(6) direct care workers are often underpaid: 45 
percent of direct care workers live at or below the 
poverty level, and nearly half live in households that 
receive one or more public benefits (such as food 
stamps or Medicaid); 
(7) the average annual income for direct care 
workers is $17,000, and more than 1 in 4 of such 
workers lack health insurance; and 
(8) State management information systems are 
rarely designed to gather and report basic informa-
tion about the direct care workforce that could be 
used assess workforce challenges or monitor changes 
in the direct care workforce over time. 
SEC. 3. LIMITATION TO EXEMPTION UNDER THE FAIR 
LABOR STANDARDS ACT. 
(a) HOME CARE WORKERS.—Section 13(a)(15) of 
the Fair Labor Standards Act of 1938 (29 U.S.C. 
213(a)(15)) is amended to read as follows: 
‘‘(15) any employee employed on a casual basis 
in domestic service employment to provide baby-
sitting services or any employee employed on a cas-
ual basis in domestic service employment to provide 
companionship services for individuals who (because 
of age, infirmity, or disability) are unable to care for 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
themselves (as such terms are defined and delimited 
by regulations of the Secretary);’’. 
(b) DEFINITION.—Section 3 of the Fair Labor 
Standards Act of 1938 (29 U.S.C. 203) is amended by 
adding at the end the following: 
‘‘(z) The term ‘casual basis in domestic service em-
ployment to provide companionship services’ means em-
ployment which is irregular or intermittent, and which is 
not performed by an individual— 
‘‘(1) whose vocation is the provision of compan-
ionship services; or 
‘‘(2) who is employed by an employer or agency 
other than the family or household using their serv-
ices. 
Employment is not on a casual basis if any family or 
household employer employs an individual performing 
companionship services for more than five (5) hours per 
week or has employed the individual for a time period that 
has extended beyond twelve (12) weeks in a calendar 
year.’’. 
SEC. 4. LONG-TERM SERVICES AND SUPPORTS. 
(a) DIRECT CARE WORKFORCE MONITORING PRO-
GRAM.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services, in cooperation with the heads of 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
other relevant departments, shall develop a program 
to monitor the capacity and adequacy of the direct 
care workforce in all relevant, as determined by the 
Secretary, Federal healthcare programs (as defined 
under section 1128B(f) of the Social Security Act 
(42 U.S.C. 1320a–7b(f)). 
(2) MONITORING
AND
EVALUATION.—Under 
the program under paragraph (1), the Secretary 
shall monitor and evaluate— 
(A) the quality of services provided by di-
rect care workers through Federal healthcare 
programs, including in home and community- 
based settings and in long-term care settings; 
and 
(B) the adequacy of the direct care work-
force to provide services through such pro-
grams, including— 
(i) the stability of such workforce, in-
cluding turnover rates; 
(ii) an evaluation of geographic vari-
ation in the adequacy of such workforce; 
and 
(iii) the adequacy of such workforce to 
meet the current and future demand for 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
long-term services and supports under such 
programs. 
(3) DATA SHARING.—For purposes of improv-
ing the adequacy of the direct care workforce and 
quality of services provided by such workforce 
through Federal healthcare programs, the Secretary 
shall— 
(A) facilitate the sharing of data on such 
workforce between relevant Federal depart-
ments and between States; 
(B) prepare cross-State comparisons of 
such data and share such comparisons with 
States; and 
(C) share with States and Federal depart-
ments best practices for developing an adequate 
workforce that provides high quality direct care 
services. 
(b) REPORTING ON WORKFORCE ADEQUACY UNDER 
MEDICAID.— 
(1) IN GENERAL.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)) is amend-
ed— 
(A) by striking ‘‘and’’ at the end of para-
graph (82); 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
(B) by striking the period at the end of 
paragraph (83) and inserting ‘‘; and’’; and 
(C) by inserting the following after para-
graph (83): 
‘‘(84) provide that the State shall submit to the 
Secretary an annual report that, with respect to 
both the current and future needs of individuals who 
are enrolled in the State plan for long term care 
services and supports, details the capacity and ade-
quacy of the direct care workforce (as such term is 
defined in subsection (ll)) in the State (including 
specifying the number of full-time and part-time di-
rect care workers, the turnover rate for such work-
ers, the number of vacancies for such workers, the 
average wage for such workers; the typical benefits 
package offered to such workers, and any other 
types of data related to the direct care workforce in 
the State that the Secretary requires).’’. 
(2) DEFINITIONS AND EXCEPTION FROM WAIV-
ER.—Section 1902 of the Social Security Act is fur-
ther amended by adding at the end the following: 
‘‘(ll) DIRECT CARE WORKERS.— 
‘‘(1) DEFINITIONS.—For purposes of this sub-
section and subsection (a)(84): 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
‘‘(A) DIRECT CARE WORKER.—The term 
‘direct care worker’ has the meaning given each 
of the following terms in the 2010 Standard 
Occupational Classifications of the Department 
of Labor: Home Health Aides [31–1011], Psy-
chiatric Aides [31–1013], Nursing Assistants 
[31–1014], and Personal Care Aides [39– 
9021]. 
‘‘(B) DIRECT
CARE
WORKFORCE.—The 
term ‘direct care workforce’ means the work-
force made up of direct care workers. 
‘‘(2) EXEMPTION FROM WAIVER.—In the case 
of any State which is providing medical assistance to 
its residents under a waiver granted under section 
1115 or section 1915, the Secretary shall require the 
State submit the report required under subsection 
(a)(84) in the same manner as the State would be 
required to submit such report if the State had in 
effect a plan approved under this title.’’. 
(3) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
this subsection shall take effect 6 months after 
the date of the enactment of this Act. 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
(B) RULE
FOR
CHANGES
REQUIRING 
STATE LEGISLATION.—In the case of a State 
plan for medical assistance under title XIX of 
the Social Security Act which the Secretary of 
Health and Human Services determines re-
quires State legislation (other than legislation 
appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this subsection, the State 
plan shall not be regarded as failing to comply 
with the requirements of such title solely on the 
basis of its failure to meet this additional re-
quirement before the first day of the first cal-
endar quarter beginning after the close of the 
first regular session of the State legislature that 
begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in 
the case of a State that has a 2-year legislative 
session, each year of such session shall be 
deemed to be a separate regular session of the 
State legislature. 
SEC. 5. PRIORITIZING ANALYSIS BY NATIONAL HEALTH 
CARE WORKFORCE COMMISSION. 
(a) ADDITIONAL HIGH PRIORITY AREA.—Subpara-
graph (A) of section 5101(d)(4) of the Patient Protection 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
and Affordable Care Act (42 U.S.C. 294q(d)(4)) is 
amended by adding at the end the following: 
‘‘(vi) With respect to the direct care 
workforce— 
‘‘(I) a review of current and pro-
jected workforce supply and demand, 
including a review of workforce size, 
employment settings, turnover, com-
pensation, and benefits; 
‘‘(II) an analysis of the adequacy 
of existing workforce data, data collec-
tion, and monitoring infrastructure; 
and 
‘‘(III) recommendations for new 
or additional uniform data elements 
across regions and States that are 
necessary to track workforce supply, 
demand, and shortages.’’. 
(b) APPLICATION.—The amendment made by para-
graph (1) applies beginning with the reports required by 
section 5101(d)(2) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 294q(d)(2)) for 2011. 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
SEC. 6. GRANTS AND TECHNICAL ASSISTANCE FOR DATA 
COLLECTION AND MONITORING. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall award grants to States, Indian 
tribes, and tribal organizations for the purpose of devel-
oping comprehensive data collection and monitoring sys-
tems to assess the adequacy and stability of the direct care 
workforce of the State or Indian tribe, as applicable, to 
meet current and future demand for long-term services 
and supports. 
(b) USE OF FUNDS.—A State, Indian tribe, or tribal 
organization receiving a grant under subsection (a) shall 
use the grant for— 
(1) an assessment of current data sources and 
data gaps on the volume, stability, and compensation 
of the State or tribe’s direct care workforce across 
all settings and programs; 
(2) consultation with all agencies of the State, 
Indian tribe, or tribal organization that collect data 
on the direct care workforce, or data on programs 
under which services are provided in connection with 
the direct care workforce, in order to streamline 
data collection; 
(3) the development of an implementation plan 
for establishing a comprehensive and ongoing pro-
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
gram for monitoring the volume, stability, and com-
pensation of the direct care workforce; 
(4) the implementation of such program; 
(5) the sharing of information on best practices 
on data collection and monitoring with other States, 
Indian tribes, or tribal organizations; and 
(6) the formulation of recommendations for ap-
propriate steps to reduce State, local, or tribal bar-
riers to comprehensive direct care workforce data 
collection and monitoring systems, including any 
necessary changes in State, local, or tribal policies. 
(c) DISTRIBUTION OF GRANTS.— 
(1) NUMBER OF GRANTS.—In carrying out sub-
section (a) the Secretary shall award grants to not 
fewer than 5 States each year. 
(2) GEOGRAPHIC
AND
DEMOGRAPHIC
DIVER-
SITY.—In selecting grant recipients under subsection 
(a), the Secretary shall ensure that grants are 
awarded to a diversity of grantees in terms of geog-
raphy and demographics. 
(3) PREFERENCE.—In selecting grant recipi-
ents under subsection (a), the Secretary shall give 
preference to States, Indian tribes, and tribal orga-
nizations with a relatively higher percentage of resi-
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS
programs funded by such grants in reducing turnover 
rates in the direct care workforce. 
SEC. 9. DEFINITIONS. 
For purposes of this Act: 
(1) DIRECT CARE WORKER.—The term ‘‘direct 
care worker’’ has the meaning given each of the fol-
lowing terms in the 2010 Standard Occupational 
Classifications of the Department of Labor: Home 
Health Aides [31–1011], Psychiatric Aides [31– 
1013], Nursing Assistants [31–1014], and Personal 
Care Aides [39–9021]. 
(2) DIRECT CARE WORKFORCE.—The term ‘‘di-
rect care workforce’’ means the workforce made up 
of direct care workers. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
Æ 
VerDate Mar 15 2010 
23:10 Jun 29, 2011
Jkt 099200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6301
E:\BILLS\H2341.IH
H2341
emcdonald on DSK2BSOYB1PROD with BILLS