Nursing Home Workforce Support and Expansion Act of 2021
Bill: H.R.5094 | Sponsor: Rep. Horsford, Steven (D-NV)
Policy area: Social Welfare

Summary:
Nursing Home Workforce Support and Expansion Act of 2021
This bill provides funding through FY2025 and otherwise revises a grant program for states and Indian tribes to support workers in nursing facilities, home health agencies, and related settings. Grant recipients must use funds to provide eligible workers with wage subsidies, educational assistance, and access to affordable child care and transportation.

To amend title XX of the Social Security Act to provide for nursing 
                      home worker training grants.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nursing Home Workforce Support and 
Expansion Act of 2021''.

SEC. 2. NURSING HOME WORKER TRAINING GRANTS.

    Section 2041 of the Social Security Act (42 U.S.C. 1397m) is 
amended to read as follows:

``SEC. 2041. NURSING HOME WORKER TRAINING GRANTS.

    ``(a) In General.--
            ``(1) State entitlement.--
                    ``(A) In general.--Each State shall be entitled to 
                receive from the Secretary for each fiscal year 
                specified in subsection (e)(1) a grant in an amount 
                equal to the amount allotted to the State under 
                subparagraph (B).
                    ``(B) State allotments.--
                            ``(i) In general.--Subject to clauses (ii) 
                        and (iii), the amount allotted to a State under 
                        this subparagraph for a fiscal year shall be--
                                    ``(I) the number of State residents 
                                who have attained 65 years of age or 
                                are under a disability (as defined in 
                                section 216(i)(1)), as determined by 
                                the Secretary using the most recent 
                                version of the American Community 
                                Survey published by the Bureau of the 
                                Census or a successor data set; divided 
                                by
                                    ``(II) the total number of such 
                                residents of all States.
                            ``(ii) Limitation.--The amount allotted to 
                        a State under this subparagraph for a fiscal 
                        year shall be not less than 0.25 percent of the 
                        available amount for the fiscal year.
                            ``(iii) Adjustment of state allotments.--
                        Subject to clause (ii), the Secretary shall 
                        proportionately increase or decrease the 
                        amounts allotted under this subparagraph for a 
                        fiscal year as necessary to ensure that the 
                        available amount for the fiscal year is 
                        allotted among the States.
                            ``(iv) Redeterminations.--
                                    ``(I) Frequency.--The Secretary 
                                shall make the determination referred 
                                to in clause (i)(I) every 5 years.
                                    ``(II) Limitation.--Subject to 
                                clause (ii), the amount allotted to a 
                                State under this subparagraph, on the 
                                basis of such a determination, for a 
                                fiscal year after fiscal year 2026 
                                shall be--
                                            ``(aa) not less than 90 
                                        percent of the amount of the 
                                        grant made to the State under 
                                        this subparagraph for the then 
                                        preceding fiscal year; and
                                            ``(bb) not more than 110 
                                        percent of the amount referred 
                                        to in item (aa).
            ``(2) Grants to indian tribes and tribal organizations.--
                    ``(A) In general.--The Secretary, in consultation 
                with the Secretary of the Interior, shall make grants 
                in accordance with this section to Indian tribes and 
                tribal organizations who operate at least 1 eligible 
                setting.
                    ``(B) Grant formula.--The Secretary, in 
                consultation with the Secretary of the Interior, shall 
                devise a formula for distributing among Indian tribes 
                and tribal organizations the amount required to be 
                reserved by subsection (e)(1) for each fiscal year.
            ``(3) Sub-grants.--A State, Indian tribe, or tribal 
        organization to which an amount is paid under this section may 
        use the amount to make sub-grants to local organizations, 
        including community organizations, local non-profits, elder 
        rights and justice groups, and workforce development boards for 
        any purpose described in paragraph (1) or (2) of subsection 
        (b).
    ``(b) Use of Funds.--
            ``(1) Required uses.--A State to which an amount is paid 
        under this section shall use the amount to--
                    ``(A) provide wage subsidies to eligible 
                individuals;
                    ``(B) provide student loan repayment or tuition 
                assistance to eligible individuals for a degree or 
                certification in a field relevant to their position 
                referred to in subsection (f)(1)(A);
                    ``(C) guarantee affordable and accessible child 
                care for eligible individuals, including help with 
                referrals, co-pays, or other direct assistance; and
                    ``(D) provide assistance where necessary with 
                obtaining appropriate transportation, including public 
                transportation if available, or gas money if public 
                transportation is unavailable or impractical based on 
                work hours or location.
            ``(2) Authorized uses.--A State to which an amount is paid 
        under this section may use the amount to--
                    ``(A) establish a reserve fund for financial 
                assistance to eligible individuals in emergency 
                situations;
                    ``(B) provide in-kind resource donations, such as 
                interview clothing and conference attendance fees;
                    ``(C) provide assistance with programs and 
                activities, including legal assistance, deemed 
                necessary to address arrest or conviction records that 
                are an employment barrier;
                    ``(D) support employers operating an eligible 
                setting in the State in providing employees with not 
                less than 2 weeks of paid leave per year; or
                    ``(E) provide other support services the Secretary 
                deems necessary to allow for successful recruitment and 
                retention of workers.
            ``(3) Provision of funds only for the benefit of eligible 
        individuals in eligible settings.--A State to which an amount 
        is paid under this section may provide the amount to only an 
        eligible individual or a partner organization serving an 
        eligible individual.
            ``(4) Nonsupplantation.--A State to which an amount is paid 
        under this section shall not use the amount to supplant the 
        expenditure of any State funds for recruiting or retaining 
        employees in an eligible setting.
            ``(5) Obligation deadline.--A State, Indian tribe, or 
        tribal organization shall remit to the Secretary for 
        reallotment under this section any amount paid under this 
        section for a fiscal year that is not obligated within 2 years 
        after the end of the fiscal year.
    ``(c) Administration.--A State to which a grant is made under this 
section shall reserve not more than 10 percent of the grant to--
            ``(1) administer subgrants in accordance with this section;
            ``(2) provide technical assistance and support for applying 
        for and accessing such a subgrant opportunity;
            ``(3) publicize the availability of the subgrants;
            ``(4) carry out activities to increase the supply of 
        eligible individuals; and
            ``(5) provide technical assistance to help subgrantees find 
        and train individuals to provide the services for which they 
        are contracted.
    ``(d) Reports.--
            ``(1) State reports.--Not less frequently than annually, 
        each State to which a grant has been made under this section 
        shall transmit to the Secretary a written report describing the 
        activities undertaken by the State pursuant to this section 
        during the period covered by the report, which shall include--
                    ``(A) the total amount expended in the State for 
                each type of use described in paragraph (1) or (2) of 
                subsection (b);
                    ``(B) the total number of non-State organizations 
                in the State to which grant funds were provided, and 
                the amount so provided to each such organization;
                    ``(C) the change in the number of individuals 
                working in each job category described in subsection 
                (f)(1)(A) in an eligible setting in the State;
                    ``(D) the average duration of employment for each 
                such job category;
                    ``(E) the average annual wage of workers in each 
                job category described in subsection (f)(1)(A) in an 
                eligible setting in the State;
                    ``(F) the average amount of paid time off to which 
                a worker in each job category described in subsection 
                (f)(1)(A) in an eligible setting in the State is 
                entitled by their contract; and
                    ``(G) such other data elements as the Secretary 
                deems relevant.
            ``(2) Report to the congress.--Not later than 3 years after 
        the date of the enactment of this section, and every 4 years 
        thereafter, the Secretary shall submit to the Congress a 
        written report outlining how the States have used the grants 
        made under this section during the period covered by the 
        report, which shall include--
                    ``(A) the total amount expended in each State for 
                each type of use described in paragraph (1) or (2) of 
                subsection (b);
                    ``(B) the total number of non-State organizations 
                in each State to which grant funds were provided, and 
                the amount so provided to each such organization;
                    ``(C) the change in the number of individuals 
                working in each job category described in subsection 
                (f)(1)(A) in an eligible setting;
                    ``(D) the average duration of employment for each 
                such job category, by State;
                    ``(E) the average annual wage of workers in each 
                job category described in subsection (f)(1)(A) in an 
                eligible setting;
                    ``(F) the average amount of paid time off to which 
                a worker in each job category described in subsection 
                (f)(1)(A) in an eligible setting is entitled by their 
                contract; and
                    ``(G) such other data elements as the Secretary 
                deems relevant.
    ``(e) Appropriation.--Out of any funds in the Treasury not 
otherwise appropriated, there is appropriated to the Secretary 
$400,000,000 for each of fiscal years 2022 through 2025 to carry out 
this section, of which 2 percent shall be reserved for grants to Indian 
tribes and tribal organizations.
    ``(f) Definitions.--In this section:
            ``(1) Available amount.--The term `available amount' means, 
        with respect to a fiscal year, the amount specified in 
        subsection (e) that remains after the reservation required by 
        such subsection for the fiscal year, plus all amounts remitted 
        to the Secretary under subsection (b)(5) that have not been 
        reallotted under subsection (a)(1)(B)(iii).
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who--
                    ``(A)(i) is a qualified home health aide, as 
                defined in section 484.80(a) of title 42, Code of 
                Federal Regulations;
                    ``(ii) is a nurse aide approved by the State as 
                meeting the requirements of sections 483.150 through 
                483.154 of such title, and is listed in good standing 
                on the State nurse aide registry;
                    ``(iii) is a personal care aide approved by the 
                State, and furnishes personal care services, as defined 
                in section 440.167 of such title;
                    ``(iv) is a qualified hospice aide, as defined in 
                section 418.76 of such title; or
                    ``(v) is a licensed practical nurse or a licensed 
                or certified social worker; or
                    ``(vi) is receiving training to be certified or 
                licensed as such an aide, nurse, or social worker; and
                    ``(B) provides (or, in the case of a trainee, 
                intends to provide) services as such an aide, nurse, or 
                social worker in an eligible setting.
            ``(3) Eligible setting.--The term `eligible setting' 
        means--
                    ``(A) a skilled nursing facility, as defined in 
                section 1819;
                    ``(B) a nursing facility, as defined in section 
                1919;
                    ``(C) a home health agency, as defined in section 
                1891;
                    ``(D) a facility approved to deliver home or 
                community-based services authorized under State options 
                described in subsection (c) or (i) of section 1915 or, 
                as relevant, demonstration projects authorized under 
                section 1115;
                    ``(E) a hospice, as defined in section 1814; or
                    ``(F) a tribal assisted living facility.
            ``(4) Tribal organization.--The term `tribal organization' 
        has the meaning given the term in section 4 of the Indian Self-
        Determination and Education Assistance Act.''.
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