I 117th CONGRESS 2d Session H. R. 8677 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.

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 . 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. ).