Investing in the nursing home workforce

(a) Medicare Section 1819(h) of the Social Security Act (42 U.S.C. 1395i–3(h)) is amended— (1) in paragraph (2)(B)(ii)(IV)(ff), by inserting, provided that not less than half of such amounts are provided to the State in which the facility is located for the purposes described in paragraph (7), after collected may; and (2) by adding at the end the following new paragraph: (7) Use of civil money penalty amounts to support the skilled nursing facility workforce (A) In general Subject to subparagraph (B), a State shall use the amounts provided to such State pursuant to paragraph (2)(B)(ii)(IV)(ff) for the fiscal year in which such amounts are provided for the following purposes: (i) Providing grants to entities such as educational institutions, advocacy organizations for skilled nursing facility residents, senior citizens, or individuals with disabilities, and unions that represent the skilled nursing facility workforce to support projects that use community-driven approaches to recruit, educate, and train individuals to expand the skilled nursing facility workforce. (ii) The funding of projects that develop new career pathway programs for the skilled nursing facility workforce. (iii) The repayment of student loans for qualified skilled nursing facility providers (as defined in subparagraph (C)) or the payment of tuition for such providers who commit to serving in a skilled nursing facility or a nursing facility (as defined in section 1919(a)) for not less than 3 years within a 10-year period. (B) Prohibitions on use of funds (i) Prohibition on providing funds to entities related to facilities A State may not provide any amounts provided to such State pursuant to paragraph (2)(B)(ii)(IV)(ff) to an entity that has a related party relationship with a nursing facility or skilled nursing facility in such State. (ii) Prohibition on using funds for reimbursement of costs incurred in completing nurse aide training and competency evaluation programs and nurse aide competency evaluation programs A State may not use any amounts provided to such State pursuant to paragraph (2)(B)(ii)(IV)(ff) to— (I) reimburse costs incurred in completing a nurse aide training and competency evaluation program or a nurse aide competency evaluation program under subsection (f)(2)(A); or (II) supplant the payment of such costs under such subsection. (C) Definitions In this paragraph: (i) Qualified skilled nursing facility provider The term qualified skilled nursing facility provider means— (I) a geriatrician or other physician, nurse practitioner, physician assistant, or other practitioner who provides services in a skilled nursing facility or nursing facility; or (II) a registered professional nurse, a licensed practical nurse (or a licensed vocational nurse), or a certified nursing assistant who provides direct care services to residents in a skilled nursing facility or nursing facility, as determined by the Secretary. (ii) Related party The term related party means an entity that, to a significant extent is associated or affiliated with, or has control of, or is controlled by, a nursing facility or skilled nursing facility. (D) Annual reporting (i) Report from States Not later than 1 year after the date of enactment of this paragraph, and annually thereafter, each State that receives amounts pursuant to paragraph (2)(B)(ii)(IV)(ff) shall submit to the Secretary a report describing— (I) how amounts received in the previous fiscal year were allocated; (II) the mechanisms to ensure such amounts benefit the development of the skilled nursing facility workforce; (III) how such amounts will impact measurable outcomes for residents of skilled nursing facilities and nursing facilities, such as staff vacancy rates, turnover rates, median hourly wages, staffing hours per resident, and resident quality outcomes; and (IV) how such State is ensuring compliance with subparagraph (B). (ii) Report to Congress Not later than 180 days after the Secretary receives the annual reports from States under clause (i), the Secretary shall submit to Congress a report describing the information contained in such reports.. (b) Medicaid Section 1919(h) of the Social Security Act (42 U.S.C. 1396r(h)) is amended— (1) in paragraph (2)(A)(ii)— (A) in the second sentence, by striking Funds collected and inserting Subject to the last sentence of this clause, funds collected; and (B) by inserting the following sentence at the end: Not less than half of the funds collected pursuant to this clause shall be used for the purposes described in paragraph (10).; (2) in paragraph (3)(C)(ii)(IV)(ff), by inserting, provided that not less than half of such amounts are provided to the State in which the facility is located for the purposes described in paragraph (10),; and (3) by adding at the end the following new paragraph: (10) Use of civil money penalty amounts to support the nursing facility workforce (A) In general Subject to subparagraph (B), a State shall use not less than half of the funds collected under paragraph (2)(A)(ii) and the amounts provided to such State pursuant to paragraph (3)(C)(ii)(IV)(ff) (collectively referred to in this paragraph as civil money penalty amounts) for the fiscal year in which such amounts are collected or provided for the following activities: (i) Providing grants to entities such as educational institutions, advocacy organizations for nursing facility residents, senior citizens, or individuals with disabilities, and unions that represent the nursing facility workforce to support projects that use community-driven approaches to recruit, educate, and train individuals to expand the nursing facility workforce. (ii) The funding of projects that develop new career pathway programs for the nursing facility workforce. (iii) The repayment of student loans for qualified nursing facility providers (as defined in subparagraph (C)) or the payment of tuition for such providers who commit to serving in a skilled nursing facility (as defined in section 1819(a)) or a nursing facility for not less than 3 years within a 10-year period. (B) Prohibition on use of funds (i) Prohibition on providing funds to entities related to facilities A State may not provide any civil money penalty amounts to an entity that has a related party relationship with a nursing facility or skilled nursing facility in such State. (ii) Prohibition on using funds for reimbursement of costs incurred in completing nurse aide training and competency programs and nurse aide competency evaluation programs A State may not use any civil money penalty amounts to— (I) reimburse costs incurred in completing a nurse aid training and competency evaluation program or a nurse aide competency evaluation program under subsection (f)(2)(A); or (II) supplant the payment of such costs under such subsection. (C) Definitions In this paragraph: (i) Qualified nursing facility provider The term qualified nursing facility provider means— (I) a geriatrician or other physician, nurse practitioner, physician assistant, or other practitioner who provides services in a skilled nursing facility or nursing facility; or (II) a registered professional nurse, licensed practical nurse (or a licensed vocational nurse), or certified nursing assistant who provides direct care services to residents in a skilled nursing facility or nursing facility, as determined by the Secretary. (ii) Related party The term related party means an entity that, to a significant extent is associated or affiliated with, or has control of, or is controlled by, a nursing facility or skilled nursing facility. (D) Annual reporting (i) Report from States Not later than 1 year after the date of enactment of this paragraph, and annually thereafter, each State that receives any civil money penalty amounts shall submit to the Secretary a report describing— (I) how amounts received in the previous fiscal year were allocated; (II) the mechanisms to ensure such amounts benefit the development of the nursing facility workforce; (III) how such amounts will impact measurable outcomes for residents of skilled nursing facilities and nursing facilities, such as staff vacancy rates, turnover rates, median hourly wages, staffing hours per resident, and resident quality outcomes; and (IV) how such State is ensuring compliance with subparagraph (B). (ii) Report to Congress Not later than 180 days after the Secretary receives the annual reports from States under clause (i), the Secretary shall submit to Congress a report describing the information contained in such report..