Title: IMPROVE Nursing Homes Act
Policy area: Health

Summary:
Infrastructure Modernization Project Related to the OVerall Enhancement of Nursing Homes Act or the IMPROVE Nursing Homes Act
This bill requires the Centers for Medicare & Medicaid Services to establish a grant program to support the conversion of traditional nursing facilities to small-house nursing facilities (i.e., facilities that offer private rooms for up to 12 residents in separate buildings or areas). Grant funds may be used to convert facilities but not for facility operation; grant recipients must agree to provide person-centered care that supports certain resident flexibilities and to operate such facilities for at least 20 years.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8677 Introduced in House (IH)]

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117th CONGRESS
  2d Session
                                H. R. 8677

 To direct the Secretary of Health and Human Services, in coordination 
 with State health departments, to establish a grant program to award 
grants to nursing facilities to replace traditional nursing facilities 
      with small-house nursing facilities, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 5, 2022

Ms. Schakowsky introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To direct the Secretary of Health and Human Services, in coordination 
 with State health departments, to establish a grant program to award 
grants to nursing facilities to replace traditional nursing facilities 
      with small-house nursing facilities, and for other purposes.

    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 ``Infrastructure Modernization Project 
Related to the OVerall Enhancement of Nursing Homes Act'' or the 
``IMPROVE Nursing Homes Act''.

SEC. 2. GRANTS TO DEVELOP SMALL-HOUSE NURSING FACILITIES.

    (a) Establishment.--For the purpose described in subsection (b), 
the Secretary of Health and Human Services (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 January 1, 2028; and
            (2) with respect to each State in which a nursing facility 
        that receives a grant under this Act is located, increasing the 
        number of--
                    (A) small-house nursing facilities in operation 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.
    (c) Use of Funds.--A nursing facility receiving a grant under this 
section shall use the grant--
            (1) exclusively for converting traditional nursing 
        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, direct care nursing home workers, and a 
        certified medical 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 approvals 
                for such facilities.
            (2) Person-centered care.--
                    (A) In general.--Sites that receive funding shall 
                agree to demonstrate person-centered care upon 
                completion of construction. Person-centered care should 
                be measured prior to starting construction, 3 months 
                following move-in at the new small-house nursing 
                facilities, and annually 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 improvement 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 Network/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 easily and regularly access outdoor spaces; 
                residents have opportunities to engage in activities 
                promoting relationship building that include different 
                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 opportunities for spontaneous and 
                meaningful enjoyment of simple daily pleasures; there 
                is consistent assignment of staff to residents; and 
                staff learn about residents' interests, memberships, 
                and relationships, and provide opportunities to 
                continue 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.--
            (1) In general.--In carrying out subsection (a), the 
        Secretary shall give priority to a nursing facility based on a 
        demonstration of financial need.
            (2) Considerations.--In assessing the financial need of a 
        nursing facility or purposes of paragraph (1), the Secretary 
        shall consider--
                    (A) the ability of the parent company of the 
                nursing facility to provide resources for converting 
                traditional nursing facilities to small-house nursing 
                facilities;
                    (B) the percentage of such facility's residents 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-quality care.
    (f) Application.--To seek a grant under this section, 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.--
            (1) Grant recipient report.--As a condition on receipt of a 
        grant under this section, a nursing facility shall agree to 
        submit to the Secretary an annual report on the activities 
        conducted through the grant, including--
                    (A) a breakdown of how and when the grant funds 
                were used; and
                    (B) with respect to each resident at such facility, 
                any difference in--
                            (i) quality of care; and
                            (ii) quality of life.
            (2) GAO report.--Not later than June 1, 2028, the 
        Comptroller General of the United States shall submit to 
        Congress a report on the grant program under this section, 
        including--
                    (A) a summary of the reports under paragraph (1); 
                and
                    (B) a summary comparing the quality of care and 
                quality of life among residents who are in a small-
                house nursing facility to residents in traditional 
                nursing facilities.
    (h) Davis-Bacon Compliance.--
            (1) In general.--All laborers and mechanics employed by 
        contractors or subcontractors to perform construction, 
        alteration, or repair on projects funded in whole or in part by 
        this Act shall be paid wages at rates not less than those 
        prevailing on projects of a character similar in the locality 
        as determined by the Secretary of Labor in accordance with 
        subchapter IV of chapter 31 of title 40, United States Code 
        (commonly referred to as the ``Davis-Bacon Act'').
            (2) Authority.--With respect to the labor standards 
        specified in paragraph (1), the Secretary of Labor shall have 
        the authority and functions set forth in Reorganization Plan 
        Numbered 14 of 1950 (64 Stat. 1267; 5 U.S.C. App.) and section 
        3145 of title 40, United States Code.
    (i) Definitions.--In this Act:
            (1) Small-house nursing facility.--The term ``small-house 
        nursing facility'' means a nursing facility that includes the 
        following:
                    (A) Provides each resident--
                            (i) a single-occupancy room with a private 
                        bathroom; or
                            (ii) at the request of the resident, a room 
                        with a private bathroom to be shared with the 
                        resident's spouse, partner, or preferred 
                        roommate.
                    (B) Serves not more than 12 residents--
                            (i) in a separate building for a nursing 
                        facility located in a rural area; or
                            (ii) in a separate building, a separate 
                        floor, or a separate wing for a nursing 
                        facility located in an urban area.
                    (C) Uses appropriately skilled staff to provide all 
                personal care for residents, including cooking, light 
                housekeeping, and laundry service.
                    (D) Assigns each nursing assistant for each work 
                shift to not more than one nursing facility segment 
                described in clauses (i) and (ii) of subparagraph (B).
                    (E) Provides resident-centered care that allows 
                maximum level of resident independence.
            (2) Nursing facility.--The term ``nursing facility'' has 
        the meaning given such term under section 1919 of the Social 
        Security Act (42 U.S.C. 1396r).
            (3) Rural area.--The term ``rural area'' means an area 
        other than an urban area or an area contiguous and adjacent to 
        an urban area.
            (4) Urban area.--The term ``urban area'' means a town or 
        city that has a population of greater than 50,000 residents, 
        according to the Census Bureau's most recent annual estimates 
        of resident population.
    (j) Appropriations.--
            (1) In general.--To carry out this Act, there is authorized 
        to be appropriated $30,000,000,000 for the period of fiscal 
        years 2024 through 2027.
            (2) Minimum amounts.--Of the amounts available under 
        paragraph (1), the Secretary shall award--
                    (A) not less than 30 percent to urban nursing 
                facilities;
                    (B) not less than 10 percent to rural nursing 
                facilities; and
                    (C) not less than 50 percent to nursing facilities 
                that have 85 percent or more residents who receive 
                benefits under the Medicaid program under title XIX of 
                the Social Security Act (42 U.S.C. 1396 et seq.).
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