
years upon completion of construction, nursing 
facilities that received project funding will not 
be eligible for the next round of these Federal 
grant funds. If person-centered quality falls 
more than 10 percent from year 2 to year 5, 
nursing facilities that received project funding 
will not be eligible for the next round of these 
Federal grant funds. 
(3) MINIMUM OF 20 YEARS OF OPERATION.— 
The nursing facility will provide for operation of the 
small-house nursing facilities funded pursuant to the 
grant for a period of not less than 20 years. 
(e) PRIORITY.— 
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(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall give priority to a nursing fa-
cility based on a demonstration of financial need. 
(2) CONSIDERATIONS.—In assessing the finan-
cial need of a nursing facility or purposes of para-
graph (1), the Secretary shall consider— 
(A) the ability of the parent company of 
the nursing facility to provide resources for con-
verting traditional nursing facilities to small- 
house nursing facilities; 
(B) the percentage of such facility’s resi-
dents who are receiving medical assistance 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) for care provided at such 
facility; and 
(C) the track record of the nursing facility 
and its parent company in providing high-qual-
ity care. 
(f) APPLICATION.—To seek a grant under this sec-
tion, a nursing facility shall submit to the Secretary an 
application at such time, in such manner, and containing 
such information as the Secretary may require, including 
funding available for construction. 
(g) REPORTS.— 
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