I 118th CONGRESS 2d Session H. R. 9067 IN THE HOUSE OF REPRESENTATIVES July 18, 2024 Mr. Guthrie introduced the following bill; which was referred to the Committee on Ways and Means , and in addition to the Committee on Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction 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.

1. Short title This Act may be cited as the Building America’s Health Care Workforce Act . 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 certification requirements for specified skilled nursing 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 facilities 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 made the election described in paragraph (1) (or, with respect to a specified skilled nursing facility located in a State that has not made such election, in the case of such a facility 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 the requirement specified in clause (i)(II) of such subsection; (B) for purposes of determining whether a nurse aide training and competency evaluation program offered by or in such facility complies 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 subsection (f)(2), apply subparagraph (A)(iv)(I) of such subsection as if such facility were not a facility 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 deficiency 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 certification requirements for specified nursing 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 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 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 nursing 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 facility 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 the requirement specified in clause (i)(II) of such subsection; (B) for purposes of determining whether a nurse aide training and competency evaluation program offered by or in such facility complies 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 subsection (f)(2), apply subparagraph (A)(iv)(I) of such subsection as if such facility were not a facility 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 defined For purposes of this subsection, the term specified nursing facility means a 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 deficiency for providing a substandard quality of care relating to direct patient care during the preceding 2 years. .