I 
118TH CONGRESS 
2D SESSION 
H. R. 9067 
To amend titles XVIII and XIX of the Social Security Act to establish 
a waiver of certain training and certification requirements for specified 
skilled nursing facilities and nursing facilities. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 18, 2024 
Mr. GUTHRIE introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to establish a waiver of certain training and certification 
requirements for specified skilled nursing facilities and 
nursing facilities. 
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 ‘‘Building America’s 
Health Care Workforce Act’’. 
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SEC. 2. ESTABLISHING A WAIVER OF CERTAIN TRAINING 
AND CERTIFICATION REQUIREMENTS FOR 
SPECIFIED SKILLED NURSING FACILITIES 
AND NURSING FACILITIES. 
(a) MEDICARE.—Section 1819 of the Social Security 
Act (42 U.S.C. 1395i–3) is amended by adding at the end 
the following new subsection: 
‘‘(l) WAIVER OF CERTAIN TRAINING AND CERTIFI-
CATION REQUIREMENTS FOR SPECIFIED SKILLED NURS-
ING FACILITIES.— 
‘‘(1) ELECTION.— 
‘‘(A) STATES.—A State may elect, in a 
form and manner specified by the Secretary, for 
the provisions of subsections (b) and (f) to be 
applied in accordance with paragraph (2) with 
respect to specified skilled nursing facilities (as 
defined in paragraph (3)) located in such State. 
‘‘(B) SPECIFIED
SKILLED
NURSING
FA-
CILITIES.—In the case of a specified skilled 
nursing facility located in a State that has not 
made the election described in subparagraph 
(A), such facility may make such election with 
respect to such facility in a form and manner 
specified by the Secretary. 
‘‘(2) WAIVERS.—In the case of a specified 
skilled nursing facility located in a State that has 
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made the election described in paragraph (1) (or, 
with respect to a specified skilled nursing facility lo-
cated in a State that has not made such election, in 
the case of such a facility that has made such elec-
tion), the Secretary shall— 
‘‘(A) apply subsection (b)(5)(A) as if the 
reference to ‘4 months’ in such subsection were 
instead a reference to ‘12 months’, except that 
such reference shall continue to be treated as a 
reference to ‘4 months’ for purposes of applying 
the requirement specified in clause (i)(II) of 
such subsection; 
‘‘(B) for purposes of determining whether 
a nurse aide training and competency evalua-
tion program offered by or in such facility com-
plies with the requirements for such program 
specified pursuant to subsection (f)(2)(A)(i), 
allow such program to count any hours worked 
by a nurse aide in a skilled nursing facility or 
nursing facility (as defined in section 1919(a)) 
toward the 75 hours of initial training described 
in subclause (II) of such subsection; and 
‘‘(C) in the case such facility is a facility 
described in subparagraph (B)(iii)(I) of sub-
section (f)(2), apply subparagraph (A)(iv)(I) of 
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such subsection as if such facility were not a fa-
cility so described, but only if the State in 
which the facility is located does not offer a 
nurse aide competency evaluation (in person or 
online) at least once per week or if availability 
is limited. 
‘‘(3) SPECIFIED
SKILLED
NURSING
FACILITY 
DEFINED.—For purposes of this subsection, the 
term ‘specified skilled nursing facility’ means a 
skilled nursing facility that— 
‘‘(A) is located in an area of a State that 
the State has designated as being a nurse aide 
shortage area; and 
‘‘(B) has not received a citation for a defi-
ciency for providing a substandard quality of 
care relating to direct patient care during the 
preceding 2 years.’’. 
(b) MEDICAID.—Section 1919 of the Social Security 
Act (42 U.S.C. 1396r) is amended by adding at the end 
the following new subsection: 
‘‘(l) WAIVER OF CERTAIN TRAINING AND CERTIFI-
CATION REQUIREMENTS FOR SPECIFIED NURSING FA-
CILITIES.— 
‘‘(1) ELECTION.— 
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‘‘(A) STATES.—A State may elect, in a 
form and manner specified by the Secretary, for 
the provisions of subsections (b) and (f) to be 
applied in accordance with paragraph (2) with 
respect to specified nursing facilities (as defined 
in paragraph (3)) located in such State. 
‘‘(B) SPECIFIED NURSING FACILITIES.—In 
the case of a specified nursing facility located in 
a State that has not made the election de-
scribed in subparagraph (A), such facility may 
make such election with respect to such facility 
in a form and manner specified by the Sec-
retary. 
‘‘(2) WAIVERS.—In the case of a specified nurs-
ing facility located in a State that has made the 
election described in paragraph (1) (or, with respect 
to a specified nursing facility located in a State that 
has not made such election, in the case of such a fa-
cility that has made such election), the Secretary 
shall— 
‘‘(A) apply subsection (b)(5)(A) as if the 
reference to ‘4 months’ in such subsection were 
instead a reference to ‘12 months’, except that 
such reference shall continue to be treated as a 
reference to ‘4 months’ for purposes of applying 
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the requirement specified in clause (i)(II) of 
such subsection; 
‘‘(B) for purposes of determining whether 
a nurse aide training and competency evalua-
tion program offered by or in such facility com-
plies with the requirements for such program 
specified pursuant to subsection (f)(2)(A)(i), 
allow such program to count any hours worked 
by a nurse aide in a nursing facility or skilled 
nursing facility (as defined in section 1819(a)) 
toward the 75 hours of initial training described 
in subclause (II) of such subsection; and 
‘‘(C) in the case such facility is a facility 
described in subparagraph (B)(iii)(I) of sub-
section (f)(2), apply subparagraph (A)(iv)(I) of 
such subsection as if such facility were not a fa-
cility so described, but only if the State in 
which the facility is located does not offer a 
nurse aide competency evaluation (in person or 
online) at least once per week or if availability 
is limited. 
‘‘(3) 
SPECIFIED
NURSING
FACILITY
DE-
FINED.—For purposes of this subsection, the term 
‘specified nursing facility’ means a nursing facility 
that— 
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‘‘(A) is located in an area of a State that 
the State has designated as being a nurse aide 
shortage area; and 
‘‘(B) has not received a citation for a defi-
ciency for providing a substandard quality of 
care relating to direct patient care during the 
preceding 2 years.’’. 
Æ 
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