,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #ijfg  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ah1 #bjbd,mr4  
,gu?rie introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to e/abli% a waiv] ( c]ta9 tra9+ & 
c]tification requirem5ts = specifi$     
skill$ nurs+ facilities & nurs+         
facilities4  #a4 ,%ort title ,?is ,act  
may be cit$ z ! ,build+ ,am]ica's ,heal?
 ,c>e ,work=ce ,act4  #b4 ,e/abli%+ a   
waiv] ( c]ta9 tra9+ & c]tification      
requirem5ts = specifi$ skill$ nurs+     
facilities & nurs+ facilities  7a7      
,m$ic>e ,section #ahai ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7l7 ,waiv] (    

c]ta9 tra9+ & c]tification requirem5ts =
 specifi$ skill$ nurs+ facilities  7#a7 
,election  7,a7 ,/ates ,a ,/ate may     
elect1 9 a =m & mann] specifi$ by !     
,secret>y1 = ! provisions ( subsections 
7b7 & 7f7 to be appli$ 9 accordance )   
p>agraph 7#b7 ) respect to specifi$     
skill$ nurs+ facilities 7z def9$ 9      
p>agraph 7#c77 locat$ 9 su* ,/ate4  7,b7
 ,specifi$ skill$ nurs+ facilities ,9 ! 
case ( a specifi$ skill$ nurs+ facility 
locat$ 9 a ,/ate t has n made ! election
 describ$ 9 subp>agraph 7,a71 su*       
facility may make su* election ) respect
 to su* facility 9 a =m & mann] specifi$
 by ! ,secret>y4  7#b7 ,waiv]s ,9 ! case
 ( a specifi$ skill$ nurs+ facility     
locat$ 9 a ,/ate t has made ! election  
describ$ 9 p>agraph 7#a7 7or1 ) respect 
to a specifi$ skill$ nurs+ facility     
locat$ 9 a ,/ate t has n made su*       
election1 9 ! case ( su* a facility t   
has made su* election71 ! ,secret>y     
%all-- 7,a7 apply subsection            
7b77#e77;,a7 z if ! ref]5ce to #d mon?s 

9 su* subsection 7 in/ead a ref]5ce to  
#ab mon?s1 except t su* ref]5ce %all    
cont9ue to be treat$ z a ref]5ce to #d  
mon?s = purposes ( apply+ ! requirem5t  
specifi$ 9 clause 7i77,,ii7 ( su*       
subsection2  7,b7 = purposes ( det]m9+  
:e!r a nurse aide tra9+ & compet5cy     
evaluation program (f]$ by or 9 su*     
facility complies ) ! requirem5ts = su* 
program specifi$ pursuant to subsection 
7f77#b77;,a77i71 all[ su* program to    
c\nt any h\rs work$ by a nurse aide 9 a 
skill$ nurs+ facility or nurs+ facility 
7z def9$ 9 section #aiai7;a77 t[>d ! #ge
 h\rs ( initial tra9+ describ$ 9        
subclause 7,,ii7 ( su* subsection2 &    
7,c7 9 ! case su* facility is a facility
 describ$ 9 subp>agraph 7,b77iii77,i7 ( 
subsection 7f77#b71 apply subp>agraph   
7,a77iv77,i7 ( su* subsection z if su*  
facility 7 n a facility s describ$1 b   
only if ! ,/ate 9 :i* ! facility is     
locat$ does n (f] a nurse aide compet5cy
 evaluation 79 p]son or onl9e7 at lea/  
once p] week or if availability is      

limit$4  7#c7 ,specifi$ skill$ nurs+    
facility def9$ ,= purposes ( ?is        
subsection1 ! t]m specifi$ skill$ nurs+ 
facility means a skill$ nurs+ facility  
t-- 7,a7 is locat$ 9 an area ( a ,/ate t
 ! ,/ate has designat$ z be+ a nurse    
aide %ortage area2 &  7,b7 has n receiv$
 a citation = a defici5cy = provid+ a   
sub/&>d quality ( c>e relat+ to direct  
pati5t c>e dur+ ! prec$+ #b ye>s4  4    
7b7 ,m$icaid ,section #aiai ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acifr7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7l7 ,waiv] ( c]ta9 tra9+ & 
c]tification requirem5ts = specifi$     
nurs+ facilities  7#a7 ,election  7,a7  
,/ates ,a ,/ate may elect1 9 a =m &     
mann] specifi$ by ! ,secret>y1 = !      
provisions ( subsections 7b7 & 7f7 to be
 appli$ 9 accordance ) p>agraph 7#b7 )  
respect to specifi$ nurs+ facilities 7z 
def9$ 9 p>agraph 7#c77 locat$ 9 su*     
,/ate4  7,b7 ,specifi$ nurs+ facilities 
,9 ! case ( a specifi$ nurs+ facility   
locat$ 9 a ,/ate t has n made ! election

 describ$ 9 subp>agraph 7,a71 su*       
facility may make su* election ) respect
 to su* facility 9 a =m & mann] specifi$
 by ! ,secret>y4  7#b7 ,waiv]s ,9 ! case
 ( a specifi$ nurs+ facility locat$ 9 a 
,/ate t has made ! election describ$ 9  
p>agraph 7#a7 7or1 ) respect to a       
specifi$ nurs+ facility locat$ 9 a ,/ate
 t has n made su* election1 9 ! case (  
su* a facility t has made su* election71
 ! ,secret>y %all-- 7,a7 apply          
subsection 7b77#e77;,a7 z if ! ref]5ce  
to #d mon?s 9 su* subsection 7 in/ead a 
ref]5ce to #ab mon?s1 except t su*      
ref]5ce %all cont9ue to be treat$ z a   
ref]5ce to #d mon?s = purposes ( apply+ 
! requirem5t specifi$ 9 clause 7i77,,ii7
 ( su* subsection2  7,b7 = purposes (   
det]m9+ :e!r a nurse aide tra9+ &       
compet5cy evaluation program (f]$ by or 
9 su* facility complies ) ! requirem5ts 
= su* program specifi$ pursuant to      
subsection 7f77#b77;,a77i71 all[ su*    
program to c\nt any h\rs work$ by a     
nurse aide 9 a nurs+ facility or skill$ 

nurs+ facility 7z def9$ 9 section       
#ahai7;a77 t[>d ! #ge h\rs ( initial    
tra9+ describ$ 9 subclause 7,,ii7 ( su* 
subsection2 &  7,c7 9 ! case su*        
facility is a facility describ$ 9       
subp>agraph 7,b77iii77,i7 ( subsection  
7f77#b71 apply subp>agraph 7,a77iv77,i7 
( su* subsection z if su* facility 7 n a
 facility s describ$1 b only if ! ,/ate 
9 :i* ! facility is locat$ does n (f] a 
nurse aide compet5cy evaluation 79 p]son
 or onl9e7 at lea/ once p] week or if   
availability is limit$4  7#c7 ,specifi$ 
nurs+ facility def9$ ,= purposes ( ?is  
subsection1 ! t]m specifi$ nurs+        
facility means a nurs+ facility t-- 7,a7
 is locat$ 9 an area ( a ,/ate t ! ,/ate
 has designat$ z be+ a nurse aide       
%ortage area2 &  7,b7 has n receiv$ a   
citation = a defici5cy = provid+ a      
sub/&>d quality ( c>e relat+ to direct  
pati5t c>e dur+ ! prec$+ #b ye>s4  4