H.R. 8541

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8541 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 8541

To support the direct care professional workforce, and for other 
purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

April 28, 2026

Mrs. Dingell (for herself and Ms. Matsui) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Education and Workforce, Ways and 
Means, the Judiciary, House Administration, and Oversight and 
Government Reform, 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 support the direct care professional workforce, 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; TABLE OF CONTENTS.

(a) In General.--This Act may be cited as the ``Long-Term Care 
Workforce Support Act''.
(b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Definitions.
TITLE I--IMPROVING REIMBURSEMENT

Sec. 101. Additional support for Medicaid long-term care services 
provided by direct care professionals.
Sec. 102. Additional support for Medicaid long-term care services and 
direct care professionals.
Sec. 103. Making permanent the State option to extend protection under 
Medicaid for recipients of home and 
community-based services against spousal 
impoverishment.
Sec. 104. Permanent extension of money follows the person rebalancing 
demonstration.
TITLE II--TRAINING, RECRUITMENT, CAREER ADVANCEMENT, AND WORKER 
SUPPORTS

Subtitle A--Improving Workforce Training

Chapter 1--Grants for Supporting the Direct Care Professional Workforce

Sec. 201. Definitions.
Sec. 202. Authority to award grants.
Sec. 203. Project plans.
Sec. 204. Uses of funds; supplement, not supplant.
Chapter 2--Other Workforce Training Grants

Sec. 205. Workforce investment activities grants for domestic workers.
Sec. 206. Direct care professional career advancement demonstration 
projects.
Sec. 207. Pathways to health careers.
Sec. 208. Increasing workforce diversity in allied health professionals 
and direct support professionals.
Subtitle B--Improving Workforce Recruitment

Sec. 211. Technical assistance center for building the direct care 
professional workforce.
Sec. 212. Report on efforts to enhance the direct care professional 
workforce.
Sec. 213. Comprehensive geriatric education.
Sec. 214. Review of the availability and quality of apprenticeship 
programs in long-term care settings.
Sec. 215. Rural health workforce grant program.
Subtitle C--Providing Career Advancement Opportunities; Assessment of 
Worker Well-being

Sec. 221. Assessment of direct care professional well-being.
Sec. 222. National Direct Care Professional Training Standards 
Commission.
Subtitle D--Increasing Supports for the Existing Direct Care 
Professional Workforce

Sec. 231. Mental health services.
Sec. 232. Dissemination of best practices with respect to mental health 
of direct care professionals.
Sec. 233. Education and awareness initiative encouraging use of mental 
health and substance use disorder services 
by direct care professionals.
Sec. 234. Direct care professional training grants.
Sec. 235. Credit for certain health care professionals.
Sec. 236. Direct Care Professional Workforce Equity Technical 
Assistance Center.
TITLE III--WORKFORCE LABOR PROTECTIONS

Subtitle A--Long-term Care Workforce Wage Theft Prevention and Wage 
Recovery Act

Sec. 301. Definitions.
Sec. 302. Direct care professional workforce wage theft prevention and 
wage recovery grant program.
Subtitle B--Direct Care Professional Rights

Sec. 311. Definitions.
Sec. 312. Written agreements.
Sec. 313. Fair scheduling practices.
Sec. 314. Right to request and receive temporary changes to scheduled 
work hours due to personal events.
Sec. 315. Privacy.
Sec. 316. Breaks for meals and rest.
Sec. 317. Prohibited acts.
Sec. 318. Enforcement authority.
Sec. 319. Effect on existing employment benefits and other laws.
Subtitle C--Workplace Violence Prevention for Health Care and Social 
Services Workers Act

Sec. 321. Workplace Violence Prevention Standard.
Sec. 322. Scope and application.
Sec. 323. Requirements for Workplace Violence Prevention Standard.
Sec. 324. Rules of construction.
Sec. 325. Definitions.
Sec. 326. Application of the Workplace Violence Prevention Standard to 
certain facilities receiving Medicare 
funds.
Subtitle D--Improving Access to Job Benefits

Sec. 331. Definitions.
Sec. 332. Paid sick time.
Sec. 333. Notice requirement.
Sec. 334. Prohibited acts.
Sec. 335. Enforcement authority.
Sec. 336. Education and outreach.
Sec. 337. Effect on existing employment benefits.
Sec. 338. Encouragement of more generous leave policies.
Sec. 339. Regulations.
Sec. 339A. Effective date.
Sec. 339B. Collection of data and further study.
TITLE IV--NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY

Sec. 401. Definitions.
Sec. 402. National Direct Care Professional Compensation Strategy.
Sec. 403. National Direct Care Professional Compensation Advisory 
Council.
Sec. 404. Sunset provision.
TITLE V--IMPROVING OVERSIGHT AND ACCOUNTABILITY

Sec. 501. Evaluation of implementation and outcomes.

SEC. 2. FINDINGS AND PURPOSES.

(a) Findings.--Congress finds the following:
(1) The nearly 5,000,000 direct care professionals in the 
United States play a vital role in supporting the health, well-
being, and independence of older individuals and people with 
disabilities.
(2) The United States faces a growing crisis in its direct 
care professional workforce at the same time that demand for 
services is rising at unprecedented rates.
(3) There will be an estimated 9,300,000 total direct care 
professional job openings from 2021 to 2031, including new jobs 
to support the growing number of people who need care and to 
fill the jobs of such professionals leaving the direct care 
professional workforce.
(4) Workforce turnover and shortages have a direct impact 
on older individuals, people with disabilities, and their 
families who suffer because they cannot get the high-quality 
care that they need and deserve.
(5) The median hourly wage for all direct care 
professionals in 2022 was only $15.43, with home care workers 
earning the least.
(6) One in 8 direct care professionals live in poverty and 
three quarters earn less than the average living wage in their 
State.
(7) Forty-six percent of direct care professionals rely on 
public assistance, such as Medicaid, food and nutrition 
assistance, or cash assistance.
(8) Direct care professionals report high levels of burnout 
and professional fatigue from their physically and emotionally 
demanding work, lack of respect for the essential, skilled care 
they provide, and lasting trauma from battling the COVID-19 
pandemic, all of which further drives high turnover.
(9) The long-term care industry is struggling to hire and 
retain direct care professionals, with a national turnover rate 
between 77 to nearly 100 percent.
(10) Ninety-two percent of nursing home respondents and 
nearly 70 percent of assisted living facilities surveyed report 
significant or severe workforce shortages.
(11) More than half of nursing homes surveyed in 2022 
reported that they limited new patient admissions due to 
staffing shortages.
(12) A survey of State home and community-based services 
(referred to in this section as ``HCBS'') programs showed that 
every State reports a shortage of workers, and in 43 States, 
some HCBS providers have closed permanently.
(13) The low-quality of direct care professional jobs 
reflects and perpetuates the racial and gender inequities faced 
by direct care professionals, who are disproportionately women, 
immigrants, and people of color.
(14) Efforts to support the direct care professional 
workforce have focused on specific care settings, even though 
these issues are widespread across the long-term care landscape 
and direct care professionals across settings face similar 
challenges of low wages, few benefits, limited training and 
support, worker exploitation, and a lack of meaningful career 
ladders.
(15) Stabilizing, growing, and supporting the direct care 
professional workforce across the continuum of long-term care 
is essential to ensuring a strong, qualified pipeline of 
workers, and improving the lives of direct care professionals 
and the older individuals, people with disabilities, and the 
families and communities that they support.
(b) Purposes.--The purposes of this Act are as follows:
(1) To increase the capacity of the direct care 
professional workforce to ensure that older individuals, people 
with disabilities, and their families receive the services they 
need in the settings of their choice as they deserve to live 
healthy, independent lives.
(2) To increase compensation so that direct care 
professionals are paid a living wage and have access to 
essential job benefits, and so that direct care professional 
jobs are good jobs.
(3) To ensure that direct care professionals are treated 
with respect, provided with a safe working environment, 
protected from exploitation, and fairly compensated for the 
skilled work they do.
(4) To improve access to and quality of long-term care, 
including collecting meaningful and actionable data on the 
direct care professional workforce and the people they support.
(5) To eliminate the race, gender, sexual orientation, age, 
and gender identity disparities that exist across the direct 
care professional workforce.
(6) To strengthen the direct care professional workforce in 
order to support the 53,000,000 unpaid family caregivers who 
are often providing complex services and supports to their 
loved ones who are older individuals and people with 
disabilities in their homes, communities, and residential 
settings.

SEC. 3. DEFINITIONS.

In this Act:
(1) Activities of daily living.--The term ``activities of 
daily living'' means basic, personal, everyday activities, 
including tasks such as eating, toileting, grooming, dressing, 
bathing, and transferring.
(2) Aging and disability resource center.--The term ``Aging 
and Disability Resource Center'' has the meaning given such 
term in section 102 of the Older Americans Act of 1965 (42 
U.S.C. 3002).
(3) Apprenticeship program.--The term ``apprenticeship 
program'' means an apprenticeship program registered under the 
Act of August 16, 1937 (commonly known as the ``National 
Apprenticeship Act''; 50 Stat. 664, chapter 663; 29 U.S.C. 50 
et seq.), including any requirement, standard, or rule 
promulgated under such Act.
(4) Appropriate committees of congress.--The term 
``appropriate committees of Congress'' means--
(A) the Committee on Finance of the Senate;
(B) the Committee on Health, Education, Labor, and 
Pensions of the Senate;
(C) the Special Committee on Aging of the Senate;
(D) the Committee on Ways and Means of the House of 
Representatives;
(E) the Committee on Energy and Commerce of the 
House of Representatives; and
(F) the Committee on Education and Workforce of the 
House of Representatives.
(5) Area agency on aging.--The term ``area agency on 
aging'' has the meaning given such term in section 102 of the 
Older Americans Act of 1965 (42 U.S.C. 3002).
(6) Assisted living facility.--The term ``assisted living 
facility'' means an adult care facility that--
(A) is a residential care setting licensed and 
regulated by the State in which the facility is located 
(or, if there is no State law providing for such 
licensing and regulation by the State, by the 
municipality or other political subdivision in which 
the facility is located);
(B)(i) makes available to residents supportive 
services to assist the residents in carrying out 
activities of daily living;
(ii) provides 24-hour on-site monitoring, personal 
care planning, food services, and personal care; and
(iii) may make available to residents home health 
care services, such as nursing and therapy; and
(C) provides dwelling units for residents, each of 
which may contain a full kitchen, bedroom, and 
bathroom, and which includes common rooms and other 
facilities appropriate for the provision of supportive 
services to the residents of the facility.
(7) Certified nursing assistant.--The term ``certified 
nursing assistant'' means a nurse aide who has completed a 
State-approved training and competency evaluation program.
(8) Commerce.--Except as provided in section 331, the term 
``commerce'' has the meaning given such term in section 3 of 
the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
(9) Community or technical college.--The term ``community 
or technical college'' means a public institution of higher 
education at which the highest degree that is predominantly 
awarded to students is an associate's degree, including Tribal 
Colleges or Universities receiving grants under section 316 of 
the Higher Education Act of 1965 (20 U.S.C. 1059c) that offer a 
2-year program for completion of such degree and State public 
institutions of higher education that offer such a 2-year 
program.
(10) Developmental disability.--The term ``developmental 
disability'' has the meaning given such term in section 102 of 
the Developmental Disabilities Assistance and Bill of Rights 
Act of 2000 (42 U.S.C. 15002).
(11) Direct care professional.--The term ``direct care 
professional'' means--
(A) a personal or home care aide;
(B) a home and community-based services worker;
(C) a direct support professional;
(D) a certified nursing assistant;
(E) a nurse aide or nursing assistant;
(F) a respite care provider;
(G) a paid family caregiver;
(H) a home health aide;
(I) a private duty nurse; or
(J) any other individual providing relevant 
services (as determined by the Secretary of Health and 
Human Services) for compensation, in the course of the 
profession of such individual, at a long-term care 
setting to a resident of such setting.
(12) Direct care professional manager.--The term ``direct 
care professional manager'' means a person who is a manager, or 
supervisory staff, with coaching, training, managerial, 
supervisory, or other oversight responsibilities of direct care 
professionals.
(13) Direct care professional workforce.--The term ``direct 
care professional workforce'' means the broad workforce of 
direct care professionals across all long-term care settings.
(14) Disability.--The term ``disability'', except as 
provided in paragraph (10), has the meaning given such term in 
section 3 of the Americans with Disabilities Act of 1990 (42 
U.S.C. 12102).
(15) Domestic partner.--
(A) In general.--The term ``domestic partner'', 
with respect to an individual, means another individual 
with whom the individual is in a committed 
relationship.
(B) Committed relationship defined.--The term 
``committed relationship'' for purposes of subparagraph 
(A)--
(i) means a relationship between 2 
individuals, each at least 18 years of age, in 
which both individuals share responsibility for 
a significant measure of each other's common 
welfare; and
(ii) includes any such relationship between 
2 individuals, including individuals of the 
same sex, that is granted legal recognition by 
a State or political subdivision of a State as 
a marriage or analogous relationship, including 
a civil union or domestic partnership.
(16) Employ.--The term ``employ'' has the meaning given the 
term in section 3 of the Fair Labor Standards Act of 1938 (29 
U.S.C. 203).
(17) Employee; employer.--Except as provided in section 
331, the terms ``employee'' and ``employer'' have the meanings 
given such terms in section 3 of such Act.
(18) Home and community-based services.--The term ``home 
and community-based services'' means any of the following 
(whether provided on a fee-for-service, risk, or other basis):
(A) Home health care services authorized under 
paragraph (7) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)).
(B) Personal care services authorized under 
paragraph (24) of such section.
(C) PACE services authorized under paragraph (26) 
of such section.
(D) Home and community-based services authorized 
under subsections (b), (c), (i), (j), and (k) of 
section 1915 of such Act (42 U.S.C. 1396n), such 
services authorized under a waiver under section 1115 
of such Act (42 U.S.C. 1315), and such services 
provided through coverage authorized under section 1937 
of such Act (42 U.S.C. 1396u-7).
(E) Case management services authorized under 
section 1905(a)(19) of the Social Security Act (42 
U.S.C. 1396d(a)(19)) and section 1915(g) of such Act 
(42 U.S.C. 1396n(g)).
(F) Rehabilitative services, including those 
related to behavioral health, described in section 
1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).
(G) Such other services specified by the Secretary 
of Health and Human Services.
(19) Home and community-based services setting.--The term 
``home and community-based services setting'' means a setting 
where home and community-based services authorized under State 
options described in subsection (c) or (i) of section 1915 of 
the Social Security Act (42 U.S.C. 1396n) or, as relevant, 
demonstration projects authorized under section 1115 of such 
Act (42 U.S.C. 1315), are provided to individuals enrolled for 
medical assistance under a State plan under title XIX (or under 
a waiver of such a plan).
(20) Home and community-based services worker.--The term 
``home and community-based services worker''--
(A) means an individual who provides home and 
community-based services for compensation; and
(B) may include individuals described in 
subparagraph (A) who are physical therapists, 
occupational therapists, or speech or language 
therapists.
(21) Indian tribe; tribal organization.--The terms ``Indian 
Tribe'' and ``Tribal organization'' have the meanings given 
such terms in section 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5304).
(22) Institution of higher education.--The term 
``institution of higher education'' means--
(A) an institution of higher education defined in 
section 101 of the Higher Education Act of 1965 (20 
U.S.C. 1001); or
(B) an institution of higher education defined in 
section 102(a)(1)(B) of such Act (20 U.S.C. 
1002(a)(1)(B)).
(23) Instrumental activities of daily living.--The term 
``instrumental activities of daily living'' means tasks that 
are not necessary for fundamental functioning, but allow an 
individual to live independently in a community of daily 
living. Such tasks include--
(A) housekeeping and room cleaning;
(B) meal preparation;
(C) taking medications;
(D) laundry;
(E) transportation;
(F) shopping for groceries, clothing, or other 
items;
(G) managing communications, such as using the 
telephone;
(H) managing finances;
(I) writing letters; and
(J) obtaining appointments.
(24) Local educational agency.--The term ``local 
educational agency'' has the meaning given the term in section 
8101 of the Elementary and Secondary Education Act of 1965 (20 
U.S.C. 7801).
(25) Long-term care services.--The term ``long-term care 
services'' means any services provided by a direct care 
professional in a long-term care setting.
(26) Long-term care setting.--The term ``long-term care 
setting'' means--
(A) a nursing home;
(B) a home and community-based services setting;
(C) an assisted living facility;
(D) an intermediate care facility;
(E) a State home, as defined in section 101(19) of 
title 38, United States Code;
(F) a Tribal nursing home operated pursuant to an 
Indian health program (as defined in section 4 of the 
Indian Health Care Improvement Act (25 U.S.C. 1603));
(G) a private home;
(H) a respite setting; or
(I) any other setting in which an individual 
provides relevant services (as determined by the 
Secretary of Health and Human Services), in the course 
of the profession of such individual, to a resident of 
such setting.
(27) Medicaid program.--The term ``Medicaid program'' 
means, with respect to a State, the State program under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
(including any waiver or demonstration under such title or 
under section 1115 of such Act (42 U.S.C. 1315) relating to 
such title).
(28) Nurse aide.--The term ``nurse aide'' has the meaning 
given such term in section 1919(b)(5) of the Social Security 
Act (42 U.S.C. 1396r(b)(5)).
(29) Nursing assistant.--The term ``nursing assistant'' 
means an individual who provides or assists with the basic care 
or support of a patient under the direction of onsite licensed 
nursing staff, which may include performing duties such as--
(A) monitoring of the health status, feeding, 
bathing, dressing, grooming, toileting, or ambulation 
of patients or residents in a health facility or 
nursing home; and
(B) medication administration and other health-
related tasks of patients in a health facility or 
nursing home.
(30) Nursing home.--The term ``nursing home'' means--
(A) a nursing facility as defined in section 
1919(a) of the Social Security Act (42 U.S.C. 
1396r(a)); or
(B) a skilled nursing facility as defined in 
section 1819(a) of such Act (42 U.S.C. 1395i-3(a)).
(31) Older individual.--The term ``older individual'' has 
the meaning given the term in section 102 of the Older 
Americans Act of 1965 (42 U.S.C. 3002).
(32) Personal or home care aide.--
(A) In general.--The term ``personal or home care 
aide'' means an individual who helps older individuals 
and people with serious illness, physical disability, 
cognitive impairment (including Alzheimer's disease or 
other dementias, a developmental disability, or another 
disability involving a mental impairment) to live in 
their own home or a residential care facility (such as 
a nursing home, assisted living facility, or any other 
facility the Secretary of Health and Human Services 
determines appropriate that is not described in 
subparagraph (B)(i)) by providing personal care 
services for compensation.
(B) Personal care services.--For purposes of 
subparagraph (A), the term ``personal care services'' 
means assistance or services--
(i) provided to an individual who is not an 
inpatient or resident of a hospital or 
institution for mental disease; and
(ii) that enable the recipient to 
accomplish activities of daily living or 
instrumental activities of daily living.
(33) Secondary school.--The term ``secondary school'' has 
the meaning given such term in section 8101 of the Elementary 
and Secondary Education Act of 1965 (20 U.S.C. 7801).
(34) Self-directed care professional.--The term ``self-
directed care professional'' (also known as an ``independent 
provider'')--
(A) means a direct care professional who is 
employed by an individual who is an older individual, a 
person with a disability, or a representative of such 
older individual or person with a disability, and such 
older individual or person with a disability has the 
decision-making authority over certain supports and 
services provided by the direct care professional and 
takes direct responsibility to manage those supports 
and services; and
(B) includes paid family caregivers.
(35) State.--The term ``State'', except as otherwise 
provided in this Act, has the meaning given such term for 
purposes of title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.).
(36) State educational agency.--The term ``State 
educational agency'' has the meaning given the term in section 
8101 of the Elementary and Secondary Education Act of 1965 (20 
U.S.C. 7801).
(37) Urban indian organization.--The term ``urban Indian 
organization'' has the meaning given the term in section 4 of 
the Indian Health Care Improvement Act (25 U.S.C. 1603).
(38) Workforce innovation and opportunity act terms.--The 
terms ``career pathway'', ``career planning'', ``in-demand 
industry sector or occupation'', ``individual with a barrier to 
employment'', ``local board'', ``on-the-job training'', 
``recognized postsecondary credential'', ``region'', and 
``State board'' have the meanings given such terms in section 3 
of the Workforce Innovation and Opportunity Act (29 U.S.C. 
3102).
(39) Work-based learning.--The term ``work-based learning'' 
has the meaning given such term in section 3 of the Carl D. 
Perkins Career and Technical Education Act of 2006 (20 U.S.C. 
2302).

TITLE I--IMPROVING REIMBURSEMENT

SEC. 101. ADDITIONAL SUPPORT FOR MEDICAID LONG-TERM CARE SERVICES 
PROVIDED BY DIRECT CARE PROFESSIONALS.

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
(1) in subsection (b), by striking ``and (ii)'' and 
inserting ``(ii), and (kk)''; and
(2) by adding at the end the following new subsection:
``(kk) Additional Support for Long-Term Care Services Provided by 
Direct Care Professionals.--
``(1) In general.--Notwithstanding subsections (b) and 
(ff), in the case of a State that satisfies the conditions 
described in paragraph (2), for each fiscal quarter during the 
period of fiscal years 2026 through 2035, the Federal medical 
assistance percentage otherwise determined for such State under 
such subsection (b) or (ff) shall, after the application of any 
other increase to the Federal medical assistance percentage for 
the State and quarter applicable under any other provision of 
law, be increased by 10 percentage points (but not to exceed 95 
percent) with respect to amounts expended by the State for 
medical assistance for long-term care services that are 
provided by direct care professionals during such quarter.
``(2) Requirements.--As a condition for receipt of the 
increase under paragraph (1) to the Federal medical assistance 
percentage determined for a State, the State shall submit to 
the Secretary, at such time and in such manner as specified by 
the Secretary, an application that includes, in addition to 
such other information as the Secretary shall require--
``(A) a description of which activities described 
in paragraph (4) that a State plans to implement and a 
description of how it plans to implement such 
activities;
``(B) assurances that all Federal funds 
attributable to the increase under paragraph (1) will 
be--
``(i) expended by the State in accordance 
with this subsection not later than September 
30, 2037; and
``(ii) used--
``(I) to implement the activities 
described in paragraph (4);
``(II) to supplement, and not 
supplant, the level of State funds 
expended for long-term care services 
provided by direct care professionals 
under the State plan (or under a waiver 
of such plan) as of the date of 
enactment of this subsection; and
``(III) to increase reimbursement 
rates for long-term care services 
provided by direct care professionals 
under the State plan (or under a waiver 
of such plan) to a level that will 
support recruitment and retention of a 
sufficient workforce to provide such 
services under the State plan (or 
waiver);
``(C) assurances that the State will use a portion 
of the Federal funds attributable to the increase under 
paragraph (1) to ensure greater service capacity, 
including reducing waiting lists and improving 
compensation, benefits, working conditions, and 
training for direct care professionals and direct care 
managers; and
``(D) assurances that the State will conduct 
adequate oversight and ensure the validity of such data 
as may be required by the Secretary.
``(3) Approval of application.--Not later than 90 days 
after the date of submission of an application of a State under 
paragraph (2), the Secretary shall certify if the application 
is complete. Upon certification that an application of a State 
is complete, the application shall be deemed to be approved for 
purposes of this section.
``(4) Activities to improve the direct care professional 
workforce.--
``(A) In general.--A State shall work with 
community partners such as Area Agencies on Aging, 
centers for independent living, as described in part C 
of title VII of the Rehabilitation Act of 1973, 
nonprofit long-term care services providers, and other 
entities to implement some or all of the purposes 
described in subparagraph (B).
``(B) Focused areas of improvement.--The purposes 
described in this paragraph, with respect to a State, 
are the following:
``(i) To increase rates for service 
provider agencies that employ direct care 
professionals (including independent providers 
in a self-directed or consumer-directed model) 
to provide long-term care services under the 
State plan (or under a waiver of such plan), 
provided that any service provider agency or 
individual that receives payment under such an 
increased rate increases the compensation it 
pay its direct care professionals.
``(ii) To provide paid sick leave, paid 
family leave, and paid medical leave for direct 
care professionals.
``(iii) To provide hazard pay, overtime 
pay, and shift differential pay for direct care 
professionals.
``(iv) To improve stability of direct care 
professional jobs, including consistent hours, 
scheduling, pay, and benefit eligibility.
``(v) To provide home and community-based 
services to individuals who are on waiting 
lists for programs approved under sections 1115 
or 1915.
``(vi) To purchase emergency supplies and 
equipment, which may include items not 
typically covered under the State plan (or 
under a waiver of such plan), such as personal 
protective equipment, necessary to enhance 
access to services and to protect the health 
and well-being of direct care professionals.
``(vii) To pay for the travel of direct 
care professionals to conduct their job 
responsibilities.
``(viii) To recruit new direct care 
professionals.
``(ix) To pay for training for direct care 
professionals, including apprenticeship 
programs.
``(x) To pay for assistive technologies, 
staffing, and training to facilitate eligible 
individuals' communication, and other costs 
incurred in order to facilitate community 
integration and ensure an individual's person-
centered service plan is fully implemented.
``(xi) To prepare information and public 
health and educational materials in accessible 
formats (including formats accessible to people 
with low literacy or intellectual disabilities 
about prevention, treatment, recovery, and 
other aspects of communicable diseases and 
threats to the health of individuals who are 
enrolled for medical assistance under the State 
plan (or under a waiver of such plan)), their 
families, and the general community served by 
agencies described in clause (i).
``(xii) To protect the health and safety of 
direct care professionals during public health 
emergencies and natural disasters.
``(xiii) To pay for interpreters to assist 
in providing long-term care services to 
individuals under the State plan (or under a 
waiver of such plan) and to inform the general 
public about communicable diseases and other 
public health threats.
``(xiv) To pay for other expenses deemed 
appropriate by the Secretary to enhance, 
expand, or strengthen long-term care services 
under the State plan (or under a waiver of such 
plan).
``(5) Reporting requirements.--
``(A) State reporting requirements.--Not later than 
December 31, 2028, and every 2 years thereafter until 
December 31, 2040, any State with respect to which an 
application is approved by the Secretary pursuant to 
paragraph (3) shall submit a report to the Secretary 
that contains the following information:
``(i) Activities and programs that were 
funded using Federal funds attributable to the 
increase to the Federal medical assistance 
percentage of the State under paragraph (1).
``(ii) The number of individuals enrolled 
under the State plan (or under a waiver of such 
plan) who were served by such activities and 
programs.
``(iii) A detailed accounting of all 
spending of funds attributable to the increase 
to the Federal medical assistance percentage of 
the State under paragraph (1) by the State and 
by any providers with whom the State entered 
into contracts or agreements to fulfill the 
requirements of this subsection.
``(B) Non-application of the paperwork reduction 
act.--Chapter 35 of title 44, United States Code 
(commonly referred to as the `Paperwork Reduction Act 
of 1995'), shall not apply to the provisions of this 
subsection.
``(6) Enforcement.--
``(A) In general.--If the Secretary determines that 
a State with respect to which an application is 
approved pursuant to paragraph (3) has failed to comply 
with the requirements of this subsection (including the 
requirement that all Federal funds attributable to the 
increase to the Federal medical assistance percentage 
of the State under paragraph (1) be spent in accordance 
with paragraph (4)) for any quarter during the period 
of fiscal years described in paragraph (1), the 
Secretary may reduce the number of percentage points by 
which the Federal medical assistance percentage for the 
State and quarter would otherwise be increased under 
paragraph (1) for such quarter.
``(B) Penalty based on severity of failure.--The 
Secretary shall impose reductions under this paragraph 
based on the degree to which a State has failed to 
comply with the requirements of this subsection.
``(7) Evaluation.--Not later than 2028 and annually until 
2037, the Secretary, in conjunction with the Secretary of 
Labor, shall evaluate the implementation and outcomes of this 
subsection on the availability of staff to cover shifts in all 
long-term care settings serving, worker credentials and skills, 
and worker compensation through a contract with an external 
evaluator who has experience with evaluation related to people 
with disabilities and older individuals.
``(8) Definitions.--In this subsection:
``(A) Direct care professional.--The term `direct 
care professional' has the meaning given such term in 
section 3 of the Long-Term Care Workforce Support Act.
``(B) Home and community-based services.--The term 
`home and community-based services' means any of the 
following:
``(i) Home health care services authorized 
under paragraph (7) of subsection (a).
``(ii) Personal care services authorized 
under paragraph (24) of such subsection.
``(iii) PACE services authorized under 
paragraph (26) of such subsection.
``(iv) Home and community-based services 
authorized under subsections (b), (c), (i), 
(j), and (k) of section 1915, such services 
authorized under a waiver under section 1115, 
and such services through coverage authorized 
under section 1937.
``(v) Case management services authorized 
under subsection (a)(19) of this section and 
section 1915(g).
``(vi) Rehabilitative services, including 
those related to behavioral health, described 
in subsection (a)(13) of this section.
``(vii) Such other services specified by 
the Secretary.''.

SEC. 102. ADDITIONAL SUPPORT FOR MEDICAID LONG-TERM CARE SERVICES AND 
DIRECT CARE PROFESSIONALS.

(a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to States for the purpose of supporting and strengthening services 
provided by direct care professionals across direct care settings and 
improving recruitment, compensation, and retention of the direct care 
professional workforce.
(b) Application.--Not later than 6 months after the date of 
enactment of this Act, each State that seeks to receive a grant under 
this section shall submit an application, in such form and manner as 
the Secretary shall require, to the Secretary that includes--
(1) information on how the State will use grant funds to 
improve long-term care services and the recruitment, 
compensation, and retention of direct care professionals in a 
manner that maximizes the independence of people with 
disabilities and older individuals, limits unnecessary 
institutionalization, and supports people living in residential 
settings;
(2) specifies the proportion of grant funds that the State 
plans to spend on activities to support long-term professional 
care workers in nursing homes, home health settings, and home 
and community-based services settings, respectively;
(3) a plan for sustaining the work at the conclusion of the 
grant period; and
(4) such other information as the Secretary shall require.
(c) Grant Amounts.--The Secretary shall award each State that 
submits an application to the Secretary that meets the requirements of 
subsection (b) a 5-year grant in an amount that bears the same 
proportion to the amount appropriated under subsection (e) as--
(1) the number of individuals who are enrolled for medical 
assistance under the Medicaid program of the State involved (as 
determined by the Secretary using the most recent data 
available as of the date of enactment of this Act); bears to
(2) the total number of individuals who are enrolled for 
medical assistance under the Medicaid programs of all States 
that submit to the Secretary an application that meets the 
requirements of subsection (b).
(d) Use of Grant Funds.--
(1) In general.--A State that receives a grant under this 
section shall use the funds of such grant in accordance with 
the requirements of this subsection.
(2) Supplement, not supplant.--A State shall use funds from 
a grant awarded under this section to supplement, and not 
supplant, the level of State funds expended for services in 
long-term care settings through programs in effect as of 
January 1, 2026.
(3) Required implementation of certain activities.--The 
State shall use funds from a grant awarded under this section 
to implement and evaluate, or supplement the implementation of, 
activities (which shall include the activities described in 
paragraph (4)) to enhance, expand, or strengthen long-term care 
services and to improve compensation to the workforce that 
provides such services.
(4) Activities to strengthen and expand the direct care 
professional workforce.--
(A) In general.--The State strengthens and expands 
the direct care professional workforce that provides 
services across long-term care settings by--
(i) adopting a salary review process to 
ensure that the rates payable for long-term 
care services under the State Medicaid program 
are sufficient to ensure access to such 
services under such program;
(ii) requiring that a percentage of all 
payments for long-term care services that are 
made under the State Medicaid program, 
including base payments and supplemental 
payments, improve compensation, benefits, 
working conditions, and training for direct 
care professionals and direct care managers; 
and
(iii) updating, developing, and adopting 
qualification standards and training 
opportunities for the continuum of direct care 
professionals, including programs for 
independent direct care professionals and 
agency direct care professionals, as well as 
unique programs.
(B) Payment rates.--In carrying out subparagraph 
(A)(i), the State shall--
(i) address insufficient payment rates 
under the State Medicaid program for delivery 
of long-term care services with an emphasis on 
supporting the recruitment and retention of 
direct care professionals;
(ii) update payment rates under the State 
Medicaid program for long-term care services, 
including home and community-based services, 
nursing home services, skilled nursing facility 
services, and intermediate care facility 
services at least every 2 years through a 
transparent process involving meaningful input 
from stakeholders, in which the majority of 
stakeholders are recipients of such services, 
families, direct care professionals, family 
caregivers, chosen representatives of direct 
care workers, aging, disability, and workforce 
advocates, long-term care providers, and may 
also include health plans; and
(iii) ensure that, with respect to any 
increases in the payment rates under the State 
Medicaid program for long-term care services--
(I) at a minimum, increases in the 
payment rates for long-term care 
services are proportionately passed 
through to direct care professionals 
and direct care professional managers 
who provide such services and in a 
manner that is determined with input 
from the stakeholders described in 
clause (ii);
(II) such payment rate increases 
are incorporated into payment rates for 
such services provided under title XIX 
of the Social Security Act (42 U.S.C. 
1396 et seq.) by a managed care entity 
(as defined in section 1932(a)(1)(B) of 
the Social Security Act (42 U.S.C. 
1396u-2(a)(1)(B)) or a prepaid 
inpatient health plan or prepaid 
ambulatory health plan, as defined in 
section 438.2 of title 42, Code of 
Federal Regulations (or any successor 
regulation)), under a contract with the 
State;
(III) such payment rate increases 
are appropriately distributed across 
settings, populations, and services so 
as to promote independence of people 
with disabilities and older 
individuals, not result in increased 
institutionalization, and assists in 
the facilitation of rebalancing the 
Medicaid program towards the least 
restrictive settings appropriate for 
individuals receiving services; and
(IV) such payment rate increases 
are prioritized toward home and 
community-based service workers in 
States that have a waiting list for 
home and community based services and 
have been determined by the Centers for 
Medicare & Medicaid Service to have 
inadequate capacity for such services.
(e) Appropriation.--There is appropriated to the Secretary for 
awarding grants under this section an amount equal to $100,000,000,000.
(f) Evaluation of Impact on HCBS Waiting Lists.--The Secretary 
shall evaluate the implementation and outcomes of this title on State 
Medicaid program waiting lists for home and community-based services 
through a contract with an external evaluator who has experience with 
evaluation related to people with disabilities and older individuals.

SEC. 103. MAKING PERMANENT THE STATE OPTION TO EXTEND PROTECTION UNDER 
MEDICAID FOR RECIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES AGAINST SPOUSAL IMPOVERISHMENT.

(a) In General.--Section 1924(h)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r-5(h)(1)(A)) is amended by striking ``is described in 
section 1902(a)(10)(A)(ii)(VI)'' and inserting the following: ``is 
eligible for medical assistance for home and community-based services 
provided under subsection (c), (d), or (i) of section 1915, under a 
waiver approved under section 1115, or who is eligible for such medical 
assistance by reason of being determined eligible under section 
1902(a)(10)(C) or by reason of section 1902(f) or otherwise on the 
basis of a reduction of income based on costs incurred for medical or 
other remedial care, or who is eligible for medical assistance for home 
and community-based attendant services and supports under section 
1915(k)''.
(b) Conforming Amendment.--Section 2404 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 1396r-5 note) is amended by striking 
``September 30, 2027'' and inserting ``the date of enactment of the 
Long-Term Care Workforce Support Act''.

SEC. 104. PERMANENT EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
DEMONSTRATION.

(a) In General.--Subsection (h)(1) of section 6071 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
(1) in subparagraph (K), by striking ``; and'' and 
inserting a semicolon;
(2) in subparagraph (L), by striking ``through 2027.'' and 
inserting ``through 2026; and''; and
(3) by adding at the end the following new subparagraph:
``(M) $500,000,000 for each fiscal year after 
fiscal year 2026.''.
(b) Redistribution of Unexpended Grant Awards.--Subsection (e)(2) 
of section 6071 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 
note) is amended by adding at the end the following new sentence: ``Any 
portion of a State grant award for a fiscal year under this section 
that is unexpended by the State at the end of the fourth succeeding 
fiscal year shall be rescinded by the Secretary and added to the 
appropriation for the fifth succeeding fiscal year for grants under 
this section.''.

TITLE II--TRAINING, RECRUITMENT, CAREER ADVANCEMENT, AND WORKER 
SUPPORTS

Subtitle A--Improving Workforce Training

CHAPTER 1--GRANTS FOR SUPPORTING THE DIRECT CARE PROFESSIONAL WORKFORCE

SEC. 201. DEFINITIONS.

In this chapter:
(1) Eligible entity.--The term ``eligible entity'' means an 
entity--
(A) that is--
(i) a State;
(ii) a labor organization, joint labor-
management organization, or employer of direct 
care professionals;
(iii) a nonprofit entity with experience in 
aging, disability, or supporting the rights and 
interests of, the training of, or educating 
direct care professionals;
(iv) an Indian Tribe, Tribal organization, 
or Urban Indian organization;
(v) a community or technical college or 
other institution of higher education; or
(vi) a consortium of entities listed in any 
of clauses (i) through (v);
(B) that agrees, as applicable with respect to the 
type of grant the entity is seeking under this chapter 
and the activities supported through such grant, to 
include as advisors and trainers in such activities--
(i) older individuals;
(ii) people with disabilities;
(iii) direct care professionals; and
(iv) family members of such individuals, 
persons, or professionals; and
(C) that agrees to consult with the State Medicaid 
agency of the State (or each State) served by the grant 
on the grant activities, to the extent that such agency 
(or each such agency) is not the eligible entity.
(2) Project participant.--The term ``project participant'' 
means an individual participating in a project or activity 
assisted with a grant under this chapter, including (as 
applicable for the category of the grant) a direct care 
professional or an individual training to be such a 
professional.
(3) Secretary.--The term ``Secretary'' means the Secretary 
of Health and Human Services.
(4) Supportive services.--The term ``supportive services'' 
means services that are necessary to enable an individual to 
participate in activities assisted with a grant under this 
chapter, such as transportation, child care, dependent care, 
housing, workplace accommodations, employee benefits such as 
paid sick leave and child care, workplace health and safety 
protections, wages and overtime pay, and needs-related 
payments.

SEC. 202. AUTHORITY TO AWARD GRANTS.

(a) Grants.--
(1) In general.--Not later than 12 months after the date of 
enactment of this Act, the Secretary, in consultation with the 
Administrator of the Centers for Medicare & Medicaid Services, 
the Secretary of Labor, and the Secretary of Education, shall 
award grants described in paragraph (2) to eligible entities. A 
grant awarded under this section may be in more than 1 category 
described in such paragraph.
(2) Categories of grants.--The categories of grants 
described in this paragraph are each of the following:
(A) Direct care professionals grants.--Grants to 
eligible entities to create and carry out projects for 
the purposes of recruiting, retaining, or providing 
advancement opportunities for direct care professionals 
who are not described in subparagraph (B), (C), or (D), 
including through education or training programs for 
such professionals or individuals seeking to become 
such professionals.
(B) Direct care professional managers grants.--
Grants to eligible entities to create and carry out 
projects for the purposes of recruiting, retaining, or 
providing advancement opportunities for direct care 
professional managers, including through education or 
training programs for such managers or individuals 
seeking to become such managers.
(C) Self-directed care professionals grants.--
Grants to eligible entities to create and carry out 
projects for the purposes of recruiting, retaining, or 
providing advancement opportunities for self-directed 
care professionals, including through education or 
training programs for such professionals or individuals 
seeking to become such professionals.
(D) Home and community-based services grants.--
Grants to eligible entities to create and carry out 
projects to recruit, retain, or provide advancement 
opportunities for home and community-based services 
workers providing services and supports to older 
individuals, or people with disabilities, who are 
eligible for coverage under a State Medicaid program.
(3) Projects for advancement opportunities.--Not less than 
30 percent of projects assisted with grants under this chapter 
shall be projects to provide career pathways that offer 
opportunities for professional development and advancement 
opportunities to direct care professionals.
(b) Treatment of Continuation Activities.--An eligible entity that 
carries out activities described in subsection (a)(2) prior to receipt 
of a grant under this chapter may use such grant to continue carrying 
out such activities, and, in using such grant to continue such 
activities, shall be treated as an eligible entity carrying out a 
project through a grant under this chapter.

SEC. 203. PROJECT PLANS.

(a) In General.--An eligible entity seeking a grant under this 
chapter shall submit to the Secretary a project plan for each project 
to be developed and carried out (including for activities to be 
continued as described in section 202(b)) with the grant. Such project 
plan shall be submitted at such time, in such manner, and containing 
such information as the Secretary may require.
(b) Contents.--A project plan submitted by an eligible entity under 
subsection (a) shall include a description of information determined 
relevant by the Secretary for purposes of the category of the grant and 
the activities to be carried out through the grant. Such information 
may include (as applicable) the following:
(1) Demographic information regarding the population in the 
State, city or municipality, or region to be served by the 
project, including a description of the populations likely to 
need services provided by direct care professionals, such as 
people with disabilities and older individuals.
(2) Projections of unmet need for services provided by 
direct care professionals based on enrollment waiting lists 
under home and community-based waivers under section 1115 of 
the Social Security Act (42 U.S.C. 1315) or section 1915(c) of 
such Act (42 U.S.C. 1396n(c)) and other relevant data to the 
extent practicable and feasible, such as direct care 
professional workforce vacancy rates and crude separation rates 
and the number of direct care professionals, including such 
professionals who are managers or supervisors, in the State or 
region to be served by the project.
(3) An advisory committee to advise the eligible entity on 
activities to be carried out through the grant. Such advisory 
committee--
(A) shall include--
(i) older individuals and people with 
disabilities receiving services from the direct 
care professionals targeted by the project;
(ii) organizations representing the rights 
and interests of people receiving services by 
the direct care professionals targeted by the 
project;
(iii) individuals who are direct care 
professionals targeted by the project and 
organizations representing the rights and 
interests of such direct care professionals;
(iv) as applicable, employers of 
individuals described in clause (iii) and labor 
organizations representing such individuals;
(v) representatives of the State Medicaid 
agency, the State agency defined in section 102 
of the Older Americans Act of 1965 (42 U.S.C. 
3002), the State developmental disabilities 
office, and the State mental health agency, in 
the State (or each State) to be served by the 
project;
(vi) parents or caregivers of children with 
disabilities or chronic conditions; and
(vii) representatives reflecting diverse 
racial, cultural, ethnic, geographic, 
socioeconomic, and gender identity and sexual 
orientation perspectives; and
(B) may include any other individuals or entities 
listed in paragraph (12).
(4) Current or projected job openings for, or relevant 
labor market information related to, the direct care 
professionals targeted by the project in the State or region to 
be served by the project, and the geographic scope of the 
workforce to be served by the project.
(5) Specific efforts and strategies that the project will 
undertake to reduce barriers to recruitment, retention, or 
advancement of the direct care professionals targeted by the 
project, including an assurance that such efforts will 
include--
(A) an assessment of the wages or other 
compensation or benefits necessary to recruit and 
retain the direct care professionals targeted by the 
project;
(B) a description of the project's projected 
compensation or benefits for the direct care 
professionals targeted by the project at the State or 
local level, including a comparison of such projected 
compensation or benefits to regional and national 
compensation or benefits and a description of how wages 
and benefits received by project participants will be 
impacted by the participation in and completion of the 
project; and
(C) a description of the projected impact of 
workplace safety issues on the recruitment and 
retention of direct care professionals targeted by the 
project, including the availability of personal 
protective equipment.
(6) In the case of a project offering an education or 
training program for direct care professionals, a description 
of such program (including how the core competencies identified 
by the Centers for Medicare & Medicaid Services will be 
incorporated, curricula, models, and standards used under the 
program, and any associated recognized postsecondary 
credentials for which the program provides preparation, as 
applicable), which shall include an assurance that such program 
will provide to each project participant in such program--
(A) relevant training regarding the rights of 
recipients of long-term care services, including their 
rights to--
(i) receive services in integrated settings 
that provide access to the broader community;
(ii) exercise self-determination;
(iii) be free from all forms of abuse, 
neglect, or exploitation; and
(iv) person-centered planning and 
practices, including participation in planning 
activities;
(B) relevant training to ensure that each project 
participant has the necessary skills to recognize abuse 
and understand their obligations with regard to 
reporting and responding to abuse appropriately in 
accordance with relevant Federal and State law;
(C) relevant training regarding the provision of 
culturally competent and disability competent supports 
to recipients of services provided by the direct care 
professionals targeted by the project;
(D) an apprenticeship program, work-based learning, 
or on-the-job training opportunities;
(E) supervision or mentoring; and
(F) for any on-the-job training portion of the 
program, a progressively increasing, clearly defined 
schedule of wages to be paid to each such participant 
that--
(i) is consistent with skill gains or 
attainment of a recognized postsecondary 
credential received as a result of 
participation in or completion of such program;
(ii) ensures the entry wage is not less 
than the greater of--
(I) the minimum wage required under 
section 6(a) of the Fair Labor 
Standards Act of 1938 (29 U.S.C. 
206(a)); or
(II) the applicable minimum wage 
required by other applicable Federal or 
State law, or a collective bargaining 
agreement; and
(iii) does not use a certificate under 
section 14(c) of the Fair Labor Standards Act 
of 1938 (29 U.S.C. 214(c)).
(7) Any other innovative models or processes the eligible 
entity will implement to support the retention and career 
advancement of the direct care professionals targeted by the 
project.
(8) The supportive services and benefits to be provided to 
the project participants in order to support the employment, 
retention, or career advancement of the direct care 
professionals targeted by the project.
(9) How the eligible entity will make use of career 
planning to support the identification of advancement 
opportunities and career pathways for the direct care 
professionals in the State or region to be served by the 
project.
(10) How the eligible entity will collect and submit to the 
Secretary direct care professional workforce data and outcomes 
of the project.
(11) How the project--
(A) will--
(i) provide adequate and safe equipment and 
facilities for training and supervision, 
including a safe work environment free from 
discrimination, which may include the provision 
of personal protective equipment and other 
necessary equipment to prevent the spread of 
infectious disease among the direct care 
professionals targeted by the project and 
recipients of services provided by such 
professionals;
(ii) incorporate remote training and 
education opportunities or technology-supported 
opportunities;
(iii) for training and education curricula, 
incorporate evidence-supported practices for 
adult learners and universal design for 
learning and ensure recipients of services 
provided by the direct care professionals 
targeted by the project participate in the 
development and implementation of such training 
and education curricula;
(iv) use outreach, recruitment, and 
retention strategies designed to reach and 
retain a diverse workforce;
(v) incorporate methods to monitor 
satisfaction with project activities for 
project participants and individuals receiving 
services from such participants; and
(vi) incorporate core competencies 
identified by the Centers for Medicare & 
Medicaid Services; and
(B) may incorporate continuing education programs 
and specialty training, with a specific focus on--
(i) trauma-informed care;
(ii) behavioral health;
(iii) developmental disabilities or other 
disabilities involving mental impairment;
(iv) co-occurring behavioral health 
conditions and a disability described in clause 
(iii);
(v) Alzheimer's and dementia care;
(vi) infection prevention and control 
measures;
(vii) chronic disease management;
(viii) age-related conditions; and
(ix) the use of supportive or assistive 
technology.
(12) How the eligible entity will consult throughout the 
implementation of the project, or coordinate the project with, 
each of the following:
(A) Older individuals and people with disabilities.
(B) The State Medicaid agency, the State agency 
defined in section 102 of the Older Americans Act of 
1965 (42 U.S.C. 3002), and the State developmental 
disabilities office for the State (or each State) to be 
served by the project.
(C) The local board and State board for each 
region, or State, to be served by the project.
(D) In the case of a project that carries out an 
education or training program, a nonprofit organization 
with demonstrated experience in the development or 
delivery of curricula or coursework.
(E) A nonprofit organization, including a labor 
organization, that fosters the professional development 
and collective engagement of the direct care 
professionals targeted by the project.
(F) Organizations representing the rights and 
interests of people receiving services by the direct 
care professionals targeted by the project.
(G) Area agencies on aging.
(H) Centers for independent living, as described in 
part C of chapter I of title VII of the Rehabilitation 
Act of 1973 (29 U.S.C. 796f et seq.).
(I) The State Council on Developmental Disabilities 
(as such term is used in subtitle B of title I of the 
Developmental Disabilities Assistance and Bill of 
Rights Act of 2000 (42 U.S.C. 15021 et seq.)) for the 
State (or each State) to be served by the project.
(J) Aging and Disability Resource Centers.
(K) A nonprofit State provider association that 
represents providers who employ the direct care 
professionals targeted by the project, where such 
associations exist.
(L) An entity that employs the direct care 
professionals targeted by the project.
(M) University Centers for Excellence in 
Developmental Disabilities Education, Research, and 
Service supported under subtitle D of title I of the 
Developmental Disabilities Assistance and Bill of 
Rights Act of 2000 (42 U.S.C. 15061 et seq.).
(N) The State protection and advocacy system 
described in section 143 of such Act (42 U.S.C. 15043) 
of the State (or each State) to be served by the 
project.
(O) Direct care professionals, and direct care 
professional workforce organizations, representing 
underserved communities, including communities of 
color.
(P) Individuals employed or working as the direct 
care professionals targeted by the project.
(Q) Representatives of such professionals.
(R) Individuals receiving services from such 
professionals.
(S) The families of such professionals.
(T) The families of individuals receiving services 
from such professionals.
(U) Individuals receiving education or training to 
become such professionals.
(13) Outreach efforts to individuals for participation in 
such project, including targeted outreach efforts to--
(A) individuals who are recipients of assistance 
under a State program funded under part A of title IV 
of the Social Security Act (42 U.S.C. 601 et seq.) or 
individuals who are eligible for such assistance; and
(B) individuals with a barrier to employment.
(c) Considerations.--In selecting eligible entities to receive a 
grant under this chapter, the Secretary shall ensure--
(1) equitable geographic and demographic diversity, 
including by selecting recipients serving rural areas and 
selecting recipients serving urban areas; and
(2) that selected eligible entities will serve areas where 
the occupation of direct care professional, or a related 
occupation, is an in-demand industry sector or occupation.

SEC. 204. USES OF FUNDS; SUPPLEMENT, NOT SUPPLANT.

(a) Uses of Funds.--
(1) In general.--Each eligible entity receiving a grant 
under this chapter shall use the funds of such grant to carry 
out at least 1 project described in section 202(a)(2).
(2) Administrative costs.--Each eligible entity receiving a 
grant under this chapter shall not use more than 5 percent of 
the funds of such grant for costs associated with the 
administration of activities under this chapter.
(3) Direct support.--Each eligible entity receiving a grant 
under this chapter shall use not less than 5 percent of the 
funds of such grant to provide direct financial benefits or 
supportive services to direct care professionals to support the 
financial needs of such participants during the duration of the 
project activities.
(b) Supplement, Not Supplant.--An eligible entity receiving a grant 
under this chapter shall use such grant only to supplement, and not 
supplant, the amount of funds that, in the absence of such grant, would 
be available to address the recruitment, training and education, 
retention, and advancement of direct care professionals, in the State 
or region served by the eligible entity.
(c) Prohibition.--No amounts made available under this chapter may 
be used for any activity that is subject to the reporting requirements 
set forth in section 203(a) of the Labor-Management Reporting and 
Disclosure Act of 1959 (29 U.S.C. 433(a)).
(d) Authorization of Appropriations.--There are authorized to be 
appropriated for grants under section 202, $500,000,000 for each of 
fiscal years 2026 through 2030.

CHAPTER 2--OTHER WORKFORCE TRAINING GRANTS

SEC. 205. WORKFORCE INVESTMENT ACTIVITIES GRANTS FOR DOMESTIC WORKERS.

(a) Definitions.--In this section:
(1) Domestic services.--The term ``domestic services''--
(A) means services--
(i) of a household nature;
(ii) provided in interstate commerce; and
(iii) performed by an individual in or 
about a private home (permanent or temporary); 
and
(B) includes services performed by individuals such 
as companions, housekeepers, nurses, home health aides, 
or personal or home care aides.
(2) Domestic worker.--The term ``domestic worker''--
(A) means, except as provided in subparagraph (B), 
an individual, including an employee, who is 
compensated directly or indirectly for the performance 
of domestic services; and
(B) does not include--
(i) an individual who is a family member, 
friend, neighbor, or parent of a child and who 
provides child care for the child in the 
child's home; and
(ii) any employee described in section 
13(a)(15) of the Fair Labor Standards Act of 
1938 (29 U.S.C. 213(a)(15)).
(3) Secretary.--The term ``Secretary'' means the Secretary 
of Labor, in consultation with the Secretary of Education and 
the Secretary of Health and Human Services.
(4) Supportive services; training services; workforce 
investment activities.--The terms ``supportive services'', 
``training services'', and ``workforce investment activities'' 
have the meanings given the terms in section 3 of the Workforce 
Innovation and Opportunity Act (29 U.S.C. 3102).
(b) National Grant Program for Domestic Workers.--Every 3 years, 
the Secretary shall, on a competitive basis, make grants to, or enter 
into contracts with, eligible entities to carry out the activities 
described in subsection (d). The Secretary shall make the grants, or 
enter into the contracts, for periods of 4 years.
(c) Eligibility.--
(1) Eligible entities.--To be eligible to receive a grant 
or enter into a contract under this section, an entity--
(A) shall have experience working with older 
individuals or people with disabilities; and
(B) shall be--
(i)(I) a nonprofit organization that is 
described in paragraph (3), (5), or (6) of 
section 501(c) of the Internal Revenue Code of 
1986, and exempt from taxation under section 
501(a) of such Code;
(II) an organization with a board of 
directors, at least one-half of the members of 
which is comprised of--
(aa) domestic workers; or
(bb) representatives of an 
organization of such workers, including 
such workers who are direct care 
professionals, which organization is 
independent from all businesses, 
organizations, corporations, or 
individuals that would pursue any 
financial interest in conflict with 
that of the workers;
(III) an organization that is independent 
as described in subclause (II)(bb); and
(IV) an organization that has expertise in 
domestic work and the workforce of domestic 
workers, including such workers who are direct 
care professionals;
(ii) an eligible provider of training 
services listed pursuant to section 122(d) of 
the Workforce Innovation and Opportunity Act 
(29 U.S.C. 3152(d)); or
(iii) an entity that carries out an 
apprenticeship program.
(2) Program plan.--
(A) In general.--To be eligible to receive a grant 
or enter into a contract under this section, an entity 
described in paragraph (1) shall submit to the 
Secretary of Labor a plan that describes a 4-year 
strategy for meeting the needs of domestic workers, 
including such workers who are direct care 
professionals, in the area to be served by such entity.
(B) Contents.--Such plan shall--
(i) describe the domestic worker 
population, which shall include domestic 
workers who provide long-term care services, to 
be served and identify the needs of such 
population to be served for workforce 
investment activities and related assistance, 
which may include employment and supportive 
services;
(ii) identify the manner in which career 
pathways to be provided will strengthen the 
ability of the domestic workers to be served to 
obtain or retain employment and to improve 
wages or working conditions, including improved 
employment standards and opportunities in the 
field of domestic work;
(iii) specifically address how the funding 
provided through the grant or contract for 
services under this section to domestic workers 
will improve wages and skills for domestic 
workers in a way that helps meet the need to 
recruit workers for and retain workers in in-
demand occupations or careers; and
(iv) provide an assurance that the 
workforce investment activities and related 
assistance carried out under this section will 
include relevant training for domestic workers 
who are direct care professionals, including--
(I) training regarding the rights 
of recipients of long-term care 
services, including the rights of such 
recipients to--
(aa) receive services in 
integrated settings that 
provide access to the broader 
community;
(bb) exercise self-
determination;
(cc) be free from all forms 
of abuse, neglect, or 
exploitation; and
(dd) receive person-
centered planning and 
practices, including through 
the participation of such 
recipients in planning 
activities;
(II) training to ensure that each 
participant of such training has the 
necessary skills to recognize abuse and 
understand their obligations with 
regard to reporting and responding to 
abuse appropriately in accordance with 
relevant Federal and State law; and
(III) training regarding the 
provision of culturally competent and 
disability-competent supports to 
recipients of long-term care services.
(3) Awards and administration.--The grants and contracts 
under this subsection shall be awarded by the Secretary using 
full and open competitive procedures and shall be administered 
by the Secretary.
(d) Authorized Activities.--Funds made available under this section 
shall be used to carry out workforce investment activities and provide 
related assistance for domestic workers, including such workers who are 
direct care professionals, which may include--
(1) outreach, employment, training services, educational 
assistance, digital literacy assistance, English language and 
literacy instruction, worker safety training, supportive 
services, school dropout prevention and recovery activities, 
individual career services, and career pathways;
(2) follow-up services for those individuals placed in 
employment;
(3) development or education as needed by domestic workers, 
including domestic workers who are direct care professionals;
(4) customized career and technical education in 
occupations that will lead to higher wages, enhanced benefits, 
and long-term employment in domestic work or another area; and
(5) the creation or maintenance of employment and training-
related placement services, including digital placement 
services.
(e) Funding Allocation.--From the funds appropriated and made 
available to carry out this section, the Secretary shall reserve not 
more than 1 percent for discretionary purposes related to carrying out 
this section, such as providing technical assistance to eligible 
entities.
(f) Eligible Provider Performance Reports.--Each eligible entity 
shall prepare performance reports to report on outcomes achieved by the 
programs of workforce investment activities and related assistance 
carried out under this section. The performance report for an eligible 
entity shall include, with respect to each such program (referred to in 
this subsection as a ``program of study'') of such entity--
(1) information specifying the levels of performance 
achieved with respect to the primary indicators of performance 
described in subclauses (I) through (V) of section 
116(b)(2)(A)(i) of the Workforce Innovation and Opportunity Act 
(29 U.S.C. 3141(b)(2)(A)(i)) with respect to all individuals 
engaging in the program of study;
(2) the total number of individuals exiting from the 
program of study;
(3) the total number of participants who received training 
services through the program;
(4) the total number of participants who exited from 
training services, disaggregated by the type of entity that 
provided the training services, during the most recent program 
year and the 3 preceding program years;
(5) the average cost per participant for the participants 
who received training services, disaggregated by the type of 
entity that provided the training services, during the most 
recent program year and the 3 preceding program years; and
(6) information on indicators specified by the Secretary 
concerning the impact of the training services on the wages, 
skills, recruitment, and retention of participants.
(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2026 through 2030.

SEC. 206. DIRECT CARE PROFESSIONAL CAREER ADVANCEMENT DEMONSTRATION 
PROJECTS.

(a) In General.--Section 2008 of the Social Security Act (42 U.S.C. 
1397g) is amended--
(1) by adding at the end the following new subsection:
``(e) Direct Care Professional Career Advancement Demonstration 
Projects.--
``(1) In general.--The Secretary, in consultation with the 
Secretary of Labor, shall award, from the amount appropriated 
under paragraph (4), grants to eligible entities to conduct 
demonstration projects that are designed to provide eligible 
individuals with opportunities for education, training, and 
career advancement as a direct care professional, including as 
a personal or home care aide, home health aide, or nursing aide 
or assistant.
``(2) Definitions.--In this subsection:
``(A) Eligible entity.--The term `eligible entity' 
has the meaning given such term in subsection (a).
``(B) Eligible individual.--The term `eligible 
individual' means an individual--
``(i) whose income does not exceed 200 
percent of the poverty line (as defined in 
section 2110(c)(5)) applicable to a family of 
the size involved; and
``(ii) who is employed as a direct care 
professional who--
``(I) has at least 30 percent 
patient volume (as estimated in 
accordance with a methodology 
established by the Secretary) 
attributable to individuals who are 
receiving medical assistance under 
title XIX; or
``(II) is employed by an agency 
that is a provider of personal or home 
care services that has at least 30 
percent of the agency's patient volume 
(as so estimated) attributable to such 
individuals.
``(C) Direct care professional.--The term `direct 
care professional' has the meaning given such term in 
section 3 of the Long-Term Care Workforce Support Act.
``(3) Requirements.--
``(A) Prioritization of projects that support rural 
areas, underserved areas, and women, individuals from 
communities of color, and individuals with 
disabilities.--The Secretary shall ensure that not less 
than half of the demonstration projects supported by 
grants awarded under this subsection support--
``(i) eligible individuals in rural areas 
(as defined in section 2007(f)(5));
``(ii) eligible individuals in underserved 
urban areas (including urban health 
professional shortage areas (as defined in 
section 332 of the Public Health Service Act);
``(iii) eligible individuals who are women, 
who are from communities of color, or who 
belong to other underserved and diverse 
populations such as Asian, Pacific Islander, 
Native American, or Alaska Native communities; 
and
``(iv) eligible individuals with 
disabilities.
``(B) Amount of grant.--In no case shall the 
Secretary award an eligible entity a grant to conduct a 
demonstration project under this subsection in an 
amount that exceeds $750,000 for each year that the 
entity conducts such project.
``(C) Reports.--
``(i) Interim reports.--An eligible entity 
awarded a grant to conduct a demonstration 
project under this subsection shall submit 
interim reports to the Secretary on the 
activities carried out under the project and a 
final report on such activities upon the 
conclusion of the entities' participation in 
the project.
``(ii) Evaluation.--The Administrator of 
the Health Resources and Services 
Administration shall evaluate the demonstration 
projects conducted under this subsection. Such 
evaluation shall include identification of 
successful activities for creating 
opportunities for developing and sustaining, 
particularly with respect to low-income 
individuals and direct care professionals, a 
health or human services professions workforce 
that has accessible opportunities for career 
advancement, that meets high standards for 
education, training, certification, and 
professional development, that provides 
increased wages and affordable benefits, 
including health care coverage, that are 
responsive to the workforce's needs, and that 
is responsive to the needs of diverse racial 
and ethnic communities.
``(iii) Report to congress.--Not later than 
1 year after the demonstration projects 
conducted under this subsection conclude, the 
Secretary shall submit a final report to 
Congress on such demonstration projects that 
includes--
``(I) the result of the evaluation 
conducted under clause (ii);
``(II) recommendations for best 
practices; and
``(III) such recommendations for 
legislation or administrative actions 
as the Secretary deems appropriate.
``(iv) Additional report.--Not later than 1 
year after the demonstration projects conducted 
under this subsection conclude, the Secretary 
shall submit to the Committee on Health, 
Education, Labor, and Pensions and the Special 
Committee on Aging of the Senate and the 
Committee on Education and the Workforce and 
the Committee on Energy and Commerce of the 
House of Representatives and make publicly 
available, a report on the activities and 
results of such projects. Such report shall 
describe--
``(I) the number and geographic 
distribution of the grants awarded 
under this subsection;
``(II) the participation of 
underrepresented and economically 
disadvantaged participants in 
demonstration projects conducted under 
this subsection; and
``(III) recommendations for program 
revisions to achieve the desired 
program outcome.
``(4) Appropriation.--Out of any funds in the Treasury not 
otherwise appropriated, there are appropriated to the Secretary 
to carry out this subsection $10,000,000 for each of fiscal 
years 2026 through 2030.''.
(b) Incentive Payments for Long-Term Care Services Furnished by 
Direct Care Professionals Who Complete Certain Training.--Section 1834 
of the Social Security Act (42 U.S.C. 1395m) is amended by adding at 
the end the following new subsection:
``(aa) Incentive Payments for Direct Care Services Furnished by 
Direct Care Professionals Who Complete Certain Training.--In the case 
of long-term care services furnished on or after October 1, 2026, by a 
direct care professional who has successfully completed education or 
training under a demonstration project under section 2008(e), in 
addition to the amount of payment that would otherwise be made for such 
services under this part, there also shall be paid an amount equal to 
25 percent of the payment amount for the service under this part to be 
paid to the direct care professional.''.

SEC. 207. PATHWAYS TO HEALTH CAREERS.

Effective October 1, 2026, title XX of the Social Security Act (42 
U.S.C. 1397-1397n-13) is amended by adding at the end the following:

``Subtitle D--Career Pathways Through Health Profession Opportunity 
Grants

``SEC. 2071. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY 
GRANTS.

``(a) Application Requirements.--An eligible entity desiring a 
grant under this section for a project shall submit to the Secretary an 
application for the grant, that includes the following:
``(1) A description of how the applicant will use a career 
pathways approach to train eligible individuals for health 
professions, including direct care professionals, that will put 
eligible individuals on a career path to an occupation that 
pays well, under the project.
``(2) A description of the adult basic education and 
literacy activities, work readiness activities, training 
activities, and case management, career coaching, and mentoring 
support services that the applicant will use to assist eligible 
individuals to gain work experience, connection to employers, 
and job placement, and a description of the plan for 
recruiting, hiring, and training staff to provide the case 
management, mentoring, and career coaching services, under the 
project directly or through local governmental, apprenticeship, 
educational, or charitable institutions.
``(3) A demonstration that the applicant has experience 
working with low-income populations, or a description of the 
plan of the applicant to work with a partner organization that 
has the experience.
``(4) A plan for providing post-employment support and 
ongoing training as part of a career pathway under the project.
``(5) A description of the support services that the 
applicant will provide under the project, including a plan for 
how child care and transportation support services will be 
guaranteed and, if the applicant will provide a cash stipend or 
wage supplement, how the stipend or supplement would be 
calculated and distributed.
``(6) A certification by the applicant that the project 
development included--
``(A) consultation or commitment to consult with a 
local workforce development board;
``(B) consideration of registered apprenticeship 
and pre-apprenticeship models;
``(C) consideration of career pathway programs in 
the State in which the project is to be conducted; and
``(D) a review of the State plan under section 102 
or 103 of the Workforce Innovation and Opportunity Act.
``(7) A description of the availability and relevance of 
recent labor market information and other pertinent evidence of 
in-demand jobs or worker shortages.
``(8) A certification that the applicant will directly 
provide or contract for the training services described in the 
application.
``(9) A commitment by the applicant that, if the grant is 
made to the applicant, the applicant will--
``(A) during the planning period for the project, 
provide the Secretary with any information needed by 
the Secretary to establish adequate data reporting and 
administrative structure for the project;
``(B) hire a person to direct the project not later 
than the end of the planning period applicable to the 
project;
``(C) accept all technical assistance offered by 
the Secretary with respect to the grant;
``(D) participate in peer technical assistance 
conferences as are regularly scheduled by the 
Secretary; and
``(E) provide all data required by the Secretary 
under subsection (g).
``(b) Additional Application Element.--In considering applications 
for a grant under this section, the Secretary shall require qualified 
applicants to have at least 1 of the following application elements:
``(1) Applications submitted by applicants to whom a grant 
was made under this section or any predecessor to this section.
``(2) Applications submitted by applicants who have 
business and community partners in each of the following 
categories:
``(A) State and local government agencies and 
social service providers, including a State or local 
entity that administers a State program funded under 
part A of this title.
``(B) Institutions of higher education, 
apprenticeship programs, and local workforce 
development boards.
``(C) Health care employers, home and community-
based services agencies, health care industry or sector 
partnerships, labor unions, and labor-management 
partnerships.
``(3) Applications that include opportunities for mentoring 
or peer support, and make career coaching available, as part of 
the case management plan.
``(4) Applications which describe a project that will serve 
a rural area in which--
``(A) the community in which the individuals to be 
enrolled in the project reside is located;
``(B) the project will be conducted; or
``(C) an employer partnership that has committed to 
hiring individuals who successfully complete all 
activities under the project is located.
``(5) Applications that include a commitment to providing 
project participants with a cash stipend or wage supplement.
``(6) Applications submitted by applicants who are serving 
or situated in communities of color and other underserved 
communities.
``(7) Applications which have an emergency cash fund to 
assist project participants financially in emergency 
situations.
``(c) Grants.--
``(1) Competitive grants.--
``(A) Grant authority.--
``(i) In general.--The Secretary shall make 
a grant in accordance with this paragraph to an 
eligible entity whose application for the grant 
is approved by the Secretary, to conduct a 
project designed to train low-income 
individuals for allied health professions, 
health information technology, physician 
assistants, nursing assistants, licensed 
practical/vocational nurse, registered nurse, 
advanced practice nurse, direct care 
professionals, and other professions considered 
part of a health care career pathway model.
``(ii) Guarantee of grantees in each state 
and the district of columbia.--For each grant 
cycle, the Secretary shall award a grant under 
this paragraph to at least 2 eligible entities 
in each State that is not a territory, to the 
extent there are a sufficient number of 
applications that have a high likelihood of 
success and that are submitted by the entities 
that meet the requirements applicable with 
respect to such a grant. If, for a grant cycle, 
there are fewer than 2 such eligible entities 
in a State that have submitted applications 
with a high likelihood of success, the 
Secretary shall identify qualified eligible 
applicants located elsewhere, that are 
otherwise approved but un-funded, and issue a 
Substitution of Grant and tailored technical 
assistance. In the preceding sentence, the term 
`issue a Substitution of Grant' means, in a 
case in which an approved grantee does not 
complete its full project period, or in which 
there are fewer than 2 qualified grantees per 
State with a high likelihood of success, 
substitute an applicant located in another 
State that was approved but un-funded during 
the competition for the award for the award 
recipient.
``(B) Guarantee of grants for indian populations.--
The Secretary shall award a grant under this paragraph 
to at least 10 eligible entities that are an Indian 
tribe, a tribal organization, or a tribal college or 
university, to the extent there are a sufficient number 
of applications submitted by the entities that meet the 
requirements applicable with respect to such a grant.
``(C) Guarantee of grantees in the territories.--
The Secretary shall award a grant under this paragraph 
to at least 2 eligible entities that are located in a 
territory, to the extent there are a sufficient number 
of applications submitted by the entities that meet the 
requirements applicable with respect to such a grant.
``(2) Grant cycle.--The grant cycle under this section 
shall be not less than 5 years, with a planning period of not 
more than the first 12 months of the grant cycle. During the 
planning period, the amount of the grant shall be in such 
lesser amount as the Secretary determines appropriate.
``(d) Use of Grant.--
``(1) In general.--An entity to which a grant is made under 
this section shall use the grant in accordance with the 
approved application for the grant.
``(2) Support to be provided.--
``(A) Required support.--A project for which a 
grant is made under this section shall include the 
following:
``(i) An assessment for adult basic skill 
competency, and provision of adult basic skills 
education if necessary for eligible individuals 
to enroll in the project and go on to enter and 
complete post-secondary training, through means 
including the following:
``(I) Establishing a network of 
partners that offer pre-training 
activities for project participants who 
need to improve basic academic skills 
or English language proficiency before 
entering a health occupational training 
career pathway program.
``(II) Offering resources to enable 
project participants to continue 
advancing adult basic skill proficiency 
while enrolled in a career pathway 
program.
``(III) Embedding adult basic skill 
maintenance as part of ongoing post-
graduation career coaching and 
mentoring.
``(ii) A guarantee that child care and 
transportation are available and affordable 
support services for project participants 
through means such as the following:
``(I) Referral to, and assistance 
with, enrollment in a subsidized child 
care program.
``(II) Direct payment to a child 
care provider if a slot in a subsidized 
child care program is not available or 
reasonably accessible.
``(III) Payment of co-payments or 
associated fees for child care and 
transportation.
``(iii) Case management plans that include 
career coaching (with the option to offer 
appropriate peer support and mentoring 
opportunities to help develop soft skills and 
social capital), which may be offered on an 
ongoing basis before, during, and after initial 
training as part of a career pathway model.
``(iv) A plan to provide project 
participants with transportation through means 
such as the following:
``(I) Referral to, and assistance 
with enrollment in, a subsidized 
transportation program.
``(II) If a subsidized 
transportation program is not 
reasonably available, direct payments 
to subsidize transportation costs.
``(B) Transportation.--For purposes of this 
paragraph, the term `transportation' includes public 
transit, or gasoline for a personal vehicle if public 
transit is not reasonably accessible or available.
``(C) Allowed support.--The goods and services 
provided under a project for which a grant is made 
under this section may include the following:
``(i) A cash stipend.
``(ii) A reserve fund for financial 
assistance to project participants in emergency 
situations.
``(iii) Tuition, certification exam fees, 
and training materials such as books, software, 
uniforms, shoes, connection to the internet, 
hair nets, and personal protective equipment.
``(iv) In-kind resource donations such as 
interview clothing and conference attendance 
fees.
``(v) Assistance with accessing and 
completing high school equivalency or adult 
basic education courses as necessary to achieve 
success in the project and make progress toward 
career goals.
``(vi) Other support services as deemed 
necessary for family well-being, success in the 
project, and progress toward career goals.
``(3) Training.--The number of hours of training provided 
to an eligible individual under a project for which a grant is 
made under this section, for a recognized postsecondary 
credential (including an industry-recognized credential, and a 
certificate awarded by a local workforce development board), 
which is awarded in recognition of attainment of measurable 
technical or occupational skills necessary to gain employment 
or advance within an occupation, shall be--
``(A) not less than the number of hours of training 
required for certification in that level of skill by 
the State in which the project is conducted; or
``(B) if there is no such requirement, such number 
of hours of training as the Secretary finds is 
necessary to achieve that skill level.
``(4) Inclusion of tanf recipients.--In the case of a 
project for which a grant is made under this section that is 
conducted in a State that has a program funded under part A of 
title IV, at least 10 percent of the eligible individuals to 
whom support is provided under the project shall meet the 
income eligibility requirements under that State program, 
without regard to whether the individuals receive benefits or 
services directly under that State program.
``(5) Income limitation.--An entity to which a grant is 
made under this section shall not use the grant to provide 
support to a person who is not an eligible individual.
``(6) Prohibition.--An entity to which a grant is made 
under this section shall not use the grant for purposes of 
entertainment, except that case management and career coaching 
services may include celebrations of specific career-based 
milestones such as completing a semester, graduation, or job 
placement.
``(e) Technical Assistance.--
``(1) In general.--The Secretary shall provide technical 
assistance--
``(A) to assist eligible entities in applying for 
grants under this section;
``(B) that is tailored to meet the needs of 
grantees at each stage of the administration of 
projects for which grants are made under this section;
``(C) that is tailored to meet the specific needs 
of Indian tribes, tribal organizations, and tribal 
colleges and universities;
``(D) that is tailored to meet the specific needs 
of the territories;
``(E) that is tailored to meet the specific needs 
of applicants, eligible entities, and grantees, in 
carrying out dedicated career pathway projects pursuant 
to subsection (h); and
``(F) to facilitate the exchange of information 
among eligible entities regarding best practices and 
promising practices used in the projects.
``(2) Continuation of peer technical assistance 
conferences.--The Secretary shall continue to hold peer 
technical assistance conferences for entities to which a grant 
is made under this section or was made under the immediate 
predecessor of this section. The preceding sentence shall not 
be interpreted to require any such conference to be held in 
person.
``(f) Evaluation of Dedicated Career Pathways.--
``(1) In general.--The Secretary shall, by grant, contract, 
or interagency agreement, conduct rigorous and well-designed 
evaluations of the dedicated career pathway projects carried 
out pursuant to subsection (h).
``(2) Requirement applicable to second chance career 
pathway.--In the case of a project of the type described in 
subsection (i), the evaluation shall include identification of 
successful activities for creating opportunities for developing 
and sustaining, particularly with respect to low-income 
individuals with arrest or conviction records, a health 
professions workforce that has accessible entry points, that 
meets high standards for education, training, certification, 
and professional development, and that provides increased wages 
and affordable benefits, including health care coverage, that 
are responsive to the needs of the workforce.
``(g) Reports.--As a condition of funding, an eligible entity 
awarded a grant to conduct a project under this section shall submit 
interim reports to the Secretary on the activities carried out under 
the project, and, on the conclusion of the project, a final report on 
the activities.
``(h) Second Chance Career Pathway.--
``(1) Grant authority.--The Secretary shall award grants in 
accordance with this subsection to eligible entities to conduct 
career pathway projects for the purpose of providing education 
and training for eligible individuals with arrest or conviction 
records to enter and follow a career pathway in the health 
professions through occupations that are expected to experience 
a labor shortage or be in high demand.
``(2) Duration.--A grant awarded under this subsection 
shall have the same grant cycle as is provided in subsection 
(c)(2), and as a condition of funding the grantee shall comply 
with all data reporting requirements associated with the grant 
cycle.
``(3) Application requirements.--An entity seeking a grant 
under this subsection for a project shall submit to the 
Secretary an application for the grant, that includes the 
following:
``(A) A demonstration that the State in which the 
project is to be conducted has in effect policies or 
laws that permit certain allied health and behavioral 
health care credentials to be awarded to people with 
certain arrest or conviction records (which policies or 
laws shall include appeals processes and other 
opportunities to demonstrate rehabilitation to obtain 
licensure and approval to work in the proposed health 
careers), and a plan described in the application which 
will use a legally permitted career pathway to train 
people with such a record to be trained and employed in 
such a career.
``(B) A discussion of how the project or future 
strategic hiring decisions will demonstrate the 
experience and expertise of the project in working with 
job seekers who have arrest or conviction records or 
employers with experience working with people with 
arrest or conviction records.
``(C) A demonstration that the applicant has 
experience working with low-income populations, or a 
description of the plan of the applicant to work with a 
partner that has the experience.
``(D) An identification of promising innovations or 
best practices that can be used to provide the 
training.
``(E) A proof of concept or demonstration that the 
applicant has done sufficient research on workforce 
shortage or in-demand jobs for which people with 
certain types of criminal records can be hired.
``(F) A plan for recruiting students who are 
eligible individuals into the project.
``(G) A plan for providing post-employment support 
and ongoing training as part of a career pathway under 
the project.
``(4) Support to be provided.--A recipient of a grant under 
this subsection for a project shall provide--
``(A) access to legal assistance for project 
participants for the purpose of addressing arrest or 
conviction records and associated workforce barriers;
``(B) assistance with programs and activities 
deemed necessary to address arrest or conviction 
records as an employment barrier; and
``(C) required supportive services described in 
subsection (d)(2)(A) to participants who need the 
services, and may expend funds on eligible supportive 
services described in subsection (d)(2)(B).
``(i) Definitions.--In this section:
``(1) Allied health profession.--The term `allied health 
profession' has the meaning given in section 799B(5) of the 
Public Health Service Act.
``(2) Career pathway.--The term `career pathway' has the 
meaning given that term in section 3(7) of the Workforce 
Innovation and Opportunity Act.
``(3) Direct care professional.--The term `direct care 
professional' has the meaning given such term in section 3 of 
the Long-Term Care Workforce Support Act.
``(4) Eligible entity.--The term `eligible entity' means 
any of the following entities that demonstrates in an 
application submitted under this section that the entity has 
the capacity to fully develop and administer the project 
described in the application:
``(A) A local workforce development board 
established under section 107 of the Workforce 
Innovation and Opportunity Act.
``(B) A State or territory, a political subdivision 
of a State or territory, or an agency of a State, 
territory, or such a political subdivision, including a 
State or local entity that administers a State program 
funded under part A of this title.
``(C) An Indian tribe, a tribal organization, or a 
tribal college or university.
``(D) An institution of higher education (as 
defined in the Higher Education Act of 1965).
``(E) A hospital (as defined in section 1861(e)).
``(F) A high-quality skilled nursing facility.
``(G) A Federally qualified health center (as 
defined in section 1861(aa)(4)).
``(H) A nonprofit organization described in section 
501(c)(3) of the Internal Revenue Code of 1986, a labor 
organization, or an entity with shared labor-management 
oversight, that has a demonstrated history of providing 
health profession training to eligible individuals.
``(I) An opioid treatment program (as defined in 
section 1861(jjj)(2)), and other comprehensive 
addiction care providers.
``(J) A home and community-based services provider 
agency.
``(5) Eligible individual.--The term `eligible individual' 
means an individual whose family income does not exceed 200 
percent of the Federal poverty level and has not been charged 
with or convicted of a violent crime or financial fraud (as 
determined by the Secretary).
``(6) Federal poverty level.--The term `Federal poverty 
level' means the poverty line (as defined in section 673(2) of 
the Omnibus Budget Reconciliation Act of 1981, including any 
revision required by such section applicable to a family of the 
size involved).
``(7) Indian tribe; tribal organization.--The terms `Indian 
tribe' and `tribal organization' have the meaning given the 
terms in section 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450b).
``(8) Institution of higher education.--The term 
`institution of higher education' has the meaning given the 
term in section 101 or 102(a)(1)(B) of the Higher Education Act 
of 1965.
``(9) Territory.--The term `territory' means the 
Commonwealth of Puerto Rico, the United States Virgin Islands, 
Guam, the Northern Mariana Islands, and American Samoa.
``(10) Tribal college or university.--The term `tribal 
college or university' has the meaning given the term in 
section 316(b) of the Higher Education Act of 1965.
``(j) Evaluation.--The Secretary of Health and Human Services, in 
conjunction with the Secretary of Labor, shall evaluate the 
implementation and outcomes of this section on the adoption of paid 
leave by long-term care services providers and the recruitment and 
retention of direct care professionals through a contract with an 
external evaluator who has experience with evaluation of labor 
practices and people with disabilities and older individuals.
``(k) Funding.--In addition to amounts otherwise available, there 
is appropriated to the Secretary--
``(1) $318,750,000 for grants under subsection (c)(1)(A) 
for each of fiscal years 2026 through 2030;
``(2) $17,000,000 for grants under subsection (c)(1)(B) for 
each of fiscal years 2026 through 2030;
``(3) $21,250,000 for grants under subsection (c)(1)(C) for 
each of fiscal years 2026 through 2030;
``(4) $25,500,000 for projects conducted under subsection 
(h) for each of fiscal years 2026 through 2030;
``(5) $25,500,000, plus all amounts referred to in 
paragraphs (1) through (4) of this subsection that remain 
unused after all grant awards are made for the fiscal year, for 
each of fiscal years 2026 through 2030, for the provision of 
technical assistance and administration; and
``(6) $17,000,000 for each of fiscal years 2026 through 
2030 for studying the effects of the projects for which a grant 
is made under this section, and for administration, for the 
purpose of supporting the rigorous evaluation of the projects, 
and supporting the continued study of the short-, medium-, and 
long-term effects of all such projects, including the 
effectiveness of new or added elements of the projects.''.

SEC. 208. INCREASING WORKFORCE DIVERSITY IN ALLIED HEALTH PROFESSIONALS 
AND DIRECT SUPPORT PROFESSIONALS.

Title VII of the Public Health Service Act is amended--
(1) by redesignating part G (42 U.S.C. 295j et seq.) as 
part H; and
(2) by inserting after part F (42 U.S.C. 295h et seq.) the 
following new part:

``PART G--INCREASING WORKFORCE DIVERSITY IN ALLIED HEALTH PROFESSIONALS 
AND DIRECT CARE PROFESSIONALS

``SEC. 783. SCHOLARSHIPS AND STIPENDS.

``(a) In General.--The Secretary may award grants and contracts to 
eligible entities to increase educational opportunities in the 
professions of physical therapy, occupational therapy, respiratory 
therapy, audiology, speech-language pathology, and direct care 
professionals for eligible individuals by--
``(1) providing student scholarships or stipends, including 
for--
``(A) completion of an accelerated degree program;
``(B) completion of an associate's, bachelor's, 
master's, or doctoral degree program; and
``(C) entry by a diploma or associate's degree 
practitioner into a bridge or degree completion 
program;
``(2) providing assistance for completion of prerequisite 
courses or other preparation necessary for acceptance for 
enrollment in the eligible entity;
``(3) carrying out activities to increase the retention of 
students in 1 or more programs in the professions of physical 
therapy, occupational therapy, respiratory therapy, audiology, 
speech-language pathology, and direct care professionals; and
``(4) building or strengthening career pipeline programs, 
including those for high school students, older workers and 
retirees, veterans, and other displaced workers.
``(b) Consideration of Recommendations.--In carrying out subsection 
(a), the Secretary shall take into consideration the recommendations of 
national organizations representing the professions of physical 
therapy, occupational therapy, respiratory therapy, audiology, speech-
language pathology, and direct care professionals, including the 
American Physical Therapy Association, the American Occupational 
Therapy Association, the American Speech-Language-Hearing Association, 
the American Association for Respiratory Care, the American Academy of 
Audiology, the Academy of Doctors of Audiology, and the National 
Alliance for Direct Support Professionals.
``(c) Required Information and Conditions for Award Recipients.--
``(1) In general.--The Secretary may require recipients of 
awards under this section to report to the Secretary concerning 
the annual admission, retention, and graduation rates for 
eligible individuals in programs of the recipient leading to a 
degree in any of the professions of physical therapy, 
occupational therapy, respiratory therapy, audiology, speech-
language pathology, and direct care professionals.
``(2) Falling rates.--If any of the rates reported by a 
recipient under paragraph (1) fall below the average for such 
recipient over the 2 years preceding the year covered by the 
report, the recipient shall provide the Secretary with plans 
for immediately improving such rates.
``(3) Ineligibility.--A recipient described in paragraph 
(2) shall be ineligible for continued funding under this 
section if the plan of the recipient fails to improve the rates 
within the 1-year period beginning on the date such plan is 
implemented.
``(d) Evaluation.--
``(1) In general.--In accordance with paragraph (2), the 
Secretary, in conjunction with the Secretary of Labor, shall 
evaluate the implementation and outcomes of this section on the 
recruitment and retention in long-term care settings of 
certified nursing assistants, physical therapists, occupational 
therapists, audiologists, speech-language pathologists, 
respiratory therapists, direct support professionals, and any 
other direct care professionals determined by the Secretary.
``(2) External evaluator.--The Secretary shall conduct the 
evaluation under paragraph (1) through a contract with an 
external evaluator who has experience with evaluation related 
to people with disabilities and older individuals.
``(e) Definitions.--In this section:
``(1) Direct care professional; disability.--The terms 
`direct care professional' and `disability' have the meanings 
given such terms in section 3 of the Long-Term Care Workforce 
Support Act.
``(2) Eligible entity.--The term `eligible entity' means an 
education program that--
``(A) is accredited by--
``(i) the Council on Academic Accreditation 
in Audiology and Speech-Language Pathology or 
the Accreditation Commission for Audiology 
Education;
``(ii) the Commission on Accreditation in 
Physical Therapy Education;
``(iii) the Accreditation Council for 
Occupational Therapy Education;
``(iv) the Commission on Accreditation for 
Respiratory Care; or
``(v) the National Alliance for Direct 
Support Professionals Certification Program; 
and
``(B) is carrying out a program for recruiting and 
retaining students underrepresented in the professions 
of physical therapy, occupational therapy, respiratory 
therapy, audiology, speech-language pathology, and 
direct care professionals (including racial or ethnic 
minorities, students with disabilities, or students 
from disadvantaged backgrounds).
``(3) Eligible individual.--The term `eligible individual' 
means an individual who--
``(A) is a member of a class of persons who are 
underrepresented in the professions of physical 
therapy, occupational therapy, respiratory therapy, 
audiology, speech-language pathology, and direct care 
professionals, including--
``(i) individuals who are racial or ethnic 
minorities; or
``(ii) individuals who are from 
disadvantaged backgrounds;
``(B) has a financial need for a scholarship or 
stipend; and
``(C) is enrolled (or accepted for enrollment) at a 
physical therapy, occupational therapy, respiratory 
therapy, audiology, speech-language pathology, or 
direct care professionals program as a full-time 
student at an eligible entity.
``(4) Individualized education program.--The term 
`individualized education program' has the meaning given such 
term in section 602 of the Individuals with Disabilities 
Education Act.
``(5) Long-term care setting.--The term `long-term care 
setting' has the meaning given such term in section 3 of the 
Long-Term Care Workforce Support Act.
``(6) Older individual.--The term `older individual' has 
the meaning given such term in section 102 of the Older 
Americans Act of 1965.
``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2026 through 2030.''.

Subtitle B--Improving Workforce Recruitment

SEC. 211. TECHNICAL ASSISTANCE CENTER FOR BUILDING THE DIRECT CARE 
PROFESSIONAL WORKFORCE.

(a) Grant Program Authorized.--
(1) In general.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award 
a grant, on a competitive basis, to an eligible partnership 
described in subsection (b) to create a national technical 
assistance center (referred to in this section as the 
``Center'') for supporting direct care professional workforce 
creation, training and education, recruitment, retention, and 
advancement, including through the activities under subsection 
(c).
(2) Consultation.--The Center shall carry out activities 
under this section in consultation with the Secretary of Labor, 
the Secretary of Education, the Secretary of Veterans Affairs, 
the Administrator of the Administration for Community Living, 
the Administrator of the Centers for Medicare & Medicaid 
Services, the Administrator of the Health Resources and 
Services Administration, and the heads of other entities as 
necessary.
(b) Eligible Partnerships.--
(1) In general.--An eligible partnership described in this 
subsection is a partnership of 3 or more of the following:
(A) An institution of higher education.
(B) A disability-led organization.
(C) An organization focusing on older individuals.
(D) An organization focusing on direct care 
professionals.
(E) An organization that represents service 
provider agencies that employ direct care 
professionals.
(F) An organization, including a labor 
organization, that fosters professional development.
(G) A University Center for Excellence in 
Developmental Disabilities Education, Research, and 
Service supported under subtitle D of title I of the 
Developmental Disabilities Assistance and Bill of 
Rights Act of 2000 (42 U.S.C. 15061 et seq.).
(H) An agency implementing a State protection and 
advocacy system described in section 143 of such Act 
(42 U.S.C. 15043).
(I) A State Council on Developmental Disabilities 
(as such term is used in subtitle B of title I of the 
Developmental Disabilities Assistance and Bill of 
Rights Act of 2000 (42 U.S.C. 15021 et seq.)).
(J) An organization representing a center for 
independent living, as described in part C of title VII 
of the Rehabilitation Act of 1973 (29 U.S.C. 796f et 
seq.).
(K) An organization representing veterans.
(L) An organization representing parents or 
caregivers of children with disabilities or chronic 
conditions.
(M) Any other entity the Secretary designates as 
important to improving the direct care professional 
workforce.
(2) Applications.--To be eligible for a grant under this 
section, an eligible partnership described in paragraph (1) 
shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary 
may require.
(c) Activities.--The Center may--
(1) develop recommendations for training and education 
curricula for direct care professionals, which such 
recommendations may include recommendations for curricula for 
higher education, postsecondary credentials, and programs with 
community and technical colleges;
(2) develop learning and dissemination strategies to--
(A) engage States and other entities in activities 
supported under this section and best practices for 
supporting the direct care professional workforce; and
(B) distribute findings from activities supported 
by the grant under this section;
(3) explore the national data gaps, workforce shortage 
areas, and data collection strategies for direct care 
professionals and make recommendations to the Director of the 
Office of Management and Budget for an occupation category in 
the Standard Occupational Classification system for direct care 
professionals as a healthcare support occupation; and
(4) recommend career development and advancement 
opportunities for direct care professionals, which may include 
occupational frameworks, national standards, recruitment 
campaigns, pre-apprenticeship and on-the-job training 
opportunities, apprenticeship programs, career pathways, 
specializations or certifications, educational information 
about career opportunities in long-term care settings, or other 
activities.
(d) Advisory Council.--
(1) In general.--The Secretary shall convene an advisory 
council to provide recommendations to the Center with respect 
to the duties of the Center under this section and may engage 
individuals described in paragraph (2) for service on the 
advisory council.
(2) Individuals.--The individuals described in this 
paragraph include--
(A) older individuals and people with disabilities;
(B) organizations representing the rights and 
interests of people receiving services from direct care 
professionals;
(C) individuals who are direct care professionals 
and organizations representing the rights and interests 
of direct care professionals;
(D) as applicable, employers of individuals 
described in subparagraph (C) and labor organizations 
representing such individuals;
(E) representatives of State Medicaid agencies, 
State agencies defined in section 102 of the Older 
Americans Act of 1965 (42 U.S.C. 3002), State 
developmental disabilities offices, and State mental 
health agencies;
(F) representatives reflecting diverse racial, 
cultural, ethnic, geographic, socioeconomic, and gender 
identity and sexual orientation perspectives;
(G) representatives of local boards and State 
boards;
(H) a nonprofit organization with demonstrated 
experience in the development or delivery of curricula 
or coursework;
(I) a nonprofit organization, including a labor 
organization, that fosters the professional development 
and collective engagement of direct care professionals;
(J) area agencies on aging;
(K) centers for independent living, as described in 
part C of title VII of the Rehabilitation Act of 1973 
(29 U.S.C. 796f et seq.);
(L) representatives of State Councils on 
Developmental Disabilities (as such term is used in 
subtitle B of title I of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000 (42 U.S.C. 
15021 et seq.));
(M) representatives of Aging and Disability 
Resource Centers;
(N) representatives of nonprofit State provider 
associations that represents providers who employ 
direct care professionals;
(O) representatives of entities that employ direct 
care professionals;
(P) representatives of University Centers for 
Excellence in Developmental Disabilities Education, 
Research, and Service supported under subtitle D of 
title I of the Developmental Disabilities Assistance 
and Bill of Rights Act of 2000 (42 U.S.C. 15061 et 
seq.);
(Q) representatives of State protection and 
advocacy systems described in section 143 of such Act 
(42 U.S.C. 15043); and
(R) representatives of direct care professional 
organizations representing underserved communities, 
including communities of color.
(e) Authorization of Appropriations.--There are authorized to be 
appropriated $10,000,000 to carry out this section for each of fiscal 
years 2026 through 2030.

SEC. 212. REPORT ON EFFORTS TO ENHANCE THE DIRECT CARE PROFESSIONAL 
WORKFORCE.

Not later than 180 days after the date of enactment of this Act, 
the Secretary of Health and Human Services shall submit to the 
appropriate committees of Congress, a report that contains an 
assessment of the programs and activities of the Department of Health 
and Human Services related to enhancing the direct care professional 
workforce, including the extent to which programs and activities 
authorized under titles VII and VIII of the Public Health Service Act 
(42 U.S.C. 292 et seq.; 42 U.S.C. 296 et seq.) address--
(1) increasing nursing faculty who are trained in geriatric 
nursing;
(2) increasing individuals preparing for careers in or 
advanced degrees in geriatric nursing or long-term care;
(3) increasing direct care professionals;
(4) the extent to which the Department coordinates with 
other Federal departments regarding programs designed to 
improve the direct care professional workforce; and
(5) recommendations for best practices.

SEC. 213. COMPREHENSIVE GERIATRIC EDUCATION.

Section 865 of the Public Health Service Act (42 U.S.C. 298) is 
amended--
(1) in subsection (a), by striking ``the elderly'' and 
inserting ``older individuals'';
(2) in subsection (b)--
(A) in paragraph (1), by striking ``the elderly'' 
and inserting ``older individuals'';
(B) in paragraph (2), by striking ``treatment'' and 
all that follows and inserting ``health care needs of 
older individuals;''; and
(C) in paragraph (5), by striking ``the elderly 
population'' and inserting ``older individuals'';
(3) in subsection (d)--
(A) in the heading, by striking ``Eligible Entity'' 
and inserting ``Definitions'';
(B) by striking ``For purposes of this section, the 
term'' and inserting ``For purposes of this section:
``(1) Eligible entity.--The term''; and
(C) by adding at the end the following:
``(2) Older individual.--The term `older individual' has 
the meaning given such term in section 102 of the Older 
Americans Act of 1965.''; and
(4) in subsection (e), by striking ``years'' and all that 
follows and inserting ``years 2026 through 2030.''.

SEC. 214. REVIEW OF THE AVAILABILITY AND QUALITY OF APPRENTICESHIP 
PROGRAMS IN LONG-TERM CARE SETTINGS.

Not later than 180 days after the date of enactment of this Act, 
the Secretary of Labor, in coordination with the Secretary of Health 
and Human Services, shall submit a report to the appropriate committees 
of Congress that--
(1) identifies the extent of vacancies at employers that 
employ direct care professionals at the State and local levels 
within the direct care professional workforce, including with 
respect to vacancies of direct care professionals;
(2) review existing apprenticeship programs in the direct 
care professional workforce;
(3) provide recommendations on the design of apprenticeship 
programs in the direct care professional workforce, including 
about potential funding opportunities, potential apprenticeship 
program sponsors, and a national competency-based occupational 
framework; and
(4) identify opportunities for coordination with other 
State and local entities, including State educational agencies, 
local educational agencies, career and technical education 
programs, institutions of higher education, State agencies with 
responsibility for administering a State Medicaid program, and 
labor management organizations, to create apprenticeship 
programs and other ways to incorporate associate and bachelor's 
degrees in apprenticeship programs.

SEC. 215. RURAL HEALTH WORKFORCE GRANT PROGRAM.

Part D of title VII of the Public Health Service Act (42 U.S.C. 294 
et seq.) is amended by adding at the end the following:

``SEC. 760A. RURAL HEALTH WORKFORCE GRANT PROGRAM.

``(a) Definitions.--In this section:
``(1) Carl d. perkins career and technical education act 
definitions.--The terms `career and technical education', 
`career guidance and academic counseling', and `program of 
study' have the meanings given the terms in section 3 of the 
Carl D. Perkins Career and Technical Education Act of 2006.
``(2) ESEA definitions.--The terms `elementary school', 
`local educational agency', and `secondary school' have the 
meanings given the terms in section 8101 of the Elementary and 
Secondary Education Act of 1965.
``(3) Institution of higher education.--The term 
`institution of higher education' has the meaning given the 
term in section 102 of the Higher Education Act of 1965.
``(4) Long-term care workforce support act.--The terms 
`direct care professional' and `direct care professional 
workforce' have the meanings given such terms in section 3 of 
the Long-Term Care Workforce Support Act.
``(5) Workforce innovation and opportunity act 
definitions.--The terms `career pathway', `industry or sector 
partnership', and `local board' have the meanings given the 
terms in section 3 of the Workforce Innovation and Opportunity 
Act.
``(b) Authorization of Grants.--
``(1) In general.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration and in consultation with the Secretary of 
Education, shall award grants on a competitive basis to 
eligible entities to develop career exploration programs 
aligned to career and technical education programs of study to 
bring awareness to elementary school and secondary school 
students in underserved rural communities about health care 
professions careers and provide children and youth underserved 
rural community health care experiences related to such 
careers.
``(2) Grant amount.--Each grant awarded under this section 
shall be in an amount that is not more than $250,000 per year.
``(3) Grant period.--Each grant awarded under this section 
shall be for a period not to exceed 5 years.
``(c) Eligible Entities.--
``(1) In general.--To be eligible to receive a grant under 
this section, an entity shall meet the following requirements:
``(A) Be a consortium consisting of a local 
educational agency and at least 2 of the following:
``(i) An institution of higher education 
that provides a recognized postsecondary 
credential in health care.
``(ii) A health care practice, facility, or 
provider organization.
``(iii) A State, Indian Tribe or Tribal 
organization, or a local governmental entity.
``(iv) A local board.
``(v) An industry or sector partnership.
``(vi) A nonprofit organization 
representing the interests of underserved rural 
communities and rural health care.
``(vii) An area health education center.
``(viii) A rural health clinic.
``(ix) Any other entity as determined 
appropriate by the Secretary.
``(B) Submit an application to the Secretary at 
such time, in such manner, and containing such 
information that the Secretary may require, including a 
plan for the long-term tracking of participants 
supported by the grant under this section.
``(2) Matching funds.--In order to ensure the institutional 
commitment of an entity to a program supported by a grant under 
this section, to be eligible to receive such a grant, the 
Secretary may require the entity seeking such grant to agree to 
make available (directly or through contributions from State, 
county or municipal governments, or the public or private 
sector) recurring non-Federal contributions in cash or in kind 
(including plant, equipment, or services) towards the costs of 
operating the program in an amount that is equal to not less 
than 50 percent of the total costs of operating such program.
``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible entities that--
``(1) include in its consortium--
``(A) an entity that has demonstrated alignment 
with a State plan or local application developed under 
the Carl D. Perkins Career and Technical Education Act 
of 2006;
``(B) a high-need local educational agency, as 
defined in section 200 of the Higher Education Act of 
1965, or a local educational agency eligible to receive 
assistance under part B of title V of the Elementary 
and Secondary Education Act of 1965;
``(C) an institution of higher education at which 
at least 30 percent of the enrolled students are 
Federal Pell Grant recipients;
``(D) a minority-serving institution of higher 
education described in any of paragraphs (1) through 
(7) of section 371(a) of the Higher Education Act of 
1965; or
``(E) a local educational agency that serves the 
greatest number of students; and
``(2) provide a plan to sustain the program funded under 
the grant beyond the period of the grant.
``(e) Use of Funds; Requirements.--An eligible entity receiving a 
grant under this section shall use the grant funds to establish, 
improve, or expand an underserved rural community training program for 
elementary school students and secondary school students that meets the 
following requirements:
``(1) Carrying out program planning, including--
``(A) development and support of a coordinating 
body to organize, administer, and oversee the 
activities of the consortium;
``(B) conducting a needs analysis using data, 
including community demographics, workforce estimates, 
and capacity of training programs to direct work of the 
consortium; and
``(C) developing a regional articulation plan that 
benefits students with respect to reducing barriers to 
program entry, reducing time to graduation, and lower 
cost training options.
``(2) Carrying out age-appropriate education activities and 
promotion of the program that align with section 135(b)(1) of 
the Carl D. Perkins Career and Technical Education Act of 2006, 
including--
``(A) engaging students in underserved rural 
communities in elementary school for exposure to health 
career workforce opportunities, and including direct 
care professionals in educational opportunities as 
practicable;
``(B) exposing secondary school students in 
underserved rural communities to health career 
workforce opportunities available in their communities, 
including by providing career guidance and academic 
counseling on such opportunities;
``(C) developing strategies to address resiliency 
and mental health among elementary school and secondary 
school students in underserved rural communities 
interested in health care professions careers in such 
communities;
``(D) providing age-appropriate mentoring, academic 
enrichment, or support for elementary school and 
secondary school students in underserved rural 
communities, carried out by health care professionals 
or peers;
``(E) enrolling secondary school students 
(including those in underserved rural communities) in 
health care career and technical education programs of 
study or career pathways in underserved rural 
communities;
``(F) developing and enrolling of secondary school 
students in pre- and youth-apprenticeships or summer 
programs that provide clinical or other health care 
professions focused experiences in underserved rural 
communities;
``(G) providing financial supplemental support for 
student transportation to, and housing at, the program 
site, as appropriate; and
``(H) such other activities as the Secretary 
determines appropriate.
``(3) Each such program shall be carried out for a term of 
not less than 5 years.
``(f) Technical Assistance.--The Administrator of the Health 
Resources and Services Administration shall, directly or indirectly, 
provide technical assistance to grant recipients for purposes of 
carrying out the programs described in subsection (e).
``(g) Reporting.--
``(1) Annual reporting by recipients.--
``(A) In general.--An eligible entity receiving a 
grant under this section shall submit an annual report 
to the Secretary on the progress of the program 
supported by such grant, based on criteria the 
Secretary determines appropriate, including the program 
selection of students who participated in the program.
``(B) Contents.--Each report required under 
subparagraph (A) shall include any data requested by 
the Secretary, which may include, as appropriate, the 
number of participants and the demographics of such 
participants served by the program supported by the 
grant, including the number of participants who 
enrolled in the program and withdrew prior to 
completion of the program.
``(2) Reports to congress.--
``(A) Annual reports.--Not later than 2 years after 
the date of enactment of this section, and annually 
thereafter until all programs supported through a grant 
under this section are completed, the Secretary shall 
prepare and submit to Congress a report that includes 
the progress of each program supported by a grant under 
this section and the challenges experienced by grantees 
with respect to such programs.
``(B) Grant cycle final report.--Not later than 
September 30, 2031, the Administrator of the Health 
Resources and Services Administration shall submit a 
report to Congress on the lessons learned through the 
programs supported by grants under this section and 
that based on such lessons identifies best practices 
for career exploration programs with a focus on 
underserved rural communities and the direct care 
professional workforce.
``(h) Regulations.--The Secretary shall, by regulation, define the 
term `underserved rural community' for purposes of this section.
``(i) Supplement Not Supplant.--Any eligible entity receiving funds 
under this section shall use such funds to supplement, not supplant, 
any other Federal, State, and local funds that would otherwise be 
expended by such entity to carry out the activities described in this 
section.
``(j) Evaluation.--
``(1) In general.--The Secretary, in conjunction with the 
Secretary of Labor, shall evaluate the implementation and 
outcomes of this section on the recruitment of secondary school 
students residing in underserved rural communities entering 
professions of direct care professionals.
``(2) External evaluator.--The Secretary shall conduct the 
evaluation under paragraph (1) through a contract with an 
external evaluator who has experience with evaluation related 
to workforce development and people with disabilities and older 
individuals.
``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2026 through 2030.''.

Subtitle C--Providing Career Advancement Opportunities; Assessment of 
Worker Well-being

SEC. 221. ASSESSMENT OF DIRECT CARE PROFESSIONAL WELL-BEING.

(a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in coordination 
with the Director of the National Institute for Occupational Safety and 
Health of the Centers for Disease Control and Prevention, the Assistant 
Secretary for Mental Health and Substance Use, and the Administrator of 
the Health Resources and Services Administration, shall--
(1) not later than 1 year after the date of enactment of 
this Act, develop a research-based tool for assessing direct 
care professional well-being, as described in subsection (b); 
and
(2) not less frequently than biennially, collect data on 
worker well-being using the tool developed pursuant to 
paragraph (1) and make such data publicly available as 
described in subsection (c).
(b) Assessment Tool.--The tool for the assessment of direct care 
professional well-being developed under subsection (a)(1) shall--
(1) include the use of an anonymous, validated survey of 
direct care professionals;
(2) at a minimum, assess and include the views of such 
professionals on--
(A) workplace policies and culture, including 
meaningful engagement of such professionals;
(B) workplace physical environment and safety;
(C) circumstances outside of work for such 
professionals; and
(D) the physical and mental health status of such 
professionals; and
(3) be developed with input from direct care professionals, 
older individuals, people with disabilities, and family members 
of older individuals and people with disabilities.
(c) Public Availability of Aggregate Data and the Assessment 
Tool.--The Secretary shall--
(1) make available, through a publicly available data 
repository, aggregated and de-identified data collected by the 
assessment of direct care professional well-being under 
subsection (a);
(2) make the assessment tool developed under subsection 
(a)(1) publicly available in a format that allows employers, 
researchers, and other entities to voluntarily use and 
administer such assessment for purposes of using information 
collected by the assessment to improve the well-being of direct 
care professionals; and
(3) conduct outreach to employers, researchers, and other 
relevant entities to increase awareness of the availability of 
the tool for the assessment of the well-being of direct care 
professionals.
(d) Burden on Participants.--In developing the assessment tool 
under subsection (a)(1), the Secretary shall minimize the burden of the 
data collection process on direct care professionals.
(e) Confidentiality.--The Secretary shall ensure that the 
assessment tool developed under subsection (a)(1), the process of data 
collection under subsection (a), and the publicly available data under 
subsection (c)(1), do not involve the collection or disclosure of any 
individually identifiable information regarding the direct care 
professionals who are being assessed.
(f) Rule of Construction.--Nothing in this section shall be 
construed to require that the assessment tool developed under 
subsection (a)(1) or the data collected through such tool be used for 
purposes of quality measurement or payment systems under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) or a State Medicaid program.
(g) Report.--Not later than 2 years after the date of enactment of 
this Act, and biennially thereafter, the Secretary shall--
(1) submit to Congress a report on the findings of the 
assessment under subsection (a), including any recommendations 
to address direct care professional well-being; and
(2) make such report publicly available on the website of 
the Centers for Disease Control and Prevention.
(h) Definition of Well-Being.--For purposes of this section, the 
term ``well-being'', with respect to a direct care professional, means 
the quality of life with respect to the health and work-related 
environment of such professional as related to organizational and 
psychosocial factors.
(i) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section $6,000,000 for 
each of fiscal years 2026 through 2031.

SEC. 222. NATIONAL DIRECT CARE PROFESSIONAL TRAINING STANDARDS 
COMMISSION.

(a) Establishment.--
(1) In general.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human 
Services shall establish the National Direct Care Professional 
Training Standards Commission (referred to in this section as 
the ``Commission'') to advise the Secretary on--
(A) developing national direct care professional 
training standards described in paragraph (2) to 
recommend to States to implement; and
(B) providing support for States in implementing 
such standards.
(2) Standards.--The standards under this subsection shall 
be--
(A) competency-based;
(B) industry-recognized; and
(C) portable across settings and States.
(3) Membership.--The Commission shall include 
representatives from the following:
(A) An organization representing older individuals.
(B) An organization led by people with 
disabilities.
(C) An organization representing the rights and 
interests of people receiving services from direct care 
professionals.
(D) An organization (other than a labor 
organization) representing direct care professionals.
(E) Labor organizations representing direct care 
professionals.
(F) An organization representing State Medicaid 
agencies, State agencies defined in section 102 of the 
Older Americans Act of 1965 (42 U.S.C. 3002), State 
developmental disabilities offices, and State mental 
health agencies.
(G) An organization representing local boards and 
State boards.
(H) An organization representing area agencies on 
aging.
(I) An organization representing centers for 
independent living, as described in part C of title VII 
of the Rehabilitation Act of 1973 (29 U.S.C. 796f et 
seq.).
(J) An organization representing State Councils on 
Developmental Disabilities (as such term is used in 
subtitle B of title I of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000 (42 U.S.C. 
15021 et seq.)).
(K) An organization representing Aging and 
Disability Resource Centers.
(L) An organization representing nonprofit State 
provider associations.
(M) An organization representing entities that 
employ direct care professionals.
(N) An organization representing University Centers 
for Excellence in Developmental Disabilities Education, 
Research, and Service supported under subtitle D of 
title I of the Developmental Disabilities Assistance 
and Bill of Rights Act of 2000 (42 U.S.C. 15061 et 
seq.).
(O) An organization representing State protection 
and advocacy systems described in section 143 of such 
Act (42 U.S.C. 15043).
(P) Representatives of direct care professional 
organizations representing underserved communities, 
including communities of color.
(Q) Representatives reflecting diverse racial, 
cultural, ethnic, geographic, socioeconomic, and gender 
identity and sexual orientation perspectives.
(4) Period of appointment; vacancies.--
(A) In general.--A member of the Commission shall 
be appointed for the life of the Commission.
(B) Vacancies.--A vacancy in the Commission--
(i) shall not affect the powers of the 
Commission; and
(ii) shall be filled in the same manner as 
the original appointment.
(5) Meetings.--
(A) Initial meeting.--Not later than 180 days after 
the date on which all members of the Commission have 
been appointed, the Commission shall hold the first 
meeting of the Commission.
(B) Frequency.--The Commission shall meet at the 
call of the Chairperson.
(C) Quorum.--A majority of the members of the 
Commission shall constitute a quorum, but a lesser 
number of members may hold hearings.
(6) Chairperson and vice chairperson.--The Commission shall 
select a Chairperson and Vice Chairperson from among the 
members of the Commission.
(b) Duties.--
(1) Study.--The Commission shall conduct a thorough study 
of all matters relating to direct care professional training 
standards.
(2) Recommendations.--The Commission shall develop 
recommendations on--
(A) national training standards for direct care 
professionals that meet the requirements under 
subsection (a)(2); and
(B) methods for supporting States in implementing 
such standards.
(3) Report.--Not later than 3 years after the date of 
enactment of this Act, the Commission shall submit to the 
Secretary and the appropriate committees of Congress a report 
that contains a detailed statement of the findings and 
conclusions of the Commission, together with the 
recommendations of the Commission for such legislation and 
administrative actions as the Commission considers appropriate.
(c) Powers of Commission.--
(1) Hearings.--The Commission may hold such hearings, sit 
and act at such times and places, take such testimony, and 
receive such evidence as the Commission considers advisable to 
carry out this section.
(2) Information from federal agencies.--
(A) In general.--The Commission may secure directly 
from a Federal department or agency such information as 
the Commission considers necessary to carry out this 
section.
(B) Furnishing information.--On request of the 
Chairperson of the Commission, the head of the 
department or agency shall furnish the information to 
the Commission.
(3) Postal services.--The Commission may use the United 
States mails in the same manner and under the same conditions 
as other departments and agencies of the Federal Government.
(4) Gifts.--The Commission may accept, use, and dispose of 
gifts or donations of services or property.
(d) Commission Personnel Matters.--
(1) Compensation of members.--A member of the Commission 
who is not an officer or employee of the Federal Government 
shall be compensated at a rate equal to the daily equivalent of 
the annual rate of basic pay prescribed for level IV of the 
Executive Schedule under section 5315 of title 5, United States 
Code, for each day (including travel time) during which the 
member is engaged in the performance of the duties of the 
Commission.
(2) Travel expenses.--A member of the Commission shall be 
allowed travel expenses, including per diem in lieu of 
subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
Code, while away from their homes or regular places of business 
in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission 
may, without regard to the civil service laws 
(including regulations), appoint and terminate an 
executive director and such other additional personnel 
as may be necessary to enable the Commission to perform 
its duties, except that the employment of an executive 
director shall be subject to confirmation by the 
Commission.
(B) Compensation.--The Chairperson of the 
Commission may fix the compensation of the executive 
director and other personnel without regard to chapter 
51 and subchapter III of chapter 53 of title 5, United 
States Code, relating to classification of positions 
and General Schedule pay rates, except that the rate of 
pay for the executive director and other personnel may 
not exceed the rate payable for level V of the 
Executive Schedule under section 5316 of that title.
(4) Detail of government employees.--A Federal Government 
employee may be detailed to the Commission without 
reimbursement, and such detail shall be without interruption or 
loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and 
intermittent services under section 3109(b) of title 5, United 
States Code, at rates for individuals that do not exceed the 
daily equivalent of the annual rate of basic pay prescribed for 
level V of the Executive Schedule under section 5316 of that 
title.
(e) Termination of Commission.--The Commission shall terminate 90 
days after the date on which the Commission submits the report required 
under subsection (b)(3).
(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $500,000 for fiscal year 2026, 
to remain available, without fiscal year limitation, until expended.

Subtitle D--Increasing Supports for the Existing Direct Care 
Professional Workforce

SEC. 231. MENTAL HEALTH SERVICES.

(a) Programs To Promote Mental Health Among Direct Care 
Professionals.--
(1) In general.--The Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') shall award 
grants, contracts, or cooperative agreements to eligible 
entities to establish or enhance evidence-based or evidence-
informed programs dedicated to improving mental health and 
resiliency for direct care professionals.
(2) Eligibility.--To be eligible to receive an award under 
this subsection, an entity shall be--
(A) a State;
(B) a labor organization, joint labor management 
organization, or employer of direct care professionals;
(C) a nonprofit entity with experience in aging, 
disability, or supporting the rights and interests of, 
the training of, or educating direct care 
professionals; or
(D) an Indian Tribe, Tribal organization, or Urban 
Indian organization.
(3) Use of funds.--A recipient of an award under this 
subsection shall use funds received through the award to 
implement and evaluate a new program or enhance an existing 
program to promote mental health among direct care 
professionals, which may include--
(A) improving awareness among direct care 
professionals about risk factors for, and signs of, 
suicide and mental health or substance use disorders, 
in accordance with evidence-based or evidence-informed 
practices;
(B) establishing new, or enhancing existing, 
evidence-based or evidence-informed programs for 
preventing suicide and improving mental health and 
resiliency among direct care professionals;
(C) establishing new, or enhancing existing, peer-
support programs for direct care professionals; or
(D) providing--
(i) mental health care;
(ii) follow-up services or care by a 
licensed or certified mental health 
professional (including by means of 
telehealth); or
(iii) a referral for such services or care 
by such a professional, as appropriate.
(4) Priority.--In awarding grants, contracts, and 
cooperative agreements under this subsection, the Secretary 
shall give priority to an eligible entity in--
(A) a rural area; or
(B) an area where the number of direct care 
professional vacancies, in the year of the application, 
is greater than 30 percent of the total number of 
direct care professional positions in the area.
(b) Training Grants.--
(1) In general.--The Secretary may establish a program to 
award grants to eligible entities to support the inclusion, in 
direct care professional preparation programs and in training, 
continuing education, or professional development programs for 
direct care professionals, of evidence-based or evidence-
informed strategies--
(A) to address mental and substance use disorders 
of direct care professionals; and
(B) to improve mental health and resiliency among 
direct care professionals.
(2) Eligibility.--To be eligible to receive a grant under 
this subsection, an entity shall be--
(A) an institution of higher education;
(B) a State or local government;
(C) an Indian Tribe or Tribal organization;
(D) a public or private nonprofit entity determined 
appropriate by the Secretary; or
(E) a consortia of entities described in any of 
subparagraphs (A) through (D), including such entities 
promoting multidisciplinary approaches.
(c) Grant Terms.--A grant, contract, or cooperative agreement 
awarded under subsection (a) or (b) shall be for a period of 3 years.
(d) Application Submission.--An entity seeking an award under 
subsection (a) or (b) shall submit an application to the Secretary at 
such time, in such manner, and accompanied by such information as the 
Secretary may require.
(e) Annual Report.--An entity receiving an award under subsection 
(a) or (b) shall submit to the Secretary an annual report evaluating 
the activities supported by the award.
(f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $20,000,000 for each of fiscal 
years 2026 through 2030.

SEC. 232. DISSEMINATION OF BEST PRACTICES WITH RESPECT TO MENTAL HEALTH 
OF DIRECT CARE PROFESSIONALS.

Not later than 2 years after the date of enactment of this Act, the 
Secretary of Health and Human Services shall--
(1) identify evidence-based or evidence-informed best 
practices--
(A) for preventing suicide and improving mental 
health and resiliency among direct care professionals; 
and
(B) for training direct care professionals in 
appropriate strategies to promote their mental health; 
and
(2) disseminate those best practices to the appropriate 
committees of Congress.

SEC. 233. EDUCATION AND AWARENESS INITIATIVE ENCOURAGING USE OF MENTAL 
HEALTH AND SUBSTANCE USE DISORDER SERVICES BY DIRECT CARE 
PROFESSIONALS.

(a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in consultation 
with relevant stakeholders, including medical professional 
associations, shall establish a national evidence-based or evidence-
informed education and awareness initiative--
(1) with the goal of preventing suicide, mental health 
conditions, and substance use disorders of direct care 
professionals, to--
(A) encourage direct care professionals to seek 
support and care for their mental health or substance 
use concerns;
(B) help such professionals identify risk factors 
associated with suicide and mental health conditions; 
and
(C) help such professionals learn how best to 
respond to such risk factors; and
(2) to address stigma associated with seeking mental health 
and substance use disorder services.
(b) Reporting.--Not later than 2 years after the date of enactment 
of this Act, the Secretary shall provide to the appropriate committees 
of Congress an update on the activities and outcomes of the initiative 
under subsection (a), including a description of quantitative and 
qualitative metrics used to evaluate such activities and outcomes.

SEC. 234. DIRECT CARE PROFESSIONAL TRAINING GRANTS.

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

``SEC. 2041. DIRECT CARE PROFESSIONAL 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) 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), 
(iii), and (iv) the amount allotted to a State 
under this subparagraph for a fiscal year shall 
be equal to the product of--
``(I) the available amount for the 
fiscal year; and
``(II) the ratio of--
``(aa) the number of State 
residents who have attained 60 
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
``(bb) 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)(II)(aa) 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 2030 
shall be--
``(aa) not less than 90 
percent of the amount of the 
grant made to the State under 
this subparagraph for the 
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) 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, Indian tribe, or tribal 
organization 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)(2)(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, Indian tribe, or tribal 
organization 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, Indian tribe, or tribal 
organization 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, Indian tribe, or 
tribal organization 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, Indian tribe, or tribal 
organization to which an amount is paid under this section 
shall not use the amount to supplant the expenditure of any 
State or tribal 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, Indian tribe, or tribal 
organization 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, Indian tribe, or tribal organization 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)(2)(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)(2)(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)(2)(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 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 Committee on 
Health, Education, Labor, and Pensions and the Special 
Committee on Aging of the Senate and the Committee on Energy 
and Commerce and the Committee on Education and Workforce of 
the House of Representatives a written report outlining how the 
grant recipients have used the grants made under this section 
during the period covered by the report, which shall include--
``(A) the total amount expended by each State, 
Indian tribe, or tribal organization for each type of 
use described in paragraph (1) or (2) of subsection 
(b);
``(B) the total number of non-State or non-tribal 
organizations in each State, Indian tribe, or tribal 
organization to which grant funds were provided, and 
the amount so provided to each such non-State or non-
tribal organization;
``(C) the change in the number of individuals 
working in each job category described in subsection 
(f)(2)(A) in an eligible setting;
``(D) the average duration of employment for each 
such job category, by State, Indian tribe, or tribal 
organization;
``(E) the average annual wage of workers in each 
job category described in subsection (f)(2)(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)(2)(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 2026 through 2030 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;
``(v) is a licensed practical nurse or a licensed 
or certified social worker;
``(vi) is receiving training to be certified or 
licensed as such an aide, nurse, or social worker; or
``(vii) is any other direct care professional; 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 setting 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;
``(F) another long-term care setting; or
``(G) 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.''.

SEC. 235. CREDIT FOR CERTAIN HEALTH CARE PROFESSIONALS.

(a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 is amended by inserting after 
section 36 the following new section:

``SEC. 36A. CREDIT FOR CERTAIN HEALTH CARE PROFESSIONALS.

``(a) Allowance of Credit.--In the case of an individual who is a 
health care professional described in subsection (b) with respect to 
the taxable year, there shall be allowed a credit of $5,000 against the 
tax imposed by this subtitle for such taxable year.
``(b) Health Care Professionals Described.--A health care 
professional described in this subsection, with respect to any taxable 
year, is any individual who, at any time during such taxable year, is--
``(1) a practitioner, as defined in section 1842(b)(18)(C) 
of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), 
providing services for compensation as such practitioner in a 
long-term care setting,
``(2) a certified nursing assistant providing services for 
compensation as such assistant in a long-term care setting,
``(3) a licensed practical nurse, or registered 
professional nurse, providing services for compensation as such 
a nurse in a long-term care setting,
``(4) a home health aide providing services for 
compensation as such aide in a long-term care setting,
``(5) a personal or home care aide providing services for 
compensation as such aide in a long-term care setting, or
``(6) a direct care professional, who is not otherwise 
described in any of paragraphs (1) through (5), providing 
services for compensation as such professional in a long-term 
care setting.
``(c) Definitions.--For purposes of this section, the terms `direct 
care professional', `long-term care setting', and `personal or home 
care aide' have the meanings given such terms in section 3 of the Long-
Term Care Workforce Support Act.''.
(b) Conforming Amendments.--
(1) Section 6211(b)(4)(A) of the Internal Revenue Code of 
1986 is amended by inserting ``, 36A'' after ``36''.
(2) The table of section for subpart C of part IV of 
subchapter A of chapter 1 such Code is amended by amending by 
inserting after the item relating to section 36 the following 
new item:

``Sec. 36A. Credit for certain health care professionals.''.
(c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2024.

SEC. 236. DIRECT CARE PROFESSIONAL WORKFORCE EQUITY TECHNICAL 
ASSISTANCE CENTER.

(a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in consultation 
with the Secretary of Labor, the Administrator of the Centers for 
Medicare & Medicaid Services, and the heads of other entities as 
necessary, shall establish a national technical assistance center to--
(1) address inequities and disparities facing the direct 
care professional workforce; and
(2) ensure that long-term care settings are meeting the 
unique demographic, cultural, and linguistic needs of the 
community in which such settings are situated and the community 
of workers within such settings.
(b) Activities.--The Center may--
(1) maintain a centralized online hub of equity-focused 
direct care professional workforce resources;
(2) conduct studies and develop trainings and resources on 
the inequities facing direct care professionals and enhancing 
diversity, equity, inclusion, and accessibility among long-term 
care settings;
(3) develop equity-specific tools and resources to support 
State and local governments in building an equitable direct 
care professional workforce;
(4) design and inform interventions in the direct care 
professional workforce that reduce disparities and promote 
equity within the direct care professional workforce;
(5) convene experts in the direct care professional 
workforce, including direct care professionals, to develop 
equity-based resources; and
(6) collaborate with organizations representing people with 
disabilities, older individuals, people of color, women, 
immigrants, and LGBT communities, and others as determined by 
the Secretary.
(c) Reporting.--Not later than 2 years after the date of enactment 
of this Act, the Secretary shall provide to the appropriate committees 
of Congress an update on the activities and outcomes of the initiative 
under subsection (a).
(d) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated to the Secretary $10,000,000 
for each of fiscal years 2026 through 2030.

TITLE III--WORKFORCE LABOR PROTECTIONS

Subtitle A--Long-term Care Workforce Wage Theft Prevention and Wage 
Recovery Act

SEC. 301. DEFINITIONS.

In this subtitle:
(1) Administrator.--The term the ``Administrator'' means 
the Administrator of the Wage and Hour Division of the 
Department of Labor.
(2) Community partner.--The term ``community partner'' 
means any stakeholder with a commitment to enforcing wage and 
hour laws and preventing abuses of such laws, including any--
(A) State department of labor;
(B) attorney general of a State or other similar 
authorized official of a political subdivision thereof;
(C) law enforcement agency;
(D) consulate;
(E) employee or advocate of employees, including a 
labor organization, community- and faith-based 
organization, business association, disability 
organization, older individual organization, or 
nonprofit legal aid organization;
(F) academic institution that plans, coordinates, 
and implements programs and activities to prevent wage 
and hour violations and recover unpaid wages, damages, 
and penalties; or
(G) any municipal agency responsible for the 
enforcement of local wage and hour laws.
(3) Community partnership.--The term ``community 
partnership'' means a partnership between--
(A) a working group consisting of community 
partners; and
(B) the Department of Labor.
(4) Covered employee.--The term ``covered employee'' means 
a direct care professional working in a long-term care setting.
(5) Covered employer.--The term ``covered employer'' means 
an employer who employs covered employees to work in or provide 
services in a long-term care setting.
(6) Eligible entity.--The term ``eligible entity'' means an 
entity that is any of the following:
(A) A nonprofit organization, including such an 
organization that is a community-based organization, 
faith-based organization, disability organization, 
older individuals organization, or labor organization, 
that provides services and support to employees, 
including assisting such employees in recovering unpaid 
wages.
(B) An employer.
(C) A business association.
(D) An institution of higher education, as defined 
in section 101 of the Higher Education Act of 1965 (20 
U.S.C. 1001).
(E) A partnership between any of the entities 
described in subparagraphs (A) through (D).
(7) Secretary.--The term ``Secretary'' means the Secretary 
of Labor.
(8) Strategic enforcement.--The term ``strategic 
enforcement'' means the process by which the Secretary--
(A) targets highly noncompliant industries, as 
identified by the Secretary, using industry-specific 
structures to influence, and ultimately reform, 
networks of interconnected employers;
(B) analyzes regulatory regimes under which 
specific industries operate; and
(C) modifies the enforcement approach of such 
regulatory regimes in order to ensure the greatest 
impact.
(9) Wage and hour law.--The term ``wage and hour law'' 
means any Federal law enforced by the Wage and Hour Division of 
the Department of Labor, including any provision of this Act 
enforced by such division.
(10) Wage and hour violation.--The term ``wage and hour 
violation'' refers to any violation of a Federal law enforced 
by the Wage and Hour Division of the Department of Labor, 
including any provision of this Act enforced by such division.

SEC. 302. DIRECT CARE PROFESSIONAL WORKFORCE WAGE THEFT PREVENTION AND 
WAGE RECOVERY GRANT PROGRAM.

(a) In General.--The Secretary, acting through the Administrator, 
shall provide grants to eligible entities to assist such entities in 
enhancing the enforcement of wage and hour laws, in accordance with 
this section and consistent with the purposes of this Act.
(b) Grants.--A grant provided under this section shall be designed 
to--
(1) support an eligible entity in establishing and 
supporting the activities described in subsection (c)(1); and
(2) develop community partnerships to expand and improve 
cooperative efforts between enforcement agencies and members of 
the community to--
(A) prevent and reduce wage and hour violations; 
and
(B) assist covered employees in recovering back pay 
for any such violations.
(c) Use of Funds.--
(1) Permissible activities.--The grants described in this 
section shall assist eligible entities in establishing and 
supporting activities that include--
(A) disseminating information and conducting 
outreach and training to educate covered employees 
about their rights under wage and hour laws;
(B) conducting educational training for covered 
employers about their obligations under wage and hour 
laws;
(C) conducting orientations and trainings jointly 
with officials of the Wage and Hour Division of the 
Department of Labor;
(D) providing assistance to covered employees in 
filing claims of wage and hour violations;
(E) assisting enforcement agencies in conducting 
investigations, including in the collection of evidence 
and recovering back pay;
(F) monitoring compliance with wage and hour laws;
(G) performing joint visitations to worksites that 
violate wage and hour laws with officials from the Wage 
and Hour Division of the Department of Labor;
(H) establishing networks for education, 
communication, and participation in the workplace and 
community;
(I) evaluating the effectiveness of programs 
designed to prevent wage and hour violations and 
enforce wage and hour laws;
(J) recruiting and hiring of staff and volunteers;
(K) production and dissemination of outreach and 
training materials;
(L) creation of a phone, short message service, 
web, or other technology-based communication for 
reporting covered employee emergencies, wage theft, or 
labor violations, seeking emergency services, or 
seeking support or guidance in lieu of emergency 
services; and
(M) any other activities as the Secretary may 
reasonably prescribe through notice and comment 
rulemaking.
(2) Prohibited activities.--Notwithstanding paragraph (1), 
an eligible entity receiving a grant under this section may not 
use the grant funds for any purpose reasonably prohibited by 
the Secretary through notice and comment rulemaking.
(d) Term of Grants.--Each grant made under this section shall be 
available for expenditure for a period that is not to exceed 3 years.
(e) Applications.--
(1) In general.--An eligible entity seeking a grant under 
this section shall submit an application for such grant to the 
Secretary in accordance with this subsection.
(2) Partnerships.--In the case of an eligible entity that 
is a partnership described in section 301(4)(E), the eligible 
entity may submit a joint application that designates a single 
entity as the lead entity for purposes of receiving and 
disbursing funds.
(3) Contents.--An application under this subsection shall 
include--
(A) a description of a plan for the program that 
the eligible entity proposes to carry out with a grant 
under this section, including a long-term strategy and 
detailed implementation plan that reflects expected 
participation of, and partnership with, community 
partners;
(B) information on the prevalence of wage and hour 
violations in each community or State of the eligible 
entity;
(C) information on any industry or geographic area 
targeted by the plan for such program;
(D) information on the type of outreach and 
relationship building that will be conducted under such 
program;
(E) information on the training and education that 
will be provided to covered employees and covered 
employers under such program; and
(F) the method by which the eligible entity will 
measure results of such program.
(f) Selection.--
(1) Competitive basis.--In accordance with this subsection, 
the Secretary shall, on a competitive basis, select grant 
recipients from among eligible entities that have submitted an 
application under subsection (e).
(2) Priority.--In selecting grant recipients under 
paragraph (1), the Secretary shall give priority to eligible 
entities that--
(A) serve covered employees in the long-term care 
industry or geographic area that is most highly at risk 
for noncompliance with wage and hour violations, as 
identified by the Secretary; and
(B) demonstrate past and ongoing work to prevent 
wage and hour violations or to recover unpaid wages.
(3) Other considerations.--In selecting grant recipients 
under paragraph (1), the Secretary shall also consider--
(A) the prevalence of ongoing community support for 
each eligible entity, including financial and other 
contributions; and
(B) the eligible entity's past and ongoing 
partnerships with other organizations.
(g) Memoranda of Understanding.--
(1) In general.--Not later than 60 days after receiving a 
grant under this section, the grant recipient shall negotiate 
and finalize with the Secretary a memorandum of understanding 
that sets forth specific goals, objectives, strategies, and 
activities that will be carried out under the grant by such 
recipient through a community partnership.
(2) Signatures.--A representative of the grant recipient 
(or, in the case of a grant recipient that is an eligible 
entity described in section 301(4)(E), a representative of each 
entity that composes the grant recipient) and the Secretary 
shall sign the memorandum of understanding under this 
subsection.
(3) Revisions.--The memorandum of understanding under this 
subsection shall be reviewed and revised by the grant recipient 
and the Secretary each year of the duration of the grant.
(h) Performance Evaluations.--
(1) In general.--Each grant recipient under this section 
shall develop procedures for reporting, monitoring, measuring, 
and evaluating the activities of each program or project funded 
under this section.
(2) Guidelines.--The procedures required under paragraph 
(1) shall be in accordance with guidelines established by the 
Secretary.
(i) Revocation or Suspension of Funding.--If the Secretary 
determines that a recipient of a grant under this section is not in 
compliance with the terms and requirements of the memorandum of 
understanding under subsection (g), the Secretary may revoke or suspend 
(in whole or in part) the funding of the grant.
(j) Use of Components.--
(1) In general.--In addition to the Wage and Hour Division, 
the Secretary (acting through the Administrator) may use any 
division or agency of the Department of Labor in carrying out 
this subtitle.
(2) Consultation with hhs.--The Secretary may consult with 
the Secretary of Health and Human Services (acting through the 
Administrator for Community Living) to carry out this subtitle.
(k) Evaluation.--The Secretary of Health and Human Services, in 
conjunction with the Secretary of Labor, shall evaluate the 
implementation and outcomes of this section on the occurrence of wage 
and hour violations through a contract with an external evaluator who 
has experience with evaluation of labor regulations and long-term care 
services.
(l) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this subtitle $50,000,000 for each of fiscal 
years 2026 through 2030, to remain available until expended.

Subtitle B--Direct Care Professional Rights

SEC. 311. DEFINITIONS.

(a) Fair Labor Standards Act Definitions.--In this subtitle--
(1) the terms ``enterprise'', ``enterprise engaged in 
commerce or in the production of goods for commerce'', and 
``person'' have the meanings given such terms in section 3 of 
the Fair Labor Standards Act of 1938 (29 U.S.C. 203); and
(2) the term ``regular rate'' has the meaning given such 
term in section 7(e) of such Act (29 U.S.C. 207(e)).
(b) Other Definitions.--In this subtitle:
(1) Child.--The term ``child''--
(A) means an individual who is under 18 years of 
age; and
(B) includes an individual described in 
subparagraph (A) who is--
(i) a biological, foster, or adopted child;
(ii) a stepchild;
(iii) a child of a domestic partner;
(iv) a legal ward; or
(v) a child of a person standing in loco 
parentis.
(2) Covered entity.--The term ``covered entity''--
(A) means any person or agency who provides 
compensation directly or indirectly to a direct care 
professional for the performance of long-term care 
services; and
(B) includes--
(i) a person acting directly or indirectly 
in the interest of the entity in relation to a 
direct care professional;
(ii) an employer of a direct care 
professional; and
(iii) an agency that contracts with an 
agency to provide direct care professionals.
(3) Medicaid hcbs-eligible older individual.--The term 
``Medicaid HCBS-eligible older individual'' means an individual 
who--
(A) is 60 years of age or older; and
(B) is eligible for and enrolled for medical 
assistance for any of the following services (whether 
provided on a fee-for-service, risk, or other basis) 
under a State Medicaid program, and includes an 
individual who becomes eligible for medical assistance 
under a State Medicaid program when removed from a 
waiting list:
(i) Home health care services authorized 
under paragraph (7) of section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)).
(ii) Personal care services authorized 
under paragraph (24) of such section.
(iii) PACE services authorized under 
paragraph (26) of such section.
(iv) Home and community-based services 
authorized under subsections (b), (c), (i), 
(j), and (k) of section 1915 of such Act (42 
U.S.C. 1396n), such services authorized under a 
waiver under section 1115 of such Act (42 
U.S.C. 1315), and such services provided 
through coverage authorized under section 1937 
of such Act (42 U.S.C. 1396u-7).
(v) Case management services authorized 
under section 1905(a)(19) of the Social 
Security Act (42 U.S.C. 1396d(a)(19)) and 
section 1915(g) of such Act (42 U.S.C. 
1396n(g)).
(vi) Rehabilitative services, including 
those related to behavioral health, described 
in section 1905(a)(13) of such Act (42 U.S.C. 
1396d(a)(13)).
(vii) Such other services specified by the 
Secretary of Health and Human Services.
(4) On-call shift.--The term ``on-call shift'' means any 
time a covered entity expects a direct care professional to--
(A) be available to work; and
(B) wait to contact, or be contacted by, the 
covered entity, or a designee of the entity, to 
determine whether the direct care professional shall 
report to work during such time.
(5) Parent.--The term ``parent'', with respect to a direct 
care professional, means--
(A) a biological, foster, or adoptive parent of a 
direct care professional;
(B) a stepparent of a direct care professional;
(C) parent-in-law of a direct care professional;
(D) parent of a domestic partner of a direct care 
professional; or
(E) a legal guardian or other person who stood in 
loco parentis to the direct care professional when the 
worker was a child.
(6) Secretary.--The term ``Secretary'' means the Secretary 
of Labor.
(7) Shared living arrangement.--The term ``shared living 
arrangement'' means a living arrangement involving--
(A) not more than 2 individuals who are a person 
with a disability or a Medicaid HCBS-eligible older 
individual, except if 1 or more of the individuals are 
related to each other (by blood or a close association 
that is equivalent to a family relationship);
(B) an individual providing services for 
compensation and living in the private home of the 
recipient of such services;
(C) an individual receiving funding through a State 
Medicaid program or another publicly funded program;
(D) a stipend or room and board as the primary form 
of payment for the individual providing such services; 
and
(E) the individual receiving such services having 
the final decision regarding who is the provider of 
such services living with the individual, through a 
consumer-driven matching process that includes 
relationship building, person-centered planning as 
defined by the Administrator of the Centers for 
Medicare & Medicaid Services, and an assessment of 
individual compatibility.
(8) Spouse.--The term ``spouse'' has the meaning given such 
term by the marriage laws of the State in which the marriage 
was celebrated.

SEC. 312. WRITTEN AGREEMENTS.

(a) Covered Direct Care Professional.--In this section, the term 
``covered direct care professional'' means any direct care professional 
to whom the covered entity expects to provide compensation for the 
performance of long-term care services by the covered direct care 
professional for not less than 8 hours per week.
(b) Requirement.--Each covered entity shall provide a written 
agreement in accordance with this section to each covered direct care 
professional who is provided compensation, directly or indirectly, by 
the covered entity for the performance of long-term care services.
(c) Written Agreement Requirements.--
(1) In general.--A written agreement required under this 
section shall--
(A) be signed and dated by the covered direct care 
professional and the covered entity;
(B) be written in a language easily and fully 
understood by the covered direct care professional and 
the covered entity, which may be in multiple languages 
if the covered direct care professional and the entity 
do not easily and fully understand the same language; 
and
(C) include the contents described in subsection 
(d).
(2) Copy.--A copy of the written agreement required under 
this section shall be provided to the covered direct care 
professional not later than 5 calendar days after the date on 
which the covered direct care professional is hired by the 
covered entity.
(d) Contents of the Written Agreement.--
(1) In general.--The contents described in this subsection 
shall include each of the following:
(A) The full name, address, and contact information 
of the covered entity, including, as appropriate, any 
``doing business as'' name of the entity and the name 
of each individual of the entity who will be doing 
business with the covered direct care professional.
(B) The address for the location where the covered 
direct care professional will be providing long-term 
care services for the covered entity.
(C) All responsibilities to be performed by the 
covered direct care professional for the covered 
entity, and the regularity in which such 
responsibilities are to be performed.
(D) The regular rate of pay of the covered direct 
care professional for any work week, including any 
overtime compensation due.
(E) The day of the week when the covered direct 
care professional will be paid.
(F) The required working hours for any work week, 
including--
(i) the time of day and day of week the 
work of the covered direct care professional 
begins;
(ii) meal and rest breaks described in 
section 316;
(iii) time off;
(iv) the work schedule of the covered 
direct care professional at the time of hire, 
including--
(I) the time of day and the days of 
the week the covered direct care 
professional will be expected to work 
each week for the covered entity; or
(II) if the time of day or the days 
of the week that the covered direct 
care professional will be expected to 
work for the covered entity will vary 
from week to week, information 
regarding a good faith estimate of the 
days and hours for which the covered 
direct care professional will be 
expected to work for the entity each 
week, including, at minimum--
(aa) the average number of 
hours the covered direct care 
professional will be expected 
to work for the entity each 
week during a typical 90-day 
period;
(bb) whether the covered 
direct care professional can 
expect to work any on-call 
shifts for the entity;
(cc) a subset of days the 
covered direct care 
professional can typically 
expect to work (or to be 
scheduled as off from work) for 
the entity; and
(dd) the amount of notice 
that the entity will provide to 
the covered direct care 
professional in advance of 
scheduled work hours (as 
defined in section 313(a)), 
which shall not be less than 72 
hours before such scheduled 
work hours are to begin (except 
during a period described in 
subparagraph (A) of section 
313(e)(1), in a case described 
in subparagraph (B) of such 
section, or in the case of a 
shared living arrangement), and 
the manner in which such notice 
shall be provided;
(v) the reporting time pay policy described 
in section 313(c); and
(vi) the right to request and receive a 
change to scheduled work hours due to personal 
events as described in section 314.
(G) If applicable, any policies of the covered 
entity with respect to the covered direct care 
professional for paying for or providing reimbursement 
for--
(i) health insurance;
(ii) transportation, meals, or lodging; and
(iii) any fees or costs associated with the 
long-term care services provided by the covered 
direct care professional for the entity.
(H) If applicable, any policies of the covered 
entity with respect to the covered direct care 
professional for--
(i) annual or other pay increases;
(ii) severance pay; and
(iii) providing materials or equipment 
related to the performance of long-term care 
services by the covered direct care 
professional, including (if applicable) any 
cleaning supplies provided by the entity.
(I) Information about policies, procedures, and 
equipment related to safety and emergencies.
(J) The policy of the covered entity pertaining to 
notice of termination of the covered direct care 
professional by the entity.
(K) In the case of a covered direct care 
professional who resides in the household of the person 
for whom the covered direct care professional provides 
long-term care services--
(i) the circumstances under which the 
covered entity may enter the designated living 
space of the covered direct care professional;
(ii) the circumstances under which the 
covered direct care professional, in a shared 
living arrangement, may enter the designated 
living space of the covered entity; and
(iii) a description of certain 
circumstances the covered entity determines as 
cause for--
(I) immediate termination of the 
covered direct care professional; and
(II) removal of the covered direct 
care professional from the household of 
the person for whom the covered direct 
care professional provides long-term 
care services not later than 48 hours 
after notice of the termination.
(L) Any additional benefits afforded to the covered 
direct care professional by the covered entity.
(M) The process for the covered direct care 
professional to raise or address grievances with 
respect to, or breaches of, the written agreement.
(N) The process used by the covered entity to 
change any policy described in subparagraphs (A) 
through (M), including addressing additional 
compensation if responsibilities are added to those 
described in subparagraph (C), after the date on which 
the written agreement is provided to the covered direct 
care professional.
(2) Prohibitions.--A written agreement required under this 
section may not--
(A) contain--
(i) a mandatory pre-dispute arbitration 
agreement for claims made by a covered direct 
care professional against a covered entity 
regarding the legal rights of the covered 
direct care professional; or
(ii) a nondisclosure agreement or 
noncompete agreement limiting the ability of 
the covered direct care professional to seek 
compensation for performing long-term care 
services after the covered direct care 
professional ceases to receive compensation 
from the covered entity for the performance of 
long-term care services; and
(B) be construed to waive the rights or protections 
of a covered direct care professional under Federal, 
State, or local law.
(e) Timing.--
(1) Initial agreement.--A covered entity shall provide a 
written agreement required under this section--
(A) to each covered direct care professional hired 
after the date of enactment of this Act, prior to the 
first day the covered direct care professional performs 
long-term care services for the entity; and
(B) to each covered direct care professional hired 
on or prior to the date of enactment of this Act, 90 
days after such date of enactment.
(2) Subsequent agreements.--Not later than 30 calendar days 
after the date on which a covered entity makes a change to a 
written agreement provided to a covered direct care 
professional under this section, the entity shall provide the 
covered direct care professional with an updated agreement in 
accordance with this section.
(f) Records.--A covered entity that is required to provide a 
written agreement under this section to a covered direct care 
professional shall retain such agreement for a period of not less than 
3 years from the date on which the covered direct care professional is 
no longer working for the entity.
(g) Model Written Agreements.--
(1) In general.--Not later than 6 months after the date of 
enactment of this Act, the Secretary shall establish and make 
available templates for model written agreements under this 
section.
(2) Requirements.--A model written agreement required under 
paragraph (1) shall--
(A) be available in multiple languages commonly 
understood by covered direct care professionals, 
including all languages in which the Secretary, acting 
through the Administrator of the Wage and Hour 
Division, translates the basic information fact sheet 
published by the Administrator; and
(B) not include any agreement described in 
subsection (d)(2)(A).

SEC. 313. FAIR SCHEDULING PRACTICES.

(a) Definitions.--In this section:
(1) Covered direct care professional.--The term ``covered 
direct care professional'' has the meaning given the term in 
section 312(a).
(2) Scheduled work hours.--The term ``scheduled work 
hours'' means the hours on a specified day during which a 
direct care professional is, through a written agreement or 
schedule, required by a covered entity to perform long-term 
care services for the entity and for which the direct care 
professional will receive compensation for such services.
(b) Requirement for Notice of Covered Direct Care Professional.--In 
the case of a covered direct care professional, the covered entity 
shall provide the covered direct care professional notice of the 
scheduled work hours of such covered direct care professional through--
(1) a written agreement described in subclause (I) of 
section 312(d)(1)(F)(iv) regarding a schedule of the time of 
day and the days of the week the covered direct care 
professional is expected to work for the covered entity each 
week; or
(2) a schedule agreed upon by the covered entity and the 
covered direct care professional provided in the amount of time 
specified in accordance with a written agreement described in 
subclause (II) of such section, regarding a good faith estimate 
of the time of day and the days of the week that the covered 
direct care professional is expected to work for the entity.
(c) Requirements for Changes to Scheduled Work Hours and Reporting 
Time Pay.--A covered entity shall--
(1) communicate in writing (which may be in an electronic 
form) any change to the scheduled work hours of a direct care 
professional, including any on-call shifts, not less than 72 
hours before the direct care professional is scheduled to begin 
work; and
(2) pay a direct care professional--
(A) the regular rate of pay of the direct care 
professional for any scheduled work hours the direct 
care professional does not work due to the covered 
entity canceling or reducing the scheduled work hours 
of the direct care professional after the direct care 
professional arrives to work for the scheduled work 
hours; or
(B) at a rate of \1/2\ of the regular rate of pay 
of the direct care professional for any scheduled work 
hours the direct care professional does not work due to 
the covered entity canceling or reducing the scheduled 
work hours of the direct care professional at a time 
that is less than 72 hours prior to the commencement of 
such scheduled work hours, unless the entity--
(i) is an individual with a disability 
relying on the direct care professional for 
disability supports and services (or an entity 
supporting an individual with a disability); 
and
(ii) requests the direct care professional 
to consent to work alternative, equivalent 
scheduled work hours within a 7-day period and 
the direct care professional consents to work 
such alternative, equivalent hours.
(d) Right To Decline Schedule Changes.--
(1) In general.--In the case of a covered direct care 
professional, if a covered entity wishes to include work hours 
in the scheduled work hours of such covered direct care 
professional that are identified as hours in which the covered 
direct care professional can typically expect to be scheduled 
as off from work in accordance with the written agreement under 
section 312(d)(1)(F)(iv)(I) or are identified as hours outside 
of the good faith estimate under section 
312(d)(1)(F)(iv)(II)(cc), the hiring entity shall obtain the 
written consent of the worker to work such hours prior to the 
commencement of such work.
(2) Consent.--The consent required under paragraph (1) may 
be transmitted electronically to the covered entity.
(e) Exceptions.--
(1) In general.--Notwithstanding any provision in this 
section, the requirements under subsection (c) shall not 
apply--
(A) during any period in which the operations of 
the covered entity cannot begin or continue due to--
(i) a fire, flood, or other natural 
disaster;
(ii) a major disaster or emergency declared 
by the President under section 401 or 501, 
respectively, of the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act 
(42 U.S.C. 5170, 5191) or a state of emergency 
declared by a Governor of a State or chief 
official of a unit of local government; or
(iii) a severe weather condition that poses 
a threat to worker safety; or
(B) in a case in which--
(i) the direct care professional 
voluntarily requested in writing a change to 
the scheduled work hours of the direct care 
professional; or
(ii) the covered entity changes the 
scheduled work hours of a direct care 
professional due to--
(I) a medical emergency requiring 
emergency medical treatment or 
hospitalization;
(II) the risk of contagion or a 
quarantine requirement related to a 
public health emergency declared by the 
Secretary of Health and Human Services 
under section 319 of the Public Health 
Service Act (42 U.S.C. 247d); or
(III) necessary coverage for an 
individual if the health and safety of 
that individual would be compromised if 
the direct care professional did not 
stay to provide support.
(2) Shared living arrangement.--Notwithstanding any 
provision in this section, the requirements under this section 
shall not apply to a shared living arrangement.
(f) Effective Date.--This section shall take effect on the date 
that is 2 years after the date of enactment of this Act.

SEC. 314. RIGHT TO REQUEST AND RECEIVE TEMPORARY CHANGES TO SCHEDULED 
WORK HOURS DUE TO PERSONAL EVENTS.

(a) Definitions.--In this section:
(1) Covered direct care professional.--The term ``covered 
direct care professional'' has the meaning given the term in 
section 312(a).
(2) Domestic violence.--The term ``domestic violence'' has 
the meaning given the term in section 331.
(3) Personal event.--The term ``personal event'', with 
respect to a covered direct care professional, means--
(A) an event resulting in the need of the covered 
direct care professional to serve as a caregiver for an 
individual related to the covered direct care 
professional by blood or affinity or whose close 
association with the covered direct care professional 
is the equivalent of a family relationship;
(B) an event resulting from the obligation of a 
covered direct care professional to attend a legal 
proceeding or hearing for subsistence benefits, 
including benefits under the supplemental nutrition 
assistance program established under the Food and 
Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) or under 
a State program for temporary assistance for needy 
families established under part A of title IV of the 
Social Security Act (42 U.S.C. 601 et seq.), to which 
the covered direct care professional, or an individual 
related to the covered direct care professional as 
described in subparagraph (A), is a party or witness; 
or
(C) any circumstance that would constitute a basis 
for permissible use of safe time, or family, medical, 
or sick leave, as determined based on the policy of the 
covered entity.
(4) Safe time.--The term ``safe time'', with respect to a 
covered direct care professional, means an absence from work of 
the covered direct care professional resulting from domestic 
violence, sexual assault, or stalking, if the absence is to--
(A) seek medical attention for the covered direct 
care professional or a child, parent, spouse, or 
domestic partner of the covered direct care 
professional, or any other individual related to the 
covered direct care professional by blood or affinity 
whose close association with the covered direct care 
professional is the equivalent of a family 
relationship, in order to recover from physical or 
psychological injury or disability caused by domestic 
violence, sexual assault, or stalking;
(B) obtain, or assist a child, parent, spouse, 
domestic partner, or other individual described in 
subparagraph (A) in obtaining, services from a victim 
services organization;
(C) obtain, or assist a child, parent, spouse, 
domestic partner, or other individual described in 
subparagraph (A) in obtaining, psychological or other 
counseling;
(D) seek relocation for the covered direct care 
professional or a child, parent, spouse, domestic 
partner, or other individual described in subparagraph 
(A); or
(E) take legal action, including preparing for or 
participating in any civil or criminal legal proceeding 
related to or resulting from domestic violence, sexual 
assault, or stalking, of the covered direct care 
professional or a child, parent, spouse, domestic 
partner, or other individual described in subparagraph 
(A).
(5) Scheduled work hours.--The term ``scheduled work 
hours'' has the meaning given such term in section 313(a), 
except that references in such section to the term ``direct 
care professional'' shall be deemed to be a reference to the 
term ``covered direct care professional''.
(6) Sexual assault; stalking.--The terms ``sexual assault'' 
and ``stalking'' have the meanings given such terms in section 
331.
(7) Temporary change.--The term ``temporary change'', with 
respect to a change in the scheduled work hours of a covered 
direct care professional, means a limited alteration in the 
hours or dates that, or locations where, a covered direct care 
professional is scheduled to work, including through using paid 
time off, trading or shifting work hours, or using short-term 
unpaid leave.
(b) Request.--
(1) In general.--In accordance with this subsection, for 
each calendar year, a covered entity shall, upon request of a 
covered direct care professional, grant to the covered direct 
care professional not less than--
(A) 2 requests for a temporary change, covering not 
more than 1 business day per request, to the scheduled 
work hours of the covered direct care professional due 
to a personal event; or
(B) 1 request for a temporary change, covering not 
more than 2 business days, to the scheduled work hours 
of the covered direct care professional due to a 
personal event.
(2) Notification of request.--
(A) In general.--A covered direct care professional 
who requests a temporary change to the scheduled work 
hours of the covered direct care professional due to a 
personal event under this subsection shall--
(i) notify the covered entity, or direct 
supervisor, of such covered direct care 
professional, as soon as the covered direct 
care professional becomes aware of the need for 
the temporary change and inform the entity or 
supervisor that the change is due to a personal 
event;
(ii) make a proposal for the temporary 
change to the scheduled work hours of the 
covered direct care professional, unless the 
covered direct care professional seeks leave 
without pay; and
(iii) subject to subparagraph (B), not be 
required to initially submit the request in 
writing.
(B) Written record.--
(i) In general.--A covered direct care 
professional that requests a temporary change 
to the scheduled work hours of the covered 
direct care professional under this subsection 
and does not initially submit a request for 
such change in writing shall, as soon as 
practicable and not later than 2 business days 
after date on which the covered direct care 
professional returns to work following the 
conclusion of the temporary change to the 
scheduled work hours, submit a written record 
of such request indicating--
(I) the date for which the change 
was requested; and
(II) that the request was made due 
to a personal event.
(ii) Electronic means.--A covered entity 
may require that a record under this 
subparagraph be submitted in electronic form if 
covered direct care professionals of the entity 
commonly use an electronic form to request and 
manage leave and schedule changes.
(c) Response.--A covered entity who receives a request under 
subsection (b) for a temporary change to the scheduled work hours of a 
covered direct care professional due to a personal event shall respond 
as soon as practicable. Such entity shall not be initially required to 
respond to such request in writing. If such entity does not initially 
respond to the requested schedule change in writing, the entity shall, 
as soon as practicable and not later than 1 week after the requested 
schedule change, provide the direct care professional with a written 
record of the response to the requested schedule change.
(d) Effective Date.--This section shall take effect on the date 
that is 2 years after the date of enactment of this Act.

SEC. 315. PRIVACY.

(a) In General.--A covered entity shall not--
(1) monitor or record a direct care professional while such 
direct care professional is--
(A) using restroom or bathing facilities;
(B) in the private living quarters of the direct 
care professional; or
(C) engaging in any activities associated with the 
dressing, undressing, or changing of clothes of the 
direct care professional;
(2) subject to subsection (b), restrict or interfere with, 
or monitor, the private communications of such direct care 
professional; or
(3) take possession of any documents or other personal 
effects of such direct care professional.
(b) Private Communications.--A covered entity may--
(1) permit the use of private communication in nonemergency 
situations, only as preapproved by each individual's person-
centered planning team;
(2) restrict, interfere with, or monitor the private 
communications of a direct care professional if the entity has 
a reasonable belief that such communications significantly 
interfere with the direct care professional's performance of 
expected duties or violate the conditions agreed upon in the 
individual's person-centered plan; and
(3) establish reasonable restrictions on the private 
communications of a direct care professional while such direct 
care professional is performing work for the entity.
(c) Relation to Other Laws.--This section shall not preclude 
liability under any other law.
(d) Definition of Private Communications.--In this section, the 
term ``private communications'' means any communication through 
telephone or internet services, including sending and receiving 
communications by text message, social media, electronic mail, and 
telephone, with an entity or individual other than the covered entity.

SEC. 316. BREAKS FOR MEALS AND REST.

(a) Meal Breaks.--
(1) In general.--Except as provided in subsection (c), a 
covered entity shall not require a direct care professional to 
work more than 5 hours for such hiring entity without an 
uninterrupted meal break of not less than 30 minutes. The 
number of hours worked by a direct care professional for 
purposes of this paragraph shall be calculated without regard 
to any rest break the direct care professional takes and to 
which the direct care professional has a right under subsection 
(b).
(2) Rate of pay.--A covered entity shall pay a direct care 
professional for a meal break under paragraph (1) at the 
regular rate of pay of the direct care professional, unless the 
direct care professional is relieved of all duty for not less 
than 30 minutes during the meal break and is permitted to leave 
the work site during such break.
(3) Paid meal break.--Except as provided in subsection (c), 
for any paid meal break required under paragraph (2), a covered 
entity--
(A) shall provide a reasonable opportunity for a 
direct care professional to take such break for a 
period of uninterrupted time that is not less than 30 
minutes; and
(B) shall not impede or discourage a direct care 
professional from taking such meal break.
(b) Rest Breaks.--
(1) In general.--Except as provided in subsection (c), for 
every 4 hours of work that a direct care professional is 
scheduled to perform for a covered entity, the entity shall 
allow the direct care professional a rest break of not less 
than 10 uninterrupted minutes in which the direct care 
professional is relieved of all duties related to providing 
long-term care services to the entity. The entity shall allow 
such rest break to occur during the first 3 hours of 
consecutive work performed by the direct care professional for 
the entity.
(2) Rate of pay.--A covered entity shall pay a direct care 
professional for the times spent by the direct care 
professional for a rest break under paragraph (1) at the 
regular rate of pay of the direct care professional. The hiring 
entity shall not impede or discourage a direct care 
professional from taking such break.
(c) Exceptions.--
(1) In general.--Subject to paragraphs (2) and (4), a 
covered entity may provide an on duty-meal break or on duty 
rest break, only in lieu of an uninterrupted meal or rest break 
otherwise required under subsection (a) or (b), and only in the 
case in which relieving the direct care professional of all 
duties would compromise the health or safety of the individual 
receiving care.
(2) On-duty breaks.--
(A) Definition of on-duty.--In this subsection, the 
term ``on-duty'', with respect to a meal break under 
subsection (a) or a rest break under subsection (b), 
means such a break in which the direct care 
professional--
(i) is not relieved of all duties of the 
direct care professional for the covered 
entity; and
(ii) may, to the extent possible given the 
duties of the direct care professional for the 
covered entity, engage in personal activities, 
such as resting, eating a meal, drinking a 
beverage, making a personal telephone call, or 
making other personal choices.
(B) Authorization.--
(i) In general.--In a case described in 
paragraph (1), the direct care professional may 
still take an on-duty meal or rest break under 
subsection (a) or (b), respectively, if--
(I) the nature of the work prevents 
a direct care professional from being 
relieved of all duties required of the 
direct care professional for the 
covered entity;
(II) the direct care professional 
and the covered entity agree to such an 
on-duty meal or rest break in a written 
agreement described in clause (ii); and
(III) the terms of such on-duty 
meal or rest break are consistent with 
the terms of an applicable collective 
bargaining agreement, if one exists.
(ii) Written agreement.--The written 
agreement under clause (i)--
(I) shall be voluntary and not a 
condition of hire, continued 
employment, scheduling, or assignment;
(II) shall not waive, reduce, or 
conflict with any rights provided under 
a collective bargaining agreement 
applicable to the direct care 
professional or applicable State or 
local law; and
(III) shall be separately executed 
and not incorporated into a general 
employment agreement.
(iii) Revokability.--A direct care 
professional may revoke an agreement under 
clause (i) at any time without prior notice to 
the covered entity.
(3) Shared living arrangement.--The requirements under this 
section shall not apply in the case of a shared living 
arrangement.
(4) Rule of construction.--Nothing in this subsection shall 
be construed to--
(A) supersede, preempt, or waive any provision of 
State or local law that provides meal or rest period 
protections that are equal to or greater than the 
protections provided under this section; or
(B) permit a deviation from requirements of this 
section except pursuant to a collective bargaining 
agreement that expressly addresses meal and rest 
periods and provides protections that are equal to or 
greater than those provided under this section.

SEC. 317. PROHIBITED ACTS.

(a) Interference With Rights.--It shall be unlawful for any person 
to interfere with, restrain, or deny the exercise of, or the attempt to 
exercise, any right provided under this subtitle, including--
(1) discharging or in any manner discriminating against 
(including retaliating against) any direct care professional 
for--
(A) exercising, or attempting to exercise, any 
right provided under this subtitle; or
(B) engaging in concerted activities for the 
purpose of collective bargaining or mutual aid or 
protection, regardless of whether such activities are 
with direct care professionals of different employers 
or direct care professionals at different worksites; 
and
(2) discriminating against any direct care professional by 
using the exercise of a right provided under this subtitle as a 
negative factor in an employment action, such as an action 
involving hiring, promotion, or changing work hours or number 
of shifts, or a disciplinary action.
(b) Retaliation Protection.--It shall be unlawful for any covered 
entity to discharge, demote, suspend, reduce the work hours of, take 
any other adverse employment action against, threaten to take an 
adverse employment action against, or in any other manner discriminate 
against a direct care professional with respect to compensation, terms, 
conditions, or privileges of employment because the direct care 
professional (or any person acting pursuant to the request of the 
direct care professional), whether at the initiative of the direct care 
professional or in the ordinary course of the direct care 
professional's duties--
(1) opposes any practice made unlawful under this subtitle;
(2) asserts any claim or right under this subtitle;
(3) assists a direct care professional in asserting such 
claim or right;
(4) informs any direct care professional about this 
subtitle;
(5) requests a change to the written agreement described in 
section 312;
(6) requests a change in scheduled work hours described in 
section 314, or any other schedule change, without regard to 
the eligibility of such direct care professional to receive any 
such change;
(7)(A) files an action, or institutes or causes to be 
instituted any proceeding, under or related to this subtitle;
(B) gives, or is about to give, any information in 
connection with any inquiry or proceeding relating to any right 
provided under this subtitle; or
(C) testifies, or is about to testify, in any inquiry or 
proceeding relating to any right provided under this subtitle; 
and
(8) engages in concerted activities for the purpose of 
collective bargaining or mutual aid or protection, regardless 
of whether such activities are with direct care professionals 
of different employers or direct care professionals at 
different worksites.
(c) Immigration-Related Actions as Discrimination.--For purposes of 
subsections (a) and (b), discrimination with respect to compensation, 
terms, conditions, or privileges of employment occurs if a person 
undertakes any of the following activities (unless such activity is 
legal conduct undertaken at the express and specific direction or 
request of the Federal Government):
(1) Reporting, or threatening to report, the citizenship or 
immigration status of a direct care professional, or the 
suspected citizenship or immigration status of a family member 
of such an individual, to a Federal, State, or local agency.
(2) Requesting more or different documents than those 
required under section 274A(b) of the Immigration and 
Nationality Act (8 U.S.C. 1324a(b)), or refusing to honor 
documents that on their face appear to be genuine.
(3) Using the Federal E-Verify system to check employment 
status in a manner not required under section 274A(b) of the 
Immigration and Nationality Act (8 U.S.C. 1324a(b)) or any 
memorandum governing use of the E-Verify system.
(4) Filing, or threatening to file, a false police report 
relating to the immigration status of a direct care 
professional, or a family member of a direct care professional.
(5) Contacting, or threatening to contact, immigration 
authorities relating to the immigration status of a direct care 
professional, or a family member of a direct care professional.
(d) Presumption of Retaliation.--
(1) In general.--For the purposes of subsections (a) and 
(b), proof that a person discharged an individual, or 
discriminated against an individual with respect to 
compensation, terms, conditions, or privileges of employment, 
within 90 days of the individual involved asserting any claim 
or right under this subtitle, or assisting any other individual 
in asserting such a claim or right, shall raise a presumption 
that the discharge or discrimination was in retaliation as 
prohibited under subsection (a) or (b), as the case may be.
(2) Rebuttal.--The presumption under paragraph (1) may be 
rebutted by clear and convincing evidence that such discharge 
or discrimination was taken for another permissible reason.

SEC. 318. ENFORCEMENT AUTHORITY.

(a) In General.--
(1) Application.--In this subsection--
(A) the term ``covered entity'' means a covered 
entity described in subsection (e)(1)(A); and
(B) the term ``direct care professional'' means a 
direct care professional described in subsection 
(e)(4)(A).
(2) Investigative authority.--
(A) In general.--To ensure compliance with the 
provisions of this subtitle, or any regulation or order 
issued under this subtitle, the Secretary shall have 
the investigative authority provided under section 
11(a) of the Fair Labor Standards Act of 1938 (29 
U.S.C. 211(a)), with respect to covered entities, 
direct care professionals, and other individuals 
affected.
(B) Obligation to keep and preserve records.--A 
covered entity shall make, keep, and preserve records 
pertaining to compliance with this subtitle in 
accordance with section 11(c) of the Fair Labor 
Standards Act of 1938 (29 U.S.C. 211(c)) and in 
accordance with regulations prescribed by the 
Secretary.
(C) Required submissions generally limited to an 
annual basis.--The Secretary shall not require under 
this paragraph a covered entity to submit to the 
Secretary any books or records more than once during 
any 12-month period, unless the Secretary--
(i) has reasonable cause to believe there 
may exist a violation of this subtitle, 
including any regulation or order issued under 
this subtitle; or
(ii) is investigating a charge under 
paragraph (4).
(D) Subpoena authority.--For the purposes of any 
investigation under this paragraph, the Secretary shall 
have the subpoena authority provided under section 9 of 
the Fair Labor Standards Act of 1938 (29 U.S.C. 209).
(3) Civil action by direct care professionals.--
(A) Right of action.--An action to recover the 
damages or equitable relief prescribed in subparagraph 
(B) may be maintained against a covered entity by one 
or more direct care professionals, or a representative 
for and on behalf of the direct care professionals and 
any other direct care professionals that may be 
similarly situated.
(B) Liability.--A covered entity that violates this 
subtitle shall be liable to a direct care professional 
aggrieved by the violation, except as provided in 
subparagraphs (C) and (D), for--
(i) damages equal to--
(I) the amount of--
(aa) any wages, salary, 
employment benefits, or other 
compensation denied or lost by 
reason of the violation; or
(bb) in a case in which 
wages, salary, employment 
benefits, or other compensation 
have not been denied or lost, 
any actual monetary losses 
sustained, or the costs 
reasonably related to damage to 
or loss of property, or any 
other injury to the person, 
reputation, character, or 
feelings, sustained by a direct 
care professional as a direct 
result of the violation, or any 
injury to another person 
sustained as a direct result of 
the violation, by the covered 
entity;
(II) the interest on the amount 
described in subclause (I) calculated 
at the prevailing rate;
(III) an additional amount as 
liquidated damages; and
(IV) such other legal relief as may 
be appropriate;
(ii) such equitable relief as may be 
appropriate, including employment, 
reinstatement, and promotion; and
(iii) a reasonable attorney's fee, 
reasonable expert witness fees, and other costs 
of the action.
(C) Meal and rest breaks.--In the case of a 
violation of section 316, the covered entity involved 
shall be liable under subparagraph (B)--
(i) for the amount of damages described in 
subclauses (I), (II), and (III) of subparagraph 
(B)(i); and
(ii) under subparagraph (B)(i)(IV), for 
each such violation, for an amount equal to 1 
hour of pay at the direct care professional's 
regular rate of compensation (but not more than 
2 hours of such pay for each workday for which 
the covered entity is in violation of such 
section).
(D) Written agreements.--In the case of a violation 
of section 312, the covered entity involved shall be 
liable, under subparagraph (B)(i)(I), for an amount 
equal to $5,000.
(E) Venue.--An action under this paragraph may be 
maintained in any Federal or State court of competent 
jurisdiction.
(4) Action by the secretary.--
(A) Administrative action.--
(i) In general.--Subject to clause (ii), 
and subparagraphs (C) and (D) of paragraph (3), 
the Secretary shall receive, investigate, and 
attempt to resolve complaints of violations of 
this subtitle in the same manner that the 
Secretary receives, investigates, and attempts 
to resolve complaints of violations of sections 
6, 7, and 15(a)(3) of the Fair Labor Standards 
Act of 1938 (29 U.S.C. 206, 207, and 
215(a)(3)), including the Secretary's authority 
to supervise payment of wages and compensation 
under section 16(c) of the Fair Labor Standards 
Act of 1938 (29 U.S.C. 216(c)).
(ii) Violations generally.--The Secretary 
may assess a civil penalty against a covered 
entity that violates any section of this 
subtitle--
(I) of not more than $15,000 for 
any first violation of any such section 
by such covered entity; and
(II) of not more than $25,000 for 
any subsequent violation of any such 
section by such covered entity.
(B) Administrative review.--Any aggrieved direct 
care professional who takes exception to an order 
issued by the Secretary under subparagraph (A) may 
request review of and a decision regarding such order 
by an administrative law judge. In reviewing the order, 
the administrative law judge may hold an administrative 
hearing concerning the order, in accordance with the 
requirements of sections 554, 556, and 557 of title 5, 
United States Code. Such hearing shall be conducted 
expeditiously. If no aggrieved direct care professional 
requests such review within 60 days after the order is 
issued under subparagraph (A), the order shall be 
considered to be a final order that is not subject to 
judicial review.
(C) Civil action.--The Secretary may bring an 
action in any court of competent jurisdiction to 
recover amounts described in paragraph (3)(B) on behalf 
of a direct care professional aggrieved by a violation 
of this subtitle.
(D) Sums recovered.--
(i) In general.--Any sums recovered by the 
Secretary under subparagraph (C) shall be held 
in a special deposit account and shall be paid, 
on order of the Secretary, directly to each 
direct care professional aggrieved by the 
violation for which the action was brought. Any 
such sums not paid to a direct care 
professional because of inability to do so 
within a period of 3 years shall be deposited 
into the Treasury of the United States as a 
miscellaneous receipt.
(ii) Civil penalty.--Any sums recovered by 
the Secretary under subparagraph (A)(ii) shall 
be deposited into the general fund of the 
Treasury of the United States as a 
miscellaneous receipt.
(5) Limitation.--
(A) In general.--Except as provided in subparagraph 
(B), an action may be brought under paragraph (3), (4), 
or (6) not later than 2 years after the date of the 
last event constituting the alleged violation for which 
the action is brought.
(B) Willful violation.--In the case of an action 
brought for a willful violation of this subtitle, such 
action may be brought not later than 3 years after the 
date of the last event constituting the alleged 
violation for which such action is brought.
(C) Commencement.--An action shall be considered 
commenced under paragraph (3), (4), or (6) for the 
purposes of this paragraph on the date on which the 
complaint is filed under such paragraph (3), (4), or 
(6).
(6) Action for injunction.--The district courts of the 
United States together with the District Court of the Virgin 
Islands and the District Court of Guam shall have jurisdiction, 
for cause shown, in an action brought by a direct care 
professional or the Secretary--
(A) to restrain violations of this subtitle, 
including the withholding of a written agreement from a 
direct care professional as required under section 312, 
or of any withholding of payment of wages, salary, 
employment benefits, or other compensation, plus 
interest, found by the court to be due to a direct care 
professional under this subtitle; or
(B) to award such other equitable relief as may be 
appropriate, including employment, reinstatement, and 
promotion, for a violation of this subtitle.
(7) Solicitor of labor.--The Solicitor of Labor may appear 
for and represent the Secretary on any litigation brought under 
paragraph (4) or (6).
(8) Government accountability office and library of 
congress.--Notwithstanding any other provision of this 
subsection, in the case of the Government Accountability Office 
and the Library of Congress, the authority of the Secretary of 
Labor under this subsection shall be exercised respectively by 
the Comptroller General of the United States and the Librarian 
of Congress.
(b) Employees Covered by Congressional Accountability Act of 
1995.--The powers, remedies, and procedures provided in the 
Congressional Accountability Act of 1995 (2 U.S.C. 1301 et seq.) to the 
Board (as defined in section 101 of that Act (2 U.S.C. 1301)), or any 
person, alleging a violation of section 202(a)(1) of that Act (2 U.S.C. 
1312(a)(1)) shall be the powers, remedies, and procedures this Act 
provides to that Board, or any person, alleging an unlawful employment 
practice in violation of this subtitle against a direct care 
professional described in subsection (e)(4)(B).
(c) Employees Covered by Chapter 5 of Title 3, United States 
Code.--The powers, remedies, and procedures provided in chapter 5 of 
title 3, United States Code, to the President, the Merit Systems 
Protection Board, or any person, alleging a violation of section 
412(a)(1) of that title, shall be the powers, remedies, and procedures 
this Act provides to the President, that Board, or any person, 
respectively, alleging an unlawful employment practice in violation of 
this subtitle against a direct care professional described in 
subsection (e)(4)(C).
(d) Employees Covered by Chapter 63 Of Title 5, United States 
Code.--The powers, remedies, and procedures provided in title 5, United 
States Code, to an employing agency, provided in chapter 12 of that 
title to the Merit Systems Protection Board, or provided in that title 
to any person, alleging a violation of chapter 63 of that title, shall 
be the powers, remedies, and procedures this Act provides to that 
agency, that Board, or any person, respectively, alleging an unlawful 
employment practice in violation of this subtitle against a direct care 
professional described in subsection (e)(4)(D).
(e) Definition.--In section 317 and this section, except as 
otherwise provided in this subsection:
(1) Covered entity.--Notwithstanding section 311, the term 
``covered entity'' means a covered entity--
(A) as defined in section 311(b) except that a 
reference in that section to a person or an employer 
shall be considered to be a reference to an employer 
described in clause (i) or (ii) of subparagraph (A), 
and subparagraph (B), of paragraph (2);
(B) as defined in section 311(b) except that a 
reference in that section to a person or an employer 
shall be considered to be a reference to an employer 
described in subparagraphs (A)(iii) and (B) of 
paragraph (2);
(C) as defined in section 311(b) except that a 
reference in that section to a person or an employer 
shall be considered to be a reference to an employer 
described in subparagraphs (A)(iv) and (B) of paragraph 
(2); and
(D) as defined in section 311(b) except that a 
reference in that section to a person or an employer 
shall be considered to be a reference to an employer 
described in subparagraphs (A)(v) and (B) of paragraph 
(2).
(2) Employer.--Notwithstanding section 311, for purposes of 
paragraph (1), the term ``employer'' means a person who is--
(A)(i) any person who is not covered under another 
clause of this subparagraph;
(ii) an entity employing a State employee described 
in section 304(a) of the Government Employee Rights Act 
of 1991;
(iii) an employing office, as defined in section 
101 of the Congressional Accountability Act of 1995;
(iv) an employing office, as defined in section 
411(c) of title 3, United States Code; or
(v) an employing agency covered under subchapter V 
of chapter 63 of title 5, United States Code; and
(B) engaged in commerce or the production of goods 
for commerce or is an enterprise engaged in commerce or 
in the production of goods for commerce.
(3) Employment.--Notwithstanding section 3, the term 
``employment'' includes work as a direct care professional.
(4) Direct care professional.--Notwithstanding section 3, 
the term ``direct care professional'' means--
(A) direct care professional (as defined in such 
section) who is compensated for the performance of 
long-term care services by an entity described in 
paragraph (1)(A);
(B) direct care professional (as defined in such 
section) who is compensated for the performance of 
long-term care services by an entity described in 
paragraph (1)(B);
(C) direct care professional (as defined in such 
section) who is compensated for the performance of 
long-term care services by an entity described in 
paragraph (1)(C); and
(D) direct care professional (as defined in such 
section) who is compensated for the performance of 
long-term care services by an entity described in 
paragraph (1)(D).

SEC. 319. EFFECT ON EXISTING EMPLOYMENT BENEFITS AND OTHER LAWS.

(a) In General.--Nothing in this subtitle shall--
(1) supersede a provision in a collective bargaining 
agreement;
(2) be construed to diminish the obligation of a covered 
entity to comply with any contract, collective bargaining 
agreement, or employment benefit program or plan that provides 
greater rights or benefits to direct care professionals than 
the rights established under this subtitle; or
(3) be construed to discourage or prevent a covered entity 
from adopting a contract, collective bargaining agreement, or 
employment benefit program or plan that provides greater rights 
or benefits to direct care professionals than the rights 
established under this subtitle.
(b) Other Laws.--Nothing in this subtitle shall--
(1) affect the obligation of a covered entity to provide a 
reasonable accommodation in the form of a change to the work 
schedule of a direct care professional required under any other 
law, or to otherwise comply with any other law;
(2) preempt, limit, or otherwise affect the applicability 
of any State or local law that provides comparable or superior 
benefits for direct care professionals to the requirements 
under this subtitle; or
(3) diminish the rights, privileges, or remedies of any 
direct care professional under any Federal or State law or 
under any collective bargaining agreement.
(c) No Waivers.--The rights and remedies in this subtitle may not 
be waived by a direct care professional through any agreement, policy, 
or form, or as a condition of employment.

Subtitle C--Workplace Violence Prevention for Health Care and Social 
Services Workers Act

SEC. 321. WORKPLACE VIOLENCE PREVENTION STANDARD.

(a) Interim Final Standard.--
(1) In general.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Labor shall issue an 
interim final standard on workplace violence prevention--
(A) to require certain employers in the health care 
and social service sectors, and certain employers in 
sectors that conduct activities similar to the 
activities in the health care and social service 
sectors, to develop and implement a comprehensive 
workplace violence prevention plan and carry out other 
activities or requirements described in section 323 to 
protect health care workers, social service workers, 
and other personnel from workplace violence;
(B) that shall, at a minimum, be based on the 
Guidelines for Preventing Workplace Violence for 
Healthcare and Social Service Workers published by the 
Occupational Safety and Health Administration of the 
Department of Labor in 2015 and adhere to the 
requirements of this subtitle; and
(C) that provides for a period determined 
appropriate by the Secretary, not to exceed 1 year, 
during which the Secretary shall prioritize technical 
assistance and advice consistent with section 21(d) of 
the Occupational Safety and Health Act of 1970 (29 
U.S.C. 670(d)) to employers subject to the standard 
with respect to compliance with the standard.
(2) Inapplicable provisions of law and executive order.--
The following provisions of law and Executive orders shall not 
apply to the issuance of the interim final standard under this 
subsection:
(A) The requirements applicable to occupational 
safety and health standards under section 6(b) of the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 
655(b)).
(B) The requirements of chapters 5 and 6 of title 
5, United States Code.
(C) Subchapter I of chapter 35 of title 44, United 
States Code (commonly referred to as the ``Paperwork 
Reduction Act'').
(D) Executive Order No. 12866 (58 Fed. Reg. 51735; 
relating to regulatory planning and review), as 
amended.
(3) Notice and comment.--Notwithstanding paragraph (2)(B), 
the Secretary shall, prior to issuing the interim final 
standard under this subsection, provide notice in the Federal 
Register of the interim final standard and a 30-day period for 
public comment.
(4) Effective date of interim standard.--The interim final 
standard shall--
(A) take effect on a date that is not later than 30 
days after issuance, except that such interim final 
standard may include a reasonable phase-in period for 
the implementation of required engineering controls 
that take effect after such date;
(B) be enforced in the same manner and to the same 
extent as any standard promulgated under section 6(b) 
of the Occupational Safety and Health Act of 1970 (29 
U.S.C. 655(b)); and
(C) be in effect until the final standard described 
in subsection (b) becomes effective and enforceable.
(5) Failure to promulgate.--If an interim final standard 
described in paragraph (1) is not issued not later than 1 year 
of the date of enactment of this Act, the provisions of section 
323 shall be in effect and enforced in the same manner and to 
the same extent as any standard promulgated under section 6(b) 
of the Occupational Safety and Health Act of 1970 (29 U.S.C. 
655(b)) until such provisions are superseded in whole by an 
interim final standard issued by the Secretary that meets the 
requirements of paragraph (1).
(b) Final Standard.--
(1) Proposed standard.--Not later than 2 years after the 
date of enactment of this Act, the Secretary of Labor shall, 
pursuant to section 6 of the Occupational Safety and Health Act 
of 1970 (29 U.S.C. 655), promulgate a proposed standard on 
workplace violence prevention--
(A) for the purposes described in subsection 
(a)(1)(A); and
(B) that shall include, at a minimum, requirements 
contained in the interim final standard required under 
subsection (a).
(2) Final standard.--Not later than 42 months after the 
date of enactment of this Act, the Secretary shall issue a 
final standard on such proposed standard that shall--
(A) provide no less protection than any workplace 
violence standard adopted by a State plan that has been 
approved by the Secretary under section 18 of the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 
667), provided the Secretary finds that the final 
standard is feasible on the basis of the best available 
evidence; and
(B) be effective and enforceable in the same manner 
and to the same extent as any standard promulgated 
under section 6(b) of the Occupational Safety and 
Health Act of 1970 (29 U.S.C. 655(b)).

SEC. 322. SCOPE AND APPLICATION.

In this subtitle:
(1) Covered facility.--
(A) In general.--The term ``covered facility'' 
means the following:
(i) Any hospital, including any specialty 
hospital, in-patient or outpatient setting, or 
clinic operating within a hospital license, or 
any setting that provides outpatient services.
(ii) Any residential treatment facility, 
including any nursing home, skilled nursing 
facility, hospice facility, Alzheimer's and 
dementia care facility, or other long-term care 
facility.
(iii) Any nonresidential treatment or 
service setting.
(iv) Any medical treatment or social 
service setting or clinic at a correctional or 
detention facility.
(v) Any community care setting, including a 
community-based residential facility, group 
home, and mental health clinic.
(vi) Any psychiatric treatment facility.
(vii) Any drug abuse or substance use 
disorder treatment center.
(viii) Any independent freestanding 
emergency center.
(ix) Any assisted living facility.
(x) Any facility described in clauses (i) 
through (ix) operated by a Federal Government 
agency and required to comply with occupational 
safety and health standards pursuant to part 
1960 of title 29, Code of Federal Regulations 
(as such part is in effect on the date of 
enactment of this Act).
(xi) Any other facility the Secretary 
determines should be covered under the 
standards promulgated under section 321.
(B) Exclusion.--The term ``covered facility'' does 
not include an office of a physician, dentist, 
podiatrist, or any other health practitioner that is 
not physically located within a covered facility 
described in clauses (i) through (xi) of subparagraph 
(A).
(2) Covered services.--
(A) In general.--The term ``covered service'' means 
the following services and operations:
(i) Any services and operations provided in 
any field work setting, including home health 
care, home-based hospice, and home-based social 
work.
(ii) Any emergency services and transport, 
including such services provided by 
firefighters and emergency responders.
(iii) Any services described in clauses (i) 
and (ii) performed by a Federal Government 
agency and required to comply with occupational 
safety and health standards pursuant to part 
1960 of title 29, Code of Federal Regulations 
(as such part is in effect on the date of 
enactment of this Act).
(iv) Any other services and operations the 
Secretary determines should be covered under 
the standards promulgated under section 321.
(B) Exclusion.--The term ``covered service'' does 
not include child day care services.
(3) Covered employer.--
(A) In general.--The term ``covered employer'' 
includes a person (including a contractor, a 
subcontractor, a temporary service firm, or an employee 
leasing entity) that employs an individual to work at a 
covered facility or to perform covered services.
(B) Exclusion.--The term ``covered employer'' does 
not include an individual who privately employs, in the 
individual's residence, a person to perform covered 
services for the individual or a family member of the 
individual or an individual who receives home and 
community-based services through a self-directed or 
participant-directed Medicaid waiver.
(4) Covered employee.--The term ``covered employee'' 
includes an individual employed by a covered employer to work 
at a covered facility or to perform covered services.

SEC. 323. REQUIREMENTS FOR WORKPLACE VIOLENCE PREVENTION STANDARD.

Each standard described in section 321 shall include, at a minimum, 
the following:
(1) Workplace violence prevention plan.--Not later than 6 
months after the date of promulgation of the interim final 
standard under section 321(a), or 18 months after the date of 
enactment of this Act in a case described in section 321(a)(5), 
a covered employer shall develop, implement, and maintain an 
effective written workplace violence prevention plan (in this 
section referred to as the ``Plan'') for covered employees at 
each covered facility and for covered employees performing a 
covered service on behalf of such employer, which meets the 
following:
(A) Plan development.--Each Plan--
(i) shall be developed and implemented with 
the meaningful participation of direct care 
professionals, other employees, and employee 
representatives, for all aspects of the Plan;
(ii) shall be tailored and specific to 
conditions and hazards for the covered facility 
or the covered service, including patient-
specific risk factors and risk factors specific 
to each work area or unit;
(iii) shall include patient-centered, 
relationship-based, trauma-informed, recovery-
oriented practices that are evidence-based;
(iv) shall be suitable for the size, 
complexity, and type of operations at the 
covered facility or for the covered service, 
and remain in effect at all times; and
(v) may be in consultation with 
stakeholders or experts who specialize in 
workplace violence prevention, emergency 
response, or other related areas of expertise 
for all relevant aspects of the Plan.
(B) Plan content.--Each Plan shall include 
procedures and methods for the following:
(i) Identification of the individual 
(including the individual's role with respect 
to the covered employer) responsible for 
implementation of the Plan.
(ii) With respect to each work area and 
unit at the covered facility or while covered 
employees are performing the covered service, 
risk assessment and identification of workplace 
violence risks and hazards to employees exposed 
to such risks and hazards (including 
environmental risk factors and patient-specific 
risk factors), and protective factors 
associated with violence, which shall be--
(I) informed by past violent 
incidents specific to such covered 
facility or such covered service; and
(II) conducted with, at a minimum--
(aa) direct care 
professionals;
(bb) where applicable, the 
representatives of such 
workers; and
(cc) the employer.
(iii) Hazard prevention, engineering 
controls, or work practice controls to correct 
hazards, in a timely manner, applying 
industrial hygiene principles of the hierarchy 
of controls, which--
(I) may include security and alarm 
systems, adequate exit routes, 
monitoring systems, barrier protection, 
established areas for patients and 
clients, lighting, entry procedures, 
staffing and working in teams, and 
systems to identify and flag clients 
with a history of violence; and
(II) shall ensure that employers 
correct, in a timely manner, hazards 
identified in any violent incident 
investigation described in paragraph 
(2) and any annual report described in 
paragraph (5).
(iv) Reporting, incident response, and 
post-incident investigation procedures, 
including procedures--
(I) for employees to report 
workplace violence risks, hazards, and 
incidents;
(II) for employers to respond to 
reports of workplace violence;
(III) for employers to perform a 
post-incident investigation and 
debriefing of all reports of workplace 
violence with the participation of 
employees and their representatives;
(IV) to provide medical care or 
first aid to affected employees; and
(V) to provide employees with 
information about available trauma and 
related counseling.
(v) Procedures for emergency response, 
including procedures for threats of mass 
casualties and procedures for incidents 
involving a firearm or a dangerous weapon.
(vi) Procedures for communicating with and 
training the covered employees on workplace 
violence hazards, threats, and work practice 
controls, the employer's plan, and procedures 
for confronting, responding to, and reporting 
workplace violence threats, incidents, and 
concerns, and employee rights.
(vii) Procedures for--
(I) ensuring the coordination of 
risk assessment efforts, Plan 
development, and implementation of the 
Plan with other employers who have 
employees who work at the covered 
facility or who are performing the 
covered service; and
(II) determining which covered 
employer or covered employers shall be 
responsible for implementing and 
complying with the provisions of the 
standard applicable to the working 
conditions over which such employers 
have control.
(viii) Procedures for conducting the annual 
evaluation under paragraph (6).
(C) Availability of plan.--Each Plan shall be made 
available at all times to the covered employees who are 
covered under such Plan.
(2) Violent incident investigation.--
(A) In general.--As soon as practicable after a 
workplace violence incident, risk, or hazard of which a 
covered employer has knowledge, the employer shall 
conduct an investigation of such incident, risk, or 
hazard under which the employer shall--
(i) review the circumstances of the 
incident, risk, or hazard, and whether any 
controls or measures implemented pursuant to 
the Plan of the employer were effective; and
(ii) solicit input from involved employees, 
their representatives, and supervisors about 
the cause of the incident, risk, or hazard, and 
whether further corrective measures (including 
system-level factors) could have prevented the 
incident, risk, or hazard.
(B) Documentation.--A covered employer shall 
document the findings, recommendations, and corrective 
measures taken for each investigation conducted under 
this paragraph.
(3) Training and education.--With respect to the covered 
employees covered under a Plan of a covered employer, the 
employer shall provide training and education to such employees 
who may be exposed to workplace violence hazards and risks, 
which meet the following requirements:
(A) Annual training and education shall include 
information on the Plan, including identified workplace 
violence hazards, work practice control measures, 
reporting procedures, recordkeeping requirements, 
response procedures, anti-retaliation policies, and 
employee rights.
(B) Additional hazard recognition training shall be 
provided for supervisors and managers to ensure they--
(i) can recognize high-risk situations; and
(ii) do not assign employees to situations 
that predictably compromise the safety of such 
employees.
(C) Additional training shall be provided for each 
such covered employee whose job circumstances have 
changed, within a reasonable timeframe after such 
change.
(D) Additional training shall be provided for each 
such covered employee whose job circumstances require 
working with victims of torture, trafficking, or 
domestic violence.
(E) Applicable training shall be provided under 
this paragraph for each new covered employee prior to 
the employee's job assignment.
(F) All training shall provide such employees 
opportunities to ask questions, give feedback on 
training, and request additional instruction, 
clarification, or other follow-up.
(G) All training shall be provided in-person and by 
an individual with knowledge of workplace violence 
prevention and of the Plan, except that any annual 
training described in subparagraph (A) provided to an 
employee after the first year such training is provided 
to such employee may be conducted by live video if in-
person training is impracticable.
(H) All training shall be appropriate in content 
and vocabulary to the language, educational level, and 
literacy of such covered employees.
(4) Recordkeeping and access to plan records.--
(A) In general.--Each covered employer shall--
(i) maintain for not less than 5 years--
(I) records related to each Plan of 
the employer, including workplace 
violence risk and hazard assessments, 
and identification, evaluation, 
correction, and training procedures;
(II) a violent incident log 
described in subparagraph (B) for 
recording all workplace violence 
incidents; and
(III) records of all incident 
investigations as required under 
paragraph (2)(B); and
(ii)(I) make such records and logs 
available, upon request, to covered employees 
and their representatives for examination and 
copying in accordance with section 1910.1020 of 
title 29, Code of Federal Regulations (as such 
section is in effect on the date of enactment 
of this Act), and in a manner consistent with 
HIPAA privacy regulations (defined in section 
1180(b)(3) of the Social Security Act (42 
U.S.C. 1320d-9(b)(3))) and part 2 of title 42, 
Code of Federal Regulations (as such part is in 
effect on the date of enactment of this Act); 
and
(II) ensure that any such records and logs 
that may be copied, transmitted electronically, 
or otherwise removed from the employer's 
control for purposes of this clause omit any 
element of personal identifying information 
sufficient to allow identification of any 
patient, resident, client, or other individual 
alleged to have committed a violent incident 
(including the individual's name, address, 
electronic mail address, telephone number, or 
social security number, or other information 
that, alone or in combination with other 
publicly available information, reveals such 
individual's identity).
(B) Violent incident log description.--Each violent 
incident log shall--
(i) be maintained by a covered employer for 
each covered facility controlled by the 
employer and for each covered service being 
performed by a covered employee on behalf of 
such employer;
(ii) be based on a template developed by 
the Secretary not later than 1 year after the 
date of enactment of this Act;
(iii) include, at a minimum, a description 
of--
(I) the violent incident (including 
environmental risk factors present at 
the time of the incident);
(II) the date, time, and location 
of the incident, and the names and job 
titles of involved employees;
(III) the nature and extent of 
injuries to covered employees;
(IV) a classification of the 
perpetrator who committed the violence, 
including whether the perpetrator was--
(aa) a patient, client, 
resident, or customer of a 
covered employer;
(bb) a family or friend of 
a patient, client, resident, or 
customer of a covered employer;
(cc) a stranger;
(dd) a coworker, 
supervisor, or manager of a 
covered employee;
(ee) a partner, spouse, 
parent, or relative of a 
covered employee; or
(ff) any other appropriate 
classification;
(V) the type of violent incident 
(such as type 1 violence, type 2 
violence, type 3 violence, or type 4 
violence); and
(VI) how the incident was abated;
(iv) not later than 7 days after the 
employer learns of such incident, contain a 
record of each violent incident, which is 
updated to ensure completeness of such record;
(v) be maintained for not less than 5 
years; and
(vi) in the case of a violent incident 
involving a privacy concern case, protect the 
identity of employees in a manner consistent 
with section 1904.29(b) of title 29, Code of 
Federal Regulations (as such section is in 
effect on the date of enactment of this Act).
(C) Annual summary.--
(i) Covered employers.--Each covered 
employer shall prepare and submit to the 
Secretary an annual summary of each violent 
incident log for the preceding calendar year 
that shall--
(I) with respect to each covered 
facility, and each covered service, for 
which such a log has been maintained, 
include--
(aa) the total number of 
violent incidents;
(bb) the number of 
recordable injuries related to 
such incidents; and
(cc) the total number of 
hours worked by the covered 
employees for such preceding 
year;
(II) be completed on a form 
provided by the Secretary;
(III) be posted for 90 days 
beginning February 1 of each year in a 
manner consistent with the requirements 
of part 1904 of title 29, Code of 
Federal Regulations (as such part is in 
effect on the date of enactment of this 
Act), relating to the posting of 
summaries of injury and illness logs;
(IV) be located in a conspicuous 
place or places where notices to 
employees are customarily posted; and
(V) not be altered, defaced, or 
covered by other material.
(ii) Secretary.--Not later than 1 year 
after the promulgation of the interim final 
standard under section 321(a), or 2 years after 
the date of enactment of this Act in a case 
described in section 321(a)(5), the Secretary 
shall make available a platform for the 
electronic submission of annual summaries 
required under this subparagraph.
(5) Annual report.--
(A) Report to secretary.--Not later than February 
15 of each year, each covered employer shall report to 
the Secretary, on a form provided by the Secretary, the 
frequency, quantity, and severity of workplace 
violence, and any incident response and post-incident 
investigation (including abatement measures) for the 
incidents set forth in the annual summary of the 
violent incident log described in paragraph (4)(C).
(B) Report to congress.--Not later than 180 days 
after February 15 of each year, the Secretary shall 
submit to Congress a summary of the reports received 
under subparagraph (A). The contents of the summary of 
the Secretary to Congress shall not disclose any 
confidential information.
(6) Annual evaluation.--Each covered employer shall conduct 
an annual written evaluation, conducted with the full, active 
participation of covered employees and employee 
representatives, of--
(A) the implementation and effectiveness of the 
Plan, including a review of the violent incident log; 
and
(B) compliance with training required by each 
standard described in section 321, and specified in the 
Plan.
(7) Plan updates.--Each covered employer shall incorporate 
changes to the Plan, in a manner consistent with paragraph 
(1)(A)(i) and based on findings from the most recent annual 
evaluation conducted under paragraph (6), as appropriate.
(8) Anti-retaliation.--
(A) Policy.--Each covered employer shall adopt a 
policy prohibiting any person (including an agent of 
the employer) from the discrimination or retaliation 
described in subparagraph (B).
(B) Prohibition.--No covered employer shall 
discriminate or retaliate against any employee for--
(i) reporting a workplace violence 
incident, threat, or concern to, or seeking 
assistance or intervention with respect to such 
incident, threat, or concern from, the 
employer, law enforcement, local emergency 
services, or a local, State, or Federal 
Government agency; or
(ii) exercising any other rights under this 
section.
(C) Enforcement.--This paragraph shall be enforced 
in the same manner and to the same extent as any 
standard promulgated under section 6(b) of the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 
655(b)).

SEC. 324. RULES OF CONSTRUCTION.

Notwithstanding section 18 of the Occupational Safety and Health 
Act of 1970 (29 U.S.C. 667)--
(1) nothing in this subtitle shall be construed to curtail 
or limit authority of the Secretary under any other provision 
of the law;
(2) the rights, privileges, or remedies of covered 
employees shall be in addition to the rights, privileges, or 
remedies provided under any Federal or State law, or any 
collective bargaining agreement;
(3) nothing in this subtitle shall be construed to limit or 
prevent health care workers, social service workers, and other 
personnel from reporting violent incidents to appropriate law 
enforcement; and
(4) nothing in this Act shall be construed to limit or 
diminish any protections in relevant Federal, State, or local 
law related to--
(A) domestic violence;
(B) stalking;
(C) dating violence; or
(D) sexual assault.

SEC. 325. DEFINITIONS.

In this subtitle:
(1) Alarm.--The term ``alarm'' means a mechanical, 
electrical, or electronic device that does not rely upon an 
employee's vocalization in order to alert others.
(2) Dangerous weapon.--The term ``dangerous weapon'' means 
an instrument capable of inflicting death or serious bodily 
injury, without regard to whether such instrument was designed 
for that purpose.
(3) Engineering controls.--
(A) In general.--The term ``engineering controls'' 
means an aspect of the built space or a device that 
removes a hazard from the workplace or creates a 
barrier between a covered employee and the hazard.
(B) Inclusions.--For purposes of reducing workplace 
violence hazards, the term ``engineering controls'' 
includes electronic access controls to employee 
occupied areas, weapon detectors (installed or 
handheld), enclosed workstations with shatter-resistant 
glass, deep service counters, separate rooms or areas 
for high-risk patients, locks on doors, removing access 
to or securing items that could be used as weapons, 
furniture affixed to the floor, opaque glass in patient 
rooms (which protects privacy, but allows the health 
care provider to see where the patient is before 
entering the room), closed-circuit television 
monitoring and video recording, sight-aids, and 
personal alarm devices.
(4) Environmental risk factors.--
(A) In general.--The term ``environmental risk 
factors'' means factors in the covered facility or area 
in which a covered service is performed that may 
contribute to the likelihood or severity of a workplace 
violence incident.
(B) Clarification.--Environmental risk factors may 
be associated with the specific task being performed or 
the work area, such as working in an isolated area, 
poor illumination or blocked visibility, and lack of 
physical barriers between individuals and persons at 
risk of committing workplace violence.
(5) Patient-specific risk factors.--The term ``patient-
specific risk factors'' means factors specific to a patient 
that may increase the likelihood or severity of a workplace 
violence incident, including--
(A) a patient's treatment and medication status, 
and history of violence and use of drugs or alcohol; 
and
(B) any conditions or disease processes of the 
patient that may cause the patient to experience 
confusion or disorientation, be nonresponsive to 
instruction, behave unpredictably, or engage in 
disruptive, threatening, or violent behavior.
(6) Secretary.--The term ``Secretary'' means the Secretary 
of Labor.
(7) Threat of violence.--The term ``threat of violence'' 
means a statement or conduct that--
(A) causes an individual to fear for such 
individual's safety because there is a reasonable 
possibility the individual might be physically injured; 
and
(B) serves no legitimate purpose.
(8) Type 1 violence.--The term ``type 1 violence''--
(A) means workplace violence directed at a covered 
employee at a covered facility or while performing a 
covered service by an individual who has no legitimate 
business at the covered facility or with respect to 
such covered service; and
(B) includes violent acts by any individual who 
enters the covered facility or worksite where a covered 
service is being performed with the intent to commit a 
crime.
(9) Type 2 violence.--The term ``type 2 violence'' means 
workplace violence directed at a covered employee by customers, 
clients, patients, students, inmates, or any individual for 
whom a covered facility provides services or for whom the 
employee performs covered services.
(10) Type 3 violence.--The term ``type 3 violence'' means 
workplace violence directed at a covered employee by a present 
or former employee, supervisor, or manager.
(11) Type 4 violence.--The term ``type 4 violence'' means 
workplace violence directed at a covered employee by an 
individual who is not an employee, but has or is known to have 
had a personal relationship with such employee, or with a 
customer, client, patient, student, inmate, or any individual 
for whom a covered facility provides services or for whom the 
employee performs covered services.
(12) Work practice controls.--
(A) In general.--The term ``work practice 
controls'' means procedures and rules that are used to 
effectively reduce workplace violence hazards.
(B) Inclusions.--The term ``work practice 
controls'' includes--
(i) assigning and placing sufficient 
numbers of staff to reduce patient-specific 
type 2 violence hazards;
(ii) provision of dedicated and available 
safety personnel such as security guards;
(iii) employee training on workplace 
violence prevention methods and techniques to 
de-escalate and minimize violent behavior; and
(iv) employee training on procedures for 
response in the event of a workplace violence 
incident and for post-incident response.
(13) Workplace violence.--
(A) In general.--The term ``workplace violence'' 
means any act of violence or threat of violence, 
without regard to intent, that occurs at a covered 
facility or while a covered employee performs a covered 
service.
(B) Exclusions.--The term ``workplace violence'' 
does not include lawful acts of self-defense or lawful 
acts of defense of others.
(C) Inclusions.--The term ``workplace violence'' 
includes--
(i) the threat or use of physical force 
against a covered employee that results in or 
has a high likelihood of resulting in injury, 
psychological trauma, or stress, without regard 
to whether the covered employee sustains an 
injury, psychological trauma, or stress; and
(ii) an incident involving the threat or 
use of a firearm or a dangerous weapon, 
including the use of common objects as weapons, 
without regard to whether the employee sustains 
an injury, psychological trauma, or stress.

SEC. 326. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION STANDARD TO 
CERTAIN FACILITIES RECEIVING MEDICARE FUNDS.

(a) In General.--Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the 
end;
(B) in subparagraph (Y), by striking the period at 
the end and inserting ``, and''; and
(C) by inserting after subparagraph (Y) the 
following new subparagraph:
``(Z) in the case of hospitals that are not 
otherwise subject to the Occupational Safety and Health 
Act of 1970 (or a State occupational safety and health 
plan that is approved under section 18(b) of such Act) 
and skilled nursing facilities that are not otherwise 
subject to such Act (or such a State occupational 
safety and health plan), to comply with the Workplace 
Violence Prevention Standard (as promulgated under 
section 321 of the Long-Term Care Workforce Support 
Act).''; and
(2) in subsection (b)(4)--
(A) in subparagraph (A), by inserting ``and a 
hospital or skilled nursing facility that fails to 
comply with the requirement of subsection (a)(1)(Z) 
(relating to the Workplace Violence Prevention 
Standard)'' after ``Bloodborne Pathogens standard)''; 
and
(B) in subparagraph (B)--
(i) by striking ``(a)(1)(U)'' and inserting 
``(a)(1)(V)''; and
(ii) by inserting ``(or, in the case of a 
failure to comply with the requirement of 
subsection (a)(1)(Z), for a violation of the 
Workplace Violence Prevention standard referred 
to in such subsection by a hospital or skilled 
nursing facility, as applicable, that is 
subject to the provisions of such Act)'' before 
the period at the end.
(b) Effective Date.--The amendments made by subsection (a) shall 
apply beginning on the date that is 1 year after the date of issuance 
of the interim final standard on workplace violence prevention required 
under section 321.

Subtitle D--Improving Access to Job Benefits

SEC. 331. DEFINITIONS.

In this subtitle:
(1) Child.--The term ``child'' means a biological, foster, 
or adopted child, a stepchild, a child of a domestic partner, a 
legal ward, or a child of a person standing in loco parentis.
(2) Commerce; industry or activity affecting commerce.--The 
terms ``commerce'' and ``industry or activity affecting 
commerce'' mean any activity, business, or industry in commerce 
or in which a labor dispute would hinder or obstruct commerce 
or the free flow of commerce, and include ``commerce'' and any 
``industry affecting commerce'', as defined in paragraphs (1) 
and (3) of section 501 of the Labor Management Relations Act, 
1947 (29 U.S.C. 142 (1) and (3)).
(3) Covered direct care professional.--The term ``covered 
direct care professional'' means an employee who is employed as 
a direct care professional by an employer.
(4) Domestic violence.--The term ``domestic violence'' has 
the meaning given the term in section 40002(a) of the Violence 
Against Women Act of 1994 (34 U.S.C. 12291(a)), except that the 
reference in such section to the term ``jurisdiction receiving 
grant funding'' shall be deemed to mean the jurisdiction in 
which the victim lives or the jurisdiction in which the 
employer involved is located. Such term also includes dating 
violence, as that term is defined in such section.
(5) Employee.--The term ``employee'' means an individual 
who is an employee, as defined in section 3(e) of the Fair 
Labor Standards Act of 1938 (29 U.S.C. 203(e)), except that a 
reference in such section to an employer shall be considered to 
be a reference to an employer described in paragraph (6).
(6) Employer.--
(A) In general.--The term ``employer''--
(i) means a person who is engaged in 
commerce or in any industry or activity 
affecting commerce who employs 1 or more 
employees;
(ii) includes--
(I) any person who acts, directly 
or indirectly, in the interest of an 
employer to any of the employees of 
such employer; and
(II) any successor in interest of 
such an employer; and
(iii) does not include any public agency.
(B) Definitions.--For purposes of this 
subparagraph:
(i) Employee.--The term ``employee'' has 
the meaning given such term in section 3 of the 
Fair Labor Standards Act of 1938 (29 U.S.C. 
203).
(ii) Person.--The term ``person'' has the 
meaning given such term in section 3 of the 
Fair Labor Standards Act of 1938 (29 U.S.C. 
203).
(iii) Public agency.--The term ``public 
agency'' has the meaning given such term in 
section 3 of the Fair Labor Standards Act of 
1938 (29 U.S.C. 203).
(C) Predecessors.--Any reference in this paragraph 
to an employer shall include a reference to any 
predecessor of such employer.
(7) Employment benefits.--The term ``employment benefits'' 
means all benefits provided or made available to employees by 
an employer, including group life insurance, health insurance, 
disability insurance, sick leave, annual leave, educational 
benefits, and pensions, regardless of whether such benefits are 
provided by a practice or written policy of an employer or 
through an ``employee benefit plan'', as defined in section 
3(3) of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1002(3)).
(8) Health care provider.--The term ``health care 
provider'' means a provider who--
(A)(i) is a doctor of medicine or osteopathy who is 
authorized to practice medicine or surgery (as 
appropriate) by the State in which the doctor 
practices; or
(ii) is any other person determined by the 
Secretary to be capable of providing health care 
services; and
(B) is not employed by an employer for whom the 
provider issues certification under this subtitle.
(9) Paid sick time.--The term ``paid sick time'' means an 
increment of compensated leave that--
(A) can be--
(i) earned by an employee for use during an 
absence from employment for a reason described 
in any paragraph of section 332(b); or
(ii) provided by an employer during a 
public health emergency for use during an 
absence from employment for a reason described 
in any paragraph of section 332(b); and
(B) is compensated at a rate that is not less than 
the greatest of--
(i) the employee's regular rate of pay;
(ii) the wage rate described in section 
6(a)(1) of the Fair Labor Standards Act of 1938 
(29 U.S.C. 206(a)(1)); or
(iii) the minimum wage rate provided for in 
the applicable State or local law for the State 
or locality in which the employee is employed.
(10) Parent.--The term ``parent'' means a biological, 
foster, or adoptive parent of an employee, a stepparent of an 
employee, parent-in-law, parent of a domestic partner, or a 
legal guardian or other person who stood in loco parentis to an 
employee when the employee was a child.
(11) Public health emergency.--The term ``public health 
emergency'' means a public health emergency declared by the 
Secretary of Health and Human Services for a jurisdiction, or 
by a State public health official with authority to declare 
such an emergency for the State or jurisdiction within the 
State.
(12) Secretary.--The term ``Secretary'' means the Secretary 
of Labor.
(13) Sexual assault.--The term ``sexual assault'' has the 
meaning given the term in section 40002(a) of the Violence 
Against Women Act of 1994 (34 U.S.C. 12291(a)).
(14) Spouse.--The term ``spouse'', with respect to an 
employee, has the meaning given such term by the marriage laws 
of the State in which the marriage was celebrated.
(15) Stalking.--The term ``stalking'' has the meaning given 
the term in section 40002(a) of the Violence Against Women Act 
of 1994 (34 U.S.C. 12291(a)).
(16) Victim services organization.--The term ``victim 
services organization'' means a nonprofit, nongovernmental 
organization that provides assistance to victims of domestic 
violence, sexual assault, or stalking or advocates for such 
victims, including a rape crisis center, an organization 
carrying out a domestic violence, sexual assault, or stalking 
prevention or treatment program, an organization operating a 
shelter or providing counseling services, or a legal services 
organization or other organization providing assistance through 
the legal process.

SEC. 332. PAID SICK TIME.

(a) Earning of Paid Sick Time.--
(1) In general.--Subject to subsection (c), an employer 
shall provide each covered direct care professional employed by 
the employer not less than 1 hour of earned paid sick time for 
every 30 hours worked, to be used as described in subsection 
(b). An employer shall not be required to permit a covered 
direct care professional to earn, under this subsection, more 
than 56 hours of paid sick time in a year, unless the employer 
chooses to set a higher limit.
(2) Exempt covered direct care professionals.--
(A) In general.--Except as provided in subparagraph 
(B), for purposes of this subsection, a covered direct 
care professional who is exempt from overtime 
requirements under section 13(a)(1) of the Fair Labor 
Standards Act of 1938 (29 U.S.C. 213(a)(1)) shall be 
deemed to work 40 hours in each workweek.
(B) Shorter normal workweek.--If the normal 
workweek of such a covered direct care professional is 
less than 40 hours, the covered direct care 
professional shall earn paid sick time under this 
subsection based upon that normal workweek.
(3) Dates for beginning to earn paid sick time and use.--
(A) In general.--Except as provided in subparagraph 
(B) and the second sentence of paragraph (8), covered 
direct care professionals shall begin to earn paid sick 
time under this section at the commencement of their 
employment. Except as provided in such subparagraph and 
such sentence, a covered direct care professional shall 
be entitled to use the earned paid sick time beginning 
on the 60th calendar day following commencement of the 
covered direct care professional's employment. After 
that 60th calendar day, the covered direct care 
professional may use the paid sick time as the time is 
earned. An employer may, at the discretion of the 
employer, loan paid sick time to a covered direct care 
professional for use by such covered direct care 
professional in advance of the covered direct care 
professional earning such sick time as provided in this 
section and may permit use before the 60th day of 
employment.
(B) Public health emergency.--Subparagraph (A) 
shall not apply with respect to additional paid sick 
time provided under subsection (c). In the event of a 
public health emergency, a covered direct care 
professional may immediately use the additional or 
accrued paid sick time described in subsection (c), 
regardless of how long the covered direct care 
professional has been employed by an employer.
(4) Carryover.--
(A) In general.--Except as provided in subparagraph 
(B), paid sick time earned under this section shall 
carry over from 1 year to the next.
(B) Construction.--Except as provided in subsection 
(c), this subtitle shall not be construed to require an 
employer to permit a covered direct care professional 
to earn more than 56 hours of earned paid sick time at 
a given time.
(5) Employers with existing policies.--Any employer with a 
paid leave policy who makes available an amount of paid leave 
that is sufficient to meet the requirements of this section and 
that may be used for the same purposes and under the same 
conditions as the purposes and conditions described in this 
section shall not be required to permit a covered direct care 
professional to earn additional paid sick time under this 
section.
(6) Construction.--Nothing in this section shall be 
construed as requiring financial or other reimbursement to a 
covered direct care professional from an employer upon the 
covered direct care professional's termination, resignation, 
retirement, or other separation from employment for earned paid 
sick time that has not been used.
(7) Reinstatement.--If a covered direct care professional 
is separated from employment with an employer and is rehired, 
within 12 months after that separation, by the same employer, 
the employer shall reinstate the covered direct care 
professional's previously earned paid sick time. The covered 
direct care professional shall be entitled to use the earned 
paid sick time and earn additional paid sick time at the 
recommencement of employment with the employer.
(8) Prohibition.--An employer may not require, as a 
condition of providing paid sick time under this subtitle, that 
the covered direct care professional involved search for or 
find a replacement to cover the hours during which the covered 
direct care professional is using paid sick time.
(b) Uses.--Paid sick time earned under this section may be used by 
a covered direct care professional for any of the following:
(1) An absence resulting from a physical or mental illness, 
injury, or medical condition of the covered direct care 
professional.
(2) An absence resulting from obtaining professional 
medical diagnosis or care, or preventive medical care, for the 
covered direct care professional.
(3) An absence resulting from the closure of a covered 
direct care professional's place of employment by order of a 
Federal or State public official with jurisdiction, or at the 
employer's discretion, due to a public health emergency.
(4) An absence because a Federal or State public official 
with jurisdiction or a health care provider has determined that 
the covered direct care professional's presence in the 
community may jeopardize the health of others because of the 
covered direct care professional's exposure to a communicable 
disease during a public health emergency, regardless of whether 
the covered direct care professional has actually contracted 
the communicable disease.
(5) An absence for the purpose of caring for a child, a 
parent, a spouse, a domestic partner, or any other individual 
related by blood or affinity whose close association with the 
covered direct care professional is the equivalent of a family 
relationship--
(A) who is a child, if the child's school or place 
of care has been closed by order of a Federal or State 
public official with jurisdiction or at the discretion 
of the school or place of care due to a public health 
emergency, including if a school or entity operating 
the place of care is physically closed but is providing 
education or care to the child remotely; or
(B) because a Federal or State public official with 
jurisdiction or a health care provider has determined 
that the presence in the community of the person 
receiving care may jeopardize the health of others 
because of the person's exposure to a communicable 
disease during a public health emergency, regardless of 
whether the person has actually contracted the 
communicable disease.
(6) An absence for the purpose of caring for a child, a 
parent, a spouse, a domestic partner, or any other individual 
related by blood or affinity whose close association with the 
covered direct care professional is the equivalent of a family 
relationship--
(A) who has any of the conditions or needs for 
diagnosis or care described in paragraph (1) or (2);
(B) who is a child, if the covered direct care 
professional is required to attend a school meeting or 
a meeting at a place where the child is receiving care 
necessitated by the child's health condition or 
disability; or
(C) who is otherwise in need of care.
(7) An absence resulting from domestic violence, sexual 
assault, or stalking, if the time is to--
(A) seek medical attention for the covered direct 
care professional or the covered direct care 
professional's child, parent, spouse, domestic partner, 
or an individual related to the covered direct care 
professional as described in paragraph (6), to recover 
from physical or psychological injury or disability 
caused by domestic violence, sexual assault, or 
stalking;
(B) obtain or assist a related person described in 
paragraph (6) in obtaining services from a victim 
services organization;
(C) obtain or assist a related person described in 
paragraph (6) in obtaining psychological or other 
counseling;
(D) seek relocation; or
(E) take legal action, including preparing for or 
participating in any civil or criminal legal proceeding 
related to or resulting from domestic violence, sexual 
assault, or stalking.
(c) Additional Paid Sick Time for Public Health Emergency.--
(1) Additional paid sick time.--On the date of a 
declaration of a public health emergency by the Secretary of 
Health and Human Services under section 319 of the Public 
Health Service Act (42 U.S.C. 247d) or a major disaster or 
emergency declared by the President under section 401 or 501, 
respectively, of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5170, 5191), an employer in 
the jurisdiction involved shall provide each covered direct 
care professional of the employer in that jurisdiction with 
additional paid sick time, in addition to any amount of paid 
sick time accrued by the covered direct care professional under 
subsection (a) (including paid leave referred to in subsection 
(a)(4)).
(2) Amount of paid sick time.--In receiving additional paid 
sick time under paragraph (1), the covered direct care 
professional shall receive--
(A) for a full-time salaried covered direct care 
professional, a specified amount of paid sick time that 
is sufficient to provide the covered direct care 
professional with 14 continuous days away from work 
without a reduction in pay; and
(B) for a part-time or hourly covered direct care 
professional, a specified amount of paid sick time 
equal to the number of hours that the covered direct 
care professional was scheduled to work or, if not so 
scheduled, regularly works in a 14-day period.
(3) Use of leave.--The additional sick time and accrued 
sick time described in this subsection shall be available for 
immediate use by the covered direct care professional for the 
purposes described in any paragraph of subsection (b) beginning 
on the date a public health emergency is declared, regardless 
of how long the covered direct care professional has been 
employed by an employer.
(4) Sequencing.--During the public health emergency, a 
covered direct care professional may first use the additional 
sick time for those purposes. The covered direct care 
professional may then use the accrued sick time during the 
public health emergency, or retain the accrued sick time for 
use after the public health emergency. An employer may not 
require a covered direct care professional to use the accrued 
sick time, or any other paid leave provided by the employer to 
the covered direct care professional, before using the 
additional sick time.
(5) Periods.--A covered direct care professional may take 
the additional sick time on the schedule that meets the covered 
direct care professional's needs, consistent with subsection 
(b), including taking the additional sick time intermittently 
or on a reduced leave schedule, and an employer may not require 
a covered direct care professional to take the additional sick 
time in a single period or on any other schedule specified by 
the employer.
(d) Scheduling.--A covered direct care professional shall make a 
reasonable effort to schedule a period of paid sick time under 
subsection (a) in a manner that does not unduly disrupt the operations 
of the employer.
(e) Procedures.--
(1) In general.--Paid sick time shall be provided upon the 
oral or written request of a covered direct care professional. 
Such request shall--
(A) include the expected duration of the period of 
such time; and
(B)(i) in a case in which the need for such period 
of time is foreseeable at least 7 days in advance of 
such period, be provided at least 7 days in advance of 
such period; and
(ii) otherwise, be provided as soon as practicable 
after the covered direct care professional is aware of 
the need for such period.
(2) Certification in general.--
(A) Provision.--
(i) In general.--Subject to subparagraphs 
(C) and (D), an employer may require that a 
request for paid sick time under this section 
for a purpose described in paragraph (1), (2), 
or (6) of subsection (b) be supported by a 
certification issued by the health care 
provider of the covered direct care 
professional or of an individual described in 
subsection (b)(6), as appropriate, if the 
period of such time covers more than 3 
consecutive workdays.
(ii) Timeliness.--The covered direct care 
professional shall provide a copy of such 
certification to the employer in a timely 
manner, not later than 30 days after the first 
day of the period of time. The employer shall 
not delay the commencement of the period of 
time on the basis that the employer has not yet 
received the certification.
(B) Sufficient certification.--
(i) In general.--A certification provided 
under subparagraph (A) shall be sufficient if 
it states--
(I) the date on which the period of 
time will be needed;
(II) the probable duration of the 
period of time;
(III) the appropriate medical facts 
within the knowledge of the health care 
provider regarding the condition 
involved, subject to clause (ii); and
(IV)(aa) for purposes of paid sick 
time under subsection (b)(1), a 
statement that absence from work is 
medically necessary;
(bb) for purposes of such time 
under subsection (b)(2), the dates on 
which testing for a medical diagnosis 
or care is expected to be given and the 
duration of such testing or care; and
(cc) for purposes of such time 
under subsection (b)(6), in the case of 
time to care for someone who is not a 
child, a statement that care is needed 
for an individual described in such 
subsection, and an estimate of the 
amount of time that such care is needed 
for such individual.
(ii) Limitation.--In issuing a 
certification under subparagraph (A), a health 
care provider shall make reasonable efforts to 
limit the medical facts described in clause 
(i)(III) that are disclosed in the 
certification to the minimum necessary to 
establish a need for the covered direct care 
professional to use paid sick time.
(C) Public health emergencies.--No certification or 
other documentation may be required under this subtitle 
by an employer during any public health emergency.
(D) Regulations.--Regulations prescribed under 
section 339 shall specify the manner in which a covered 
direct care professional who does not have health 
insurance shall provide a certification for purposes of 
this paragraph.
(E) Confidentiality and nondisclosure.--
(i) Protected health information.--Nothing 
in this subtitle shall be construed to require 
a health care provider to disclose information 
in violation of section 1177 of the Social 
Security Act (42 U.S.C. 1320d-6) or the 
regulations promulgated pursuant to section 
264(c) of the Health Insurance Portability and 
Accountability Act of 1996 (42 U.S.C. 1320d-2 
note).
(ii) Health information records.--If an 
employer possesses health information about a 
covered direct care professional, a covered 
direct care professional's child, parent, 
spouse, domestic partner, or an individual 
related to the covered direct care professional 
as described in subsection (b)(6), such 
information shall--
(I) be maintained on a separate 
form and in a separate file from other 
personnel information;
(II) be treated as a confidential 
medical record; and
(III) not be disclosed except to 
the affected covered direct care 
professional or with the permission of 
the affected covered direct care 
professional.
(3) Certification in the case of domestic violence, sexual 
assault, or stalking.--
(A) In general.--An employer may require that a 
request for paid sick time under this section for a 
purpose described in subsection (b)(7) be supported by 
any one of the following:
(i) A police report indicating that the 
covered direct care professional, or a member 
of the covered direct care professional's 
family described in subsection (b)(7), was a 
victim of domestic violence, sexual assault, or 
stalking.
(ii) A court order protecting or separating 
the covered direct care professional or a 
member of the covered direct care 
professional's family described in subsection 
(b)(7) from the perpetrator of an act of 
domestic violence, sexual assault, or stalking, 
or other evidence from the court or prosecuting 
attorney that the covered direct care 
professional or a member of the covered direct 
care professional's family described in 
subsection (b)(7) has appeared in court or is 
scheduled to appear in court in a proceeding 
related to domestic violence, sexual assault, 
or stalking.
(iii) Other documentation signed by a 
covered direct care professional or volunteer 
working for a victim services organization, an 
attorney, a police officer, a medical 
professional, a social worker, an antiviolence 
counselor, or a member of the clergy, affirming 
that the covered direct care professional or a 
member of the covered direct care 
professional's family described in subsection 
(b)(7) is a victim of domestic violence, sexual 
assault, or stalking.
(B) Requirements.--The requirements of paragraph 
(2) shall apply to certifications under this paragraph, 
except that--
(i) subclauses (III) and (IV) of 
subparagraph (B)(i) and subparagraph (B)(ii) of 
such paragraph shall not apply;
(ii) the certification shall state the 
reason that the leave is required with the 
facts to be disclosed limited to the minimum 
necessary to establish a need for the covered 
direct care professional to be absent from 
work, and the covered direct care professional 
shall not be required to explain the details of 
the domestic violence, sexual assault, or 
stalking involved; and
(iii) with respect to confidentiality under 
subparagraph (E) of such paragraph, any 
information provided to the employer under this 
paragraph shall be confidential, except to the 
extent that any disclosure of such information 
is--
(I) requested or consented to in 
writing by the covered direct care 
professional; or
(II) otherwise required by 
applicable Federal or State law.
(C) Specification of documentation.--An employer 
may not specify which of the forms of documentation 
described in clause (i), (ii), or (iii) of subparagraph 
(A) is required to be provided in order to satisfy the 
requirement under such subparagraph.

SEC. 333. NOTICE REQUIREMENT.

(a) In General.--Each employer shall notify each covered direct 
care professional employed by the employer and include in any employee 
handbook the information--
(1) describing paid sick time available to covered direct 
care professionals under this subtitle;
(2) pertaining to the filing of an action under this 
subtitle;
(3) on the details of the notice requirement for a 
foreseeable period of time under section 332(e)(1)(B)(i); and
(4) that describes--
(A) the protections that a covered direct care 
professional has in exercising rights under this 
subtitle; and
(B) how the covered direct care professional can 
contact the Secretary if any of the rights are 
violated.
(b) Posting of Notice.--Each employer shall post and keep posted a 
notice, to be prepared or approved in accordance with procedures 
specified in regulations prescribed under section 339, setting forth 
excerpts from, or summaries of, the pertinent provisions of this 
subtitle including the information described in paragraphs (1) through 
(4) of subsection (a).
(c) Location.--The notice described under subsection (b) shall be 
posted--
(1) in conspicuous places on the premises of the employer, 
where notices to employees (including applicants) are 
customarily posted; or
(2) in employee handbooks.
(d) Violation; Penalty.--Any employer who willfully violates the 
posting requirements of this section shall be subject to a civil fine 
in an amount not to exceed $100 for each separate offense.

SEC. 334. PROHIBITED ACTS.

(a) Interference With Rights.--
(1) Exercise of rights.--It shall be unlawful for any 
employer to interfere with, restrain, or deny the exercise of, 
or the attempt to exercise, any right provided under this 
subtitle, including--
(A) discharging or discriminating against 
(including retaliating against) any individual, 
including a job applicant, for exercising, or 
attempting to exercise, any right provided under this 
subtitle;
(B) using the taking of paid sick time under this 
subtitle as a negative factor in an employment action, 
such as hiring, promotion, reducing hours or number of 
shifts, or a disciplinary action; or
(C) counting the paid sick time under a no-fault 
attendance policy or any other absence-control policy.
(2) Discrimination.--It shall be unlawful for any employer 
to discharge or in any other manner discriminate against 
(including retaliating against) any individual, including a job 
applicant, for opposing any practice made unlawful by this 
subtitle.
(b) Interference With Proceedings or Inquiries.--It shall be 
unlawful for any person to discharge or in any other manner 
discriminate against (including retaliating against) any individual, 
including a job applicant, because such individual--
(1) has filed an action, or has instituted or caused to be 
instituted any proceeding, under or related to this subtitle;
(2) has given, or is about to give, any information in 
connection with any inquiry or proceeding relating to any right 
provided under this subtitle; or
(3) has testified, or is about to testify, in any inquiry 
or proceeding relating to any right provided under this 
subtitle.
(c) Construction.--Nothing in this section shall be construed to 
state or imply that the scope of the activities prohibited by section 
105 of the Family and Medical Leave Act of 1993 (29 U.S.C. 2615) is 
less than the scope of the activities prohibited by this section.

SEC. 335. ENFORCEMENT AUTHORITY.

(a) Investigative Authority.--
(1) In general.--To ensure compliance with the provisions 
of this subtitle, or any regulation or order issued under this 
subtitle, the Secretary shall have, subject to paragraph (3), 
the investigative authority provided under section 11(a) of the 
Fair Labor Standards Act of 1938 (29 U.S.C. 211(a)), with 
respect to employers, covered direct care professionals, and 
other individuals affected by an employer.
(2) Obligation to keep and preserve records.--An employer 
shall make, keep, and preserve records pertaining to compliance 
with this subtitle in accordance with section 11(c) of the Fair 
Labor Standards Act of 1938 (29 U.S.C. 211(c)) and in 
accordance with regulations prescribed by the Secretary.
(3) Required submissions generally limited to an annual 
basis.--The Secretary shall not require, under the authority of 
this subsection, an employer to submit to the Secretary any 
books or records more than once during any 12-month period, 
unless the Secretary has reasonable cause to believe there may 
exist a violation of this subtitle or any regulation or order 
issued pursuant to this subtitle, or is investigating a charge 
pursuant to subsection (c).
(4) Subpoena authority.--For the purposes of any 
investigation provided for in this subsection, the Secretary 
shall have the subpoena authority provided for under section 9 
of the Fair Labor Standards Act of 1938 (29 U.S.C. 209).
(b) Civil Action by Covered Direct Care Professionals or 
Individuals.--
(1) Right of action.--An action to recover the damages or 
equitable relief prescribed in paragraph (1) may be maintained 
against any employer in any Federal or State court of competent 
jurisdiction by a covered direct care professional or 
individual or a representative for and on behalf of--
(A) the covered direct care professional or 
individual; or
(B) the covered direct care professional or 
individual and others similarly situated.
(2) Liability.--Any employer who violates section 334 
(including a violation relating to rights provided under 
section 332) shall be liable to any covered direct care 
professional or individual affected--
(A) for damages equal to--
(i) the amount of--
(I) any wages, salary, employment 
benefits, or other compensation denied 
or lost by reason of the violation; or
(II) in a case in which wages, 
salary, employment benefits, or other 
compensation have not been denied or 
lost, any actual monetary losses 
sustained as a direct result of the 
violation up to a sum equal to 56 hours 
of wages or salary for the covered 
direct care professional or individual, 
or the specified period described in 
section 332(c)(3), or a combination of 
those hours and that period, as the 
case may be;
(ii) the interest on the amount described 
in clause (i) calculated at the prevailing 
rate; and
(iii) an additional amount as liquidated 
damages; and
(B) for such equitable relief as may be 
appropriate, including employment, reinstatement, and 
promotion.
(3) Fees and costs.--The court in an action under this 
subsection shall, in addition to any judgment awarded to the 
plaintiff, allow a reasonable attorney's fee, reasonable expert 
witness fees, and other costs of the action to be paid by the 
defendant.
(c) Action by the Secretary.--
(1) Administrative action.--The Secretary shall receive, 
investigate, and attempt to resolve complaints of violations of 
section 334 (including a violation relating to rights provided 
under section 332) in the same manner that the Secretary 
receives, investigates, and attempts to resolve complaints of 
violations of sections 6 and 7 of the Fair Labor Standards Act 
of 1938 (29 U.S.C. 206 and 207).
(2) Civil action.--The Secretary may bring an action in any 
court of competent jurisdiction to recover the damages 
described in subsection (b)(2)(A).
(3) Sums recovered.--Any sums recovered by the Secretary 
pursuant to paragraph (2) shall be held in a special deposit 
account and shall be paid, on order of the Secretary, directly 
to each covered direct care professional or individual 
affected. Any such sums not paid to a covered direct care 
professional or individual affected because of inability to do 
so within a period of 3 years shall be deposited into the 
Treasury of the United States as miscellaneous receipts.
(d) Limitation.--
(1) In general.--Except as provided in paragraph (2), an 
action may be brought under subsection (b), (c), or (e) not 
later than 2 years after the date of the last event 
constituting the alleged violation for which the action is 
brought.
(2) Willful violation.--In the case of an action brought 
for a willful violation of section 334 (including a willful 
violation relating to rights provided under section 332), such 
action may be brought not later than 3 years after the last 
event constituting the alleged violation for which such action 
is brought.
(3) Commencement.--In determining when an action is 
commenced under subsection (b), (c), or (e) for the purposes of 
this subsection, it shall be considered to be commenced on the 
date when the complaint is filed.
(e) Action for Injunction by Secretary.--The district courts of the 
United States shall have jurisdiction, for cause shown, in an action 
brought by the Secretary--
(1) to restrain violations of section 334 (including a 
violation relating to rights provided under section 332), 
including the restraint of any withholding of payment of wages, 
salary, employment benefits, or other compensation, plus 
interest, found by the court to be due to covered direct care 
professionals or individuals eligible under this subtitle; or
(2) to award such other equitable relief as may be 
appropriate, including employment, reinstatement, and 
promotion.
(f) Solicitor of Labor.--The Solicitor of Labor may appear for and 
represent the Secretary on any litigation brought under subsection (c) 
or (e).

SEC. 336. EDUCATION AND OUTREACH.

(a) In General.--The Secretary may conduct a public awareness 
campaign to educate and inform the public of the requirements for paid 
sick time required by this subtitle.
(b) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary $20,000,000 to carry out such campaign.

SEC. 337. EFFECT ON EXISTING EMPLOYMENT BENEFITS.

(a) More Protective.--Nothing in this subtitle shall be construed 
to diminish the obligation of an employer to comply with any contract, 
collective bargaining agreement, or any employment benefit program or 
plan that provides greater paid sick leave or other leave rights to 
covered direct care professionals or individuals than the rights 
established under this subtitle.
(b) Less Protective.--The rights established for covered direct 
care professionals under this subtitle shall not be diminished by any 
contract, collective bargaining agreement, or any employment benefit 
program or plan.

SEC. 338. ENCOURAGEMENT OF MORE GENEROUS LEAVE POLICIES.

Nothing in this subtitle shall be construed--
(1) to discourage employers from adopting or retaining 
leave policies more generous than policies that comply with the 
requirements of this subtitle; or
(2) to discourage or prevent an employer from adopting a 
contract, collective bargaining agreement, or employment 
benefit program or plan that provides greater right or benefits 
to covered direct care professionals than the rights 
established under this subtitle.

SEC. 339. REGULATIONS.

(a) In General.--Subject to subsection (b), not later than 180 days 
after the date of enactment of this Act, the Secretary shall prescribe 
such regulations as are necessary to carry out this subtitle.
(b) Immediate Compliance.--The rights and responsibilities 
specified in this subtitle shall take effect on the date of enactment 
of this Act and employers and other persons subject to those 
responsibilities shall comply immediately, without regard whether 
regulations have been prescribed under this section.

SEC. 339A. EFFECTIVE DATE.

If a public health emergency was declared before and remains in 
effect on the date of enactment of this Act, for purposes of this 
subtitle, including section 332(c), the public health emergency shall 
be considered to have been declared on the date of enactment of this 
Act.

SEC. 339B. COLLECTION OF DATA AND FURTHER STUDY.

(a) Compilation of Information.--The Commissioner of the Bureau of 
Labor Statistics shall--
(1) collect data on--
(A) the amount of paid and unpaid sick time 
available to covered direct care professionals by 
occupation and type of employment establishment; and
(B) an estimate of the average sick time used by 
covered direct care professionals according to 
occupation and the type of covered direct care 
professional; and
(2) annually report that data to the Comptroller General of 
the United States.
(b) GAO Study.--The Comptroller General of the United States 
shall--
(1) conduct a study to evaluate the implementation of this 
subtitle--
(A) that includes an estimation of the access of 
covered direct care professionals to paid sick time, 
the awareness of covered direct care professionals of 
rights under this Act, and the experiences of employers 
in complying with this subtitle; and
(B) that takes into account access, awareness, and 
experiences of covered direct care professionals by 
race, ethnicity, gender, disability, occupation, and 
any other characteristic determined by the Secretary; 
and
(2) not later than 5 years after the date of enactment of 
this Act, submit the report to the Committee on Health, 
Education, Labor, and Pensions and the Special Committee on 
Aging of the Senate and the Committee on Education and 
Workforce of the House of Representatives.

TITLE IV--NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY

SEC. 401. DEFINITIONS.

In this title:
(1) Advisory council.--The term ``Advisory Council'' means 
the National Direct Care Professional Compensation Advisory 
Council convened under section 403.
(2) Secretary.--The term ``Secretary'' means the Secretary 
of Health and Human Services.
(3) Strategy.--The term ``Strategy'' means the National 
Direct Care Professional Compensation Strategy set forth under 
section 402.

SEC. 402. NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION STRATEGY.

(a) In General.--The Secretary, in consultation with the heads of 
other appropriate Federal agencies, shall develop jointly with the 
Advisory Council and submit to the appropriate committees of Congress, 
and the State agencies responsible for carrying out direct care 
professional programs, and make publicly available on the internet 
website of the Department of Health and Human Services, a National 
Direct Care Professional Compensation Strategy.
(b) Contents.--
(1) In general.--The Strategy shall identify recommended 
actions that the Federal Government (under existing Federal 
programs), State and local governments, communities, health 
care providers, including direct care professionals and others, 
are taking, or may take, to provide direct care professionals a 
livable wage, including recommendations on--
(A) how to calculate the fair cost of labor 
provided by direct care professionals;
(B) how State Medicaid agencies, managed care 
organizations, and other public payers should establish 
policies and procedures to ensure the direct care 
professional workforce is compensated at the full cost 
of their labor;
(C) how to set clear expectations for employers of 
direct care professionals with respect to compensation 
for such professionals; and
(D) how to ensure additional training and 
certification is tied to increased compensation for 
such professionals.
(2) Considerations.--The recommendations under paragraph 
(1) shall take into account--
(A) the particular challenges of the direct care 
professional workforce, including--
(i) the largely part-time nature of the 
work;
(ii) the mobile or transient nature of 
positions in the direct care professional 
workforce;
(iii) precarity due to race, ethnicity, 
sexual orientation, gender identity, and 
immigration status; and
(iv) any decrease in public benefits that 
direct care professionals may experience 
following an increase in wages; and
(B) strategies for wage enhancement for direct care 
professionals.
(c) Duties of the Secretary.--The Secretary, in carrying out 
subsection (a), shall oversee the following:
(1) Collecting and making publicly available information 
submitted by the Advisory Council under section 403(e) to the 
appropriate committees of Congress, and the State agencies 
responsible for carrying out direct care professional programs, 
including evidence-based or promising practices and innovative 
models (both domestic and foreign) regarding compensation for 
direct care professionals.
(2) Coordinating and assessing existing Federal Government 
programs and activities to compensate direct care professionals 
while ensuring maximum effectiveness and avoiding unnecessary 
duplication.
(3) Providing technical assistance, as appropriate, such as 
disseminating identified best practices and information sharing 
based on reports provided under section 403(e), to State or 
local efforts to compensate direct care professionals.
(d) Initial Strategy; Updates.--The Secretary shall--
(1) not later than 18 months after the date of enactment of 
this Act, develop, publish, and submit to the appropriate 
committees of Congress, and the State agencies responsible for 
carrying out direct care professional programs, an initial 
Strategy incorporating the items addressed in the Advisory 
Council's initial report under section 403(e) and other 
relevant information, including best practices, for 
compensating direct care professionals; and
(2) biennially update, republish, and submit to the 
appropriate committees of Congress and the State agencies 
responsible for carrying out direct care professional programs 
the Strategy, taking into account the most recent annual report 
submitted under section 403(e)(1)--
(A) to reflect new developments, challenges, 
opportunities, and solutions; and
(B) to review progress based on recommendations for 
compensating direct care professionals in the Strategy 
and, based on the results of such review, recommend 
priority actions for improving the implementation of 
such recommendations, as appropriate.
(e) Process for Public Input.--The Secretary shall establish a 
process for public input to inform the development of, and updates to, 
the Strategy, including a process for the public to submit 
recommendations to the Advisory Council and an opportunity for public 
comment on the proposed Strategy.
(f) No Preemption.--Nothing in this title preempts any authority of 
a State or local government to compensate direct care professionals.
(g) Rule of Construction.--Nothing in this title shall be construed 
to permit the Secretary (through regulation, guidance, grant criteria, 
or otherwise) to--
(1) mandate, direct, or control the allocation of State or 
local resources;
(2) mandate the use of any of the best practices identified 
in the reports required under this title; or
(3) otherwise expand the authority of the Secretary beyond 
that expressly provided to the Secretary in this title.
(h) Authorization of Appropriations.--There is authorized to be 
appropriated for the advisory committee $100,000 for each of years 2026 
through 2030.

SEC. 403. NATIONAL DIRECT CARE PROFESSIONAL COMPENSATION ADVISORY 
COUNCIL.

(a) Convening.--The Secretary shall convene a National Direct Care 
Professional Compensation Advisory Council to advise and provide 
recommendations, including identified best practices, to the Secretary 
on compensating direct care professionals.
(b) Membership.--
(1) In general.--The members of the Advisory Council shall 
consist of--
(A) the appointed members under paragraph (2); and
(B) the Federal members under paragraph (3).
(2) Appointed members.--In addition to the Federal members 
under paragraph (3), the Secretary shall appoint not more than 
15 voting members of the Advisory Council who are not 
representatives of Federal departments or agencies and who 
shall include at least 1 representative of each of the 
following:
(A) Direct care professionals.
(B) Older individuals eligible for long-term care 
services under a State Medicaid program.
(C) People with disabilities.
(D) Health care and social service providers.
(E) Employers of direct care professionals.
(F) State and local officials responsible for 
direct care professional policies in their 
jurisdictions.
(G) Accreditation bodies responsible for 
accrediting direct care professionals.
(H) Veterans who are older individuals or people 
with disabilities.
(I) Organizations representing workers, including 
labor organizations.
(J) As appropriate, other experts in direct care 
and advocacy organizations for the direct care 
professional workforce.
(3) Federal members.--The Federal members of the Advisory 
Council, who shall be nonvoting members, shall consist of the 
following:
(A) The Administrator of the Centers for Medicare & 
Medicaid Services (or the Administrator's designee).
(B) The Administrator of the Administration for 
Community Living (or the Administrator's designee who 
has experience in both aging and disability).
(C) The Secretary of Veterans Affairs (or the 
Secretary's designee).
(D) The Secretary of Labor (or the Secretary's 
designee).
(E) The Administrator of the Health Resources and 
Services Administration (or the Administrator's 
designee).
(F) The heads of other Federal departments or 
agencies (or their designees), including relevant 
departments or agencies that oversee labor and 
workforce, economic, government financial policies, 
community service, and other impacted populations, as 
appointed by the Secretary or the Chair of the Advisory 
Council.
(4) Diverse representation.--The Secretary shall ensure 
that the membership of the Advisory Council reflects the 
diversity of direct care professionals and individuals eligible 
for long-term care services under a State Medicaid program.
(c) Meetings.--The Advisory Council shall meet quarterly during the 
1-year period beginning on the date of enactment of this Act and at 
least 3 times during each year thereafter. Meetings of the Advisory 
Council shall be open to the public.
(d) Non-Federal Member Compensation.--
(1) Compensation of members.--A member of the Advisory 
Council who is not an officer or employee of the Federal 
Government shall be compensated at a rate equal to the daily 
equivalent of the annual rate of basic pay prescribed for level 
IV of the Executive Schedule under section 5315 of title 5, 
United States Code, for each day (including travel time) during 
which the member is engaged in the performance of the duties of 
the Commission.
(2) Travel expenses.--A member of the Advisory Council who 
is not an officer or employee of the Federal Government shall 
be allowed travel expenses, including per diem in lieu of 
subsistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
Code, while away from their homes or regular places of business 
in the performance of services for the Commission.
(3) Child care.--A member of the Advisory Council who is 
not an officer or employee of the Federal Government shall be 
permitted expenses for child care during the period for which 
they are required to meet with the Advisory Council or travel 
to and from meetings of the Advisory Council.
(4) Technology support.--A member of the Advisory Council 
who is not an officer or employee of the Federal Government 
shall be permitted expenses for technology necessary to 
participate in activities of the Advisory Council.
(e) Advisory Council Annual Reports.--
(1) In general.--Not later than 12 months after the date of 
enactment of this Act, and annually thereafter, the Advisory 
Council shall submit to the Secretary, the appropriate 
committees of Congress, and the State agencies responsible for 
carrying out direct care professional programs, and make 
publicly available on the internet website of the Department of 
Health and Human Services, a report concerning the development, 
maintenance, and updating of the Strategy, including a 
description of the outcomes of the recommendations and any 
priorities included in the initial report pursuant to paragraph 
(2), as appropriate.
(2) Initial report.--The Advisory Council's initial report 
under paragraph (1) shall include--
(A) an inventory and assessment of all federally 
funded efforts to compensate direct care professionals 
and the outcomes of such efforts, including analyses of 
the extent to which federally funded efforts are 
reaching direct care professionals and gaps in such 
efforts;
(B) recommendations--
(i) to improve and better coordinate 
Federal programs and activities to compensate 
direct care professionals, as well as 
opportunities to improve the coordination of 
such Federal programs and activities with State 
programs; and
(ii) to effectively deliver services based 
on the performance, mission, and purpose of a 
program while eliminating redundancies, 
avoiding unnecessary duplication and overlap, 
and ensuring the needs of direct care 
professionals are met;
(C) the identification of challenges faced by 
direct care professionals, including financial, health, 
and other challenges, and existing approaches to 
address such challenges; and
(D) an evaluation of how the status of the direct 
care professional workforce affects the Medicare 
program, the Medicaid program, and other Federal 
programs.
(f) Nonapplicability of Federal Advisory Committee Act.--Chapter 10 
of title 5, United States Code, shall not apply to the Advisory 
Council.

SEC. 404. SUNSET PROVISION.

The authority and obligations established by this title shall 
terminate on the date that is 10 years after the date of enactment of 
this Act.

TITLE V--IMPROVING OVERSIGHT AND ACCOUNTABILITY

SEC. 501. EVALUATION OF IMPLEMENTATION AND OUTCOMES.

(a) In General.--The Secretary of Health and Human Services, in 
conjunction with the Secretary of Labor, shall evaluate the 
implementation and outcomes of this Act in the aggregate through a 
contract with an external evaluator who has experience in evaluating--
(1) home and community-based services;
(2) disability programs;
(3) programs for older individuals;
(4) nursing homes and intermediate care facilities; and
(5) health care workforce programs, including direct care 
professional workforce programs.
(b) Evaluation Criteria.--The external evaluator shall document and 
evaluate the implementation and outcomes of this Act, and the 
amendments made by this Act, including outcomes based on--
(1) the impact on workforce creation, training, education, 
recruitment, retention, professional development, and 
advancement of the direct care professional workforce, 
including direct care professionals from low-income families;
(2) the economic effects, including the impact on 
compensation and benefits, on the direct care professional 
workforce;
(3) the impact on working conditions, including scheduling 
flexibility and stability, for direct care professionals;
(4) the impact of workforce investment activities, 
including supportive services, on recruitment, wages, benefits, 
and advancement of direct care professionals;
(5) the impact on burnout, attrition, and stability of the 
direct care professional workforce;
(6) the impact on vacancy rates and crude separation rates 
of the direct care professional workforce;
(7) the economic effects on--
(A) individuals enrolled for medical assistance 
under a State Medicaid program;
(B) people with disabilities and older individuals 
receiving long-term care services, including home and 
community-based services; and
(C) the families of any such individuals or persons 
described in subparagraph (A) or (B);
(8) the impact on the capacity of States to ensure the 
delivery of long-term care services and on the costs to the 
Medicare and Medicaid programs;
(9) the capacity of the direct care professional workforce 
to provide services for individuals needing long-term care 
services or changes in access, availability, and quality of 
long-term care services;
(10) the impact on State waiting lists for home and 
community-based services;
(11) the impact on mental health outcomes, including 
substance use disorders and suicidality, among direct care 
professionals;
(12) promising practices identified by activities 
authorized or conducted pursuant to this Act, or the amendments 
made by this Act; and
(13) any other factor as determined appropriate by the 
Secretary of Health and Human Services.
(c) Fiscal Analysis.--The Secretary of Health and Human Services, 
in conjunction with the Secretary of Labor, shall contract with an 
independent external evaluator to track spending by States and 
providers of funding provided to States under sections 101 and 102 
(including the amendments made by such sections). The evaluator shall--
(1) collect spending data from each State receiving funds 
under such sections;
(2) analyze the data to determine what percentage of 
funding under such sections was expended to improve wages and 
benefits of direct care professionals, disaggregated by 
subcategories of direct care professionals described in section 
3(11);
(3) beginning 2 years after the date of enactment of this 
Act, and every year thereafter through fiscal year 2040--
(A) publish an annual report of State spending and 
the analyses conducted under paragraph (2); and
(B) provide all such reports to the appropriate 
committees of Congress; and
(4) share the data described in paragraph (1) with 
researchers to encourage further analysis.
(d) Dissemination of Evaluation Findings.--The Secretary of Health 
and Human Services shall--
(1) disseminate the findings from the evaluations conducted 
under this section, and from any other evaluation conducted 
under this Act or an amendment made by this Act, to--
(A) all State Medicaid agencies; and
(B) the appropriate committees of Congress; and
(2) make all such findings publicly available in an 
accessible electronic format and any other accessible format 
determined appropriate by the Secretary.
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