,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #hfgg  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,augu/ #e1 #bjbb,ms4  
,s*ak[sky introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce  ,a ,,bill  ,to direct !       
,secret>y ( ,heal? & ,human ,s]vices1 9 
coord9ation ) ,/ate heal? dep>tm5ts1 to 
e/abli% a grant program to aw>d grants  
to nurs+ facilities to replace          
traditional nurs+ facilities )          
small-h\se nurs+ facilities1 & = o!r    
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,infra/ructure             
,mod]nization ,project ,relat$ to !     
,o,verall ,enhancem5t ( ,nurs+ ,homes   
,act or ! ,,improve ,nurs+ ,homes ,act4 
#b4 ,grants to develop small-h\se nurs+ 
facilities  7a7 ,e/abli%m5t ,= ! purpose
 describ$ 9 subsection 7b71 ! ,secret>y 
( ,heal? & ,human ,s]vices 79 ?is       
section ref]r$ to z ! ,secret>y71 act+  
?r\gh ! ,adm9i/rator ( ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices1 & 9         
coord9ation ) ,/ate heal? dep>tm5ts1    

%all e/abli% a grant program to aw>d    
grants to nurs+ facilities to conv]t    
traditional nurs+ facilities to         
small-h\se nurs+ facilities4  7b7       
,purpose ,! purpose ( ! grant program "u
 subsection 7a7 %all be to replace b$s  
us$ = long-t]m c>e 9 nurs+ facilities ) 
b$s us$ = long-t]m c>e 9 small-h\se     
nurs+ facilities1 includ+ by-- 7#a7     
increas+ ! total numb] ( su* b$s        
available 9 small-h\se nurs+ facilities 
z ( ! date ( enactm5t ( ?is ,act by     
#bej1jjj by ,janu>y #a1 #bjbh2 &  7#b7 )
 respect to ea* ,/ate 9 :i* a nurs+     
facility t receives a grant "u ?is ,act 
is locat$1 increas+ ! numb] (-- 7,a7    
small-h\se nurs+ facilities 9 op]ation 9
 ! ,/ate by n few] ?an five sites2 &    
7,b7 b$s available at su* nurs+         
facilities 9 ! ,/ate by n few] ?an #bej4
  7c7 ,use ( funds ,a nurs+ facility    
receiv+ a grant "u ?is section %all use 
! grant-- 7#a7 exclusively = conv]t+    
traditional nurs+ facilities to         
small-h\se nurs+ facilities2 &  7#b7 n =

 op]ation ( ! conv]t$ facilities4  7d7  
,requirem5ts ,z a condition on receipt (
 a grant "u ?is section1 a nurs+        
facility %all agree to ea* ( ! foll[+3  
7#a7 ,consultation 9 plann+ & design    
process ,! nurs+ facility w consult )   
resid5ts1 families1 a long-t]m c>e      
ombudsman1 direct c>e nurs+ home work]s1
 & a c]tifi$ m$ical director f !        
,am]ican ,bo>d ( ,po/-,acute &          
,long-,t]m ,c>e ,m$ic9e z "p (-- 7,a7 ! 
plann+ & design process = conv]t+       
traditional nurs+ facilities to         
small-h\se nurs+ facilities pursuant to 
! grant2 &  7,b7 obta9+ any necess>y    
regulatory approvals = su* facilities4  
7#b7 ,p]son-c5t]$ c>e  7,a7 ,9 g5]al    
,sites t receive fund+ %all agree to    
demon/rate p]son-c5t]$ c>e ^u completion
 ( con/ruction4 ,p]son-c5t]$ c>e %\ld be
 measur$ prior to />t+ con/ruction1 #c  
mon?s foll[+ move-9 at ! new small-h\se 
nurs+ facilities1 & annually !reaft] =  
#e ye>s4  7,b7 ,measurem5t ,! measurem5t
 describ$ 9 subp>agraph 7,a7 %all be    

done ?r\gh a p>tn]%ip e/abli%$ betwe5   
ea* site aw>d$ ! fund+1 a quality       
improvem5t organization1 ! ,dep>tm5t (  
,heal? & ,human ,s]vices ,(fice ( !     
,inspector ,g5]al1 & ! ,dep>tm5t ( ,h\s+
 & ,urban ,developm5t4 ,! quality       
improvem5t organization may be a        
,quality ,innovation ,network_/,quality 
,improvem5t ,organization 7,,q9_/,,qio74
 ,quality improvem5t organizations %\ld 
provide te*nical assi/ance = nurs+ home 
sites & advise sites 9 _! cont9u\s      
quality improvem5t ef=ts4  7,c7         
,practices ,p]son-c5t]$ c>e %all be     
measur$ via at lea/ ! foll[+ practices3 
food & dr9k are available #bd_/g2       
resid5ts are able to *oose :5 to g to b$
 & :5 to wake up2 resid5ts are able to  
easily & regul>ly access outdoor spaces2
 resid5ts h opportunities to engage 9   
activities promot+ relation%ip build+ t 
include diff]5t ages & abilities2       
p]son-c5t]$ c>e tra9+ is requir$ z "p ( 
on-bo>d+ = new /aff & is requir$ z "p ( 
cont9u+ education = all /aff2 resid5ts h

 opportunities = spontane\s & mean+ful  
enjoym5t ( simple daily pleasures2 !re  
is consi/5t assignm5t ( /aff to         
resid5ts2 & /aff le>n ab\t resid5ts'    
int]e/s1 memb]%ips1 & relation%ips1 &   
provide opportunities to cont9ue ^!4    
7,d7 ,eligibility ,if p]son-c5t]$ c>e   
improvem5t is n demon/rat$ )9 #b ye>s ^u
 completion ( con/ruction1 nurs+        
facilities t receiv$ project fund+ w n  
be eligible = ! next r\nd ( ^! ,f$]al   
grant funds4 ,if p]son-c5t]$ quality    
falls m ?an #aj p]c5t f ye> #b to ye>   
#e1 nurs+ facilities t receiv$ project  
fund+ w n be eligible = ! next r\nd ( ^!
 ,f$]al grant funds4  7#c7 ,m9imum ( #bj
 ye>s ( op]ation ,! nurs+ facility w    
provide = op]ation ( ! small-h\se nurs+ 
facilities fund$ pursuant to ! grant = a
 p]iod ( n less ?an #bj ye>s4  7e7      
,priority  7#a7 ,9 g5]al ,9 c>ry+ out   
subsection 7a71 ! ,secret>y %all give   
priority to a nurs+ facility bas$ on a  
demon/ration ( f9ancial ne$4  7#b7      
,consid]ations ,9 assess+ ! f9ancial ne$

 ( a nurs+ facility or purposes (       
p>agraph 7#a71 ! ,secret>y %all         
consid]-- 7,a7 ! ability ( ! p>5t       
company ( ! nurs+ facility to provide   
res\rces = conv]t+ traditional nurs+    
facilities to small-h\se nurs+          
facilities2  7,b7 ! p]c5tage ( su*      
facility's resid5ts :o are receiv+      
m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 = c>e provid$ at su*     
facility2 &  7,c7 ! track record ( !    
nurs+ facility & its p>5t company 9     
provid+ high-quality c>e4  7f7          
,application ,to seek a grant "u ?is    
section1 a nurs+ facility %all submit to
 ! ,secret>y an application at su* "t1 9
 su* mann]1 & conta9+ su* in=mation z ! 
,secret>y may require1 includ+ fund+    
available = con/ruction4  7g7 ,reports  
7#a7 ,grant recipi5t report ,z a        
condition on receipt ( a grant "u ?is   
section1 a nurs+ facility %all agree to 
submit to ! ,secret>y an annual report  
on ! activities conduct$ ?r\gh ! grant1 

includ+-- 7,a7 a breakd[n ( h[ & :5 !   
grant funds 7 us$2 &  7,b7 ) respect to 
ea* resid5t at su* facility1 any        
diff]5ce 9-- 7i7 quality ( c>e2 &  7ii7 
quality ( life4  7#b7 ,,gao report ,n   
lat] ?an ,june #a1 #bjbh1 ! ,comptroll] 
,g5]al ( ! ,unit$ ,/ates %all submit to 
,congress a report on ! grant program "u
 ?is section1 includ+-- 7,a7 a summ>y ( 
! reports "u p>agraph 7#a72 &  7,b7 a   
summ>y comp>+ ! quality ( c>e & quality 
( life among resid5ts :o are 9 a        
small-h\se nurs+ facility to resid5ts 9 
traditional nurs+ facilities4  7h7      
,davis-,bacon ,compliance  7#a7 ,9 g5]al
 ,all labor]s & me*anics employ$ by     
contractors or subcontractors to p]=m   
con/ruction1 alt]ation1 or repair on    
projects fund$ 9 :ole or 9 "p by ?is    
,act %all be paid wages at rates n less 
?an ^? prevail+ on projects ( a "*      
simil> 9 ! locality z det]m9$ by !      
,secret>y ( ,labor 9 accordance )       
sub*apt] ,,iv ( *apt] #ca ( title #dj1  
,unit$ ,/ates ,code 7commonly ref]r$ to 

z ! ,davis-,bacon ,act74  7#b7 ,au?ority
 ,) respect to ! labor /&>ds specifi$ 9 
p>agraph 7#a71 ! ,secret>y ( ,labor %all
 h ! au?ority & functions set =? 9      
,reorganization ,plan ,numb]$ #ad (     
#aiej 7#fd ,/at4 #abfg2 #e ,u4,s4,c4    
,app47 & section #cade ( title #dj1     
,unit$ ,/ates ,code4  7i7 ,def9itions ,9
 ?is ,act3 7#a7 ,small-h\se nurs+       
facility ,! t]m small-h\se nurs+        
facility means a nurs+ facility t       
includes ! foll[+3 7,a7 ,provides ea*   
resid5t-- 7i7 a s+le-occupancy room ) a 
private ba?room2 or  7ii7 at ! reque/ ( 
! resid5t1 a room ) a private ba?room to
 be %>$ ) ! resid5t's sp\se1 p>tn]1 or  
pref]r$ roommate4  7,b7 ,s]ves n m ?an  
#ab resid5ts-- 7i7 9 a sep>ate build+ = 
a nurs+ facility locat$ 9 a rural area2 
or  7ii7 9 a sep>ate build+1 a sep>ate  
floor1 or a sep>ate w+ = a nurs+        
facility locat$ 9 an urban area4  7,c7  
,uses appropriately skill$ /aff to      
provide all p]sonal c>e = resid5ts1     
includ+ cook+1 light h\sekeep+1 &       

laundry s]vice4  7,d7 ,assigns ea* nurs+
 assi/ant = ea* "w %ift to n m ?an "o   
nurs+ facility segm5t describ$ 9 clauses
 7i7 & 7ii7 ( subp>agraph 7,b74  7,e7   
,provides resid5t-c5t]$ c>e t all[s     
maximum level ( resid5t indep5d5ce4     
7#b7 ,nurs+ facility ,! t]m nurs+       
facility has ! mean+ giv5 su* t]m "u    
section #aiai ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr74  7#c7 ,rural   
area ,! t]m rural area means an area o!r
 ?an an urban area or an area contigu\s 
& adjac5t to an urban area4  7#d7 ,urban
 area ,! t]m urban area means a t[n or  
city t has a population ( great] ?an    
#ej1jjj resid5ts1 accord+ to ! ,c5sus   
,bureau's mo/ rec5t annual e/imates (   
resid5t population4  7j7 ,appropriations
  7#a7 ,9 g5]al ,to c>ry out ?is ,act1  
!re is au?oriz$ to be appropriat$       
#cj1jjj1jjj1jjj = ! p]iod ( fiscal ye>s 
#bjbd ?r\gh #bjbg4  7#b7 ,m9imum am\nts 
,( ! am\nts available "u p>agraph 7#a71 
! ,secret>y %all aw>d-- 7,a7 n less ?an 
#cj p]c5t to urban nurs+ facilities2    

7,b7 n less ?an #aj p]c5t to rural nurs+
 facilities2 &  7,c7 n less ?an #ej     
p]c5t to nurs+ facilities t h #he p]c5t 
or m resid5ts :o receive b5efits "u !   
,m$icaid program "u title ,,xix ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474