,i #aaith ,,congress #b;d ,session ,h4 ,r4 #heda ,,in ,,the ,,house ,,of ,,representatives ,april #bh1 #bjbf,mrs4 ,dingell 7for herself and ,ms4 ,matsui7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and ,workforce1 ,ways and ,means1 the ,judiciary1 ,house ,administration1 and ,oversight and ,government ,reform1 for a period to be subsequently determined by the ,speaker1 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 workforce1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,in general ,this ,act may be cited as the ,long-,term ,care ,workforce ,support ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings and purposes4 ,sec4 #c4 ,definitions4 ,,title ,i--,improving ,reimbursement ,sec4 #aja4 ,additional support for ,medicaid long-term care services provided by direct care professionals4 ,sec4 #ajb4 ,additional support for ,medicaid long-term care services and direct care professionals4 ,sec4 #ajc4 ,making permanent the ,state option to extend protection under ,medicaid for recipients of home and community-based services against spousal impoverishment4 ,sec4 #ajd4 ,permanent extension of money follows the person rebalancing demonstration4 ,,title ,,ii--,training1 ,recruitment1 ,career ,advancement1 and ,worker ,supports ,subtitle ,a--,improving ,workforce ,training ,chapter #a--;,grants for ,supporting the ,direct ,care ,professional ,workforce ,sec4 #bja4 ,definitions4 ,sec4 #bjb4 ,authority to award grants4 ,sec4 #bjc4 ,project plans4 ,sec4 #bjd4 ,uses of funds2 supplement1 not supplant4 ,chapter #b--,other workforce training grants ,sec4 #bje4 ,workforce investment activities grants for domestic workers4 ,sec4 #bjf4 ,direct care professional career advancement demonstration projects4 ,sec4 #bjg4 ,pathways to health careers4 ,sec4 #bjh4 ,increasing workforce diversity in allied health professionals and direct support professionals4 ,subtitle ,b--,improving ,workforce ,recruitment ,sec4 #baa4 ,technical assistance center for building the direct care professional workforce4 ,sec4 #bab4 ,report on efforts to enhance the direct care professional workforce4 ,sec4 #bac4 ,comprehensive geriatric education4 ,sec4 #bad4 ,review of the availability and quality of apprenticeship programs in long-term care settings4 ,sec4 #bae4 ,rural health workforce grant program4 ,subtitle ,c--,providing career advancement opportunities2 assessment of worker well-being ,sec4 #bba4 ,assessment of direct care professional well-being4 ,sec4 #bbb4 ,national ,direct ,care ,professional ,training ,standards ,commission4 ,subtitle ,d--,increasing supports for the existing direct care professional workforce ,sec4 #bca4 ,mental health services4 ,sec4 #bcb4 ,dissemination of best practices with respect to mental health of direct care professionals4 ,sec4 #bcc4 ,education and awareness initiative encouraging use of mental health and substance use disorder services by direct care professionals4 ,sec4 #bcd4 ,direct care professional training grants4 ,sec4 #bce4 ,credit for certain health care professionals4 ,sec4 #bcf4 ,direct ,care ,professional ,workforce ,equity ,technical ,assistance ,center4 ,,title ,,iii--,workforce labor protections ,subtitle ,a--,long-term ,care ,workforce ,wage ,theft ,prevention and ,wage ,recovery ,act ,sec4 #cja4 ,definitions4 ,sec4 #cjb4 ,direct care professional workforce wage theft prevention and wage recovery grant program4 ,subtitle ,b--,direct care professional rights ,sec4 #caa4 ,definitions4 ,sec4 #cab4 ,written agreements4 ,sec4 #cac4 ,fair scheduling practices4 ,sec4 #cad4 ,right to request and receive temporary changes to scheduled work hours due to personal events4 ,sec4 #cae4 ,privacy4 ,sec4 #caf4 ,breaks for meals and rest4 ,sec4 #cag4 ,prohibited acts4 ,sec4 #cah4 ,enforcement authority4 ,sec4 #cai4 ,effect on existing employment benefits and other laws4 ,subtitle ,c--,workplace ,violence ,prevention for ,health ,care and ,social ,services ,workers ,act ,sec4 #cba4 ,workplace ,violence ,prevention ,standard4 ,sec4 #cbb4 ,scope and application4 ,sec4 #cbc4 ,requirements for ,workplace ,violence ,prevention ,standard4 ,sec4 #cbd4 ,rules of construction4 ,sec4 #cbe4 ,definitions4 ,sec4 #cbf4 ,application of the ,workplace ,violence ,prevention ,standard to certain facilities receiving ,medicare funds4 ,subtitle ,d--,improving access to job benefits ,sec4 #cca4 ,definitions4 ,sec4 #ccb4 ,paid sick time4 ,sec4 #ccc4 ,notice requirement4 ,sec4 #ccd4 ,prohibited acts4 ,sec4 #cce4 ,enforcement authority4 ,sec4 #ccf4 ,education and outreach4 ,sec4 #ccg4 ,effect on existing employment benefits4 ,sec4 #cch4 ,encouragement of more generous leave policies4 ,sec4 #cci4 ,regulations4 ,sec4 #cci;,a4 ,effective date4 ,sec4 #cci;,b4 ,collection of data and further study4 ,,title ,,iv--,national ,direct ,care ,professional ,compensation ,strategy ,sec4 #dja4 ,definitions4 ,sec4 #djb4 ,national ,direct ,care ,professional ,compensation ,strategy4 ,sec4 #djc4 ,national ,direct ,care ,professional ,compensation ,advisory ,council4 ,sec4 #djd4 ,sunset provision4 ,,title ,v--,improving oversight and accountability ,sec4 #eja4 ,evaluation of implementation and outcomes4 #b4 ,findings and purposes 7a7 ,findings ,congress finds the following3 7#a7 ,the nearly #e1jjj1jjj direct care professionals in the ,united ,states play a vital role in supporting the health1 well-being1 and independence of older individuals and people with disabilities4 7#b7 ,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 rates4 7#c7 ,there will be an estimated #i1cjj1jjj total direct care professional job openings from #bjba to #bjca1 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 workforce4 7#d7 ,workforce turnover and shortages have a direct impact on older individuals1 people with disabilities1 and their families who suffer because they cannot get the high-quality care that they need and deserve4 7#e7 ,the median hourly wage for all direct care professionals in #bjbb was only #ae4dc1 with home care workers earning the least4 7#f7 ,one in #h direct care professionals live in poverty and three quarters earn less than the average living wage in their ,state4 7#g7 ,forty-six percent of direct care professionals rely on public assistance1 such as ,medicaid1 food and nutrition assistance1 or cash assistance4 7#h7 ,direct care professionals report high levels of burnout and professional fatigue from their physically and emotionally demanding work1 lack of respect for the essential1 skilled care they provide1 and lasting trauma from battling the ,,covid-#ai pandemic1 all of which further drives high turnover4 7#i7 ,the long-term care industry is struggling to hire and retain direct care professionals1 with a national turnover rate between #gg to nearly #ajj percent4 7#aj7 ,ninety-two percent of nursing home respondents and nearly #gj percent of assisted living facilities surveyed report significant or severe workforce shortages4 7#aa7 ,more than half of nursing homes surveyed in #bjbb reported that they limited new patient admissions due to staffing shortages4 7#ab7 ,a survey of ,state home and community-based services 7referred to in this section as ,,hcbs7 programs showed that every ,state reports a shortage of workers1 and in #dc ,states1 some ,,hcbs providers have closed permanently4 7#ac7 ,the low-quality of direct care professional jobs reflects and perpetuates the racial and gender inequities faced by direct care professionals1 who are disproportionately women1 immigrants1 and people of color4 7#ad7 ,efforts to support the direct care professional workforce have focused on specific care settings1 even though these issues are widespread across the long-term care landscape and direct care professionals across settings face similar challenges of low wages1 few benefits1 limited training and support1 worker exploitation1 and a lack of meaningful career ladders4 7#ae7 ,stabilizing1 growing1 and supporting the direct care professional workforce across the continuum of long-term care is essential to ensuring a strong1 qualified pipeline of workers1 and improving the lives of direct care professionals and the older individuals1 people with disabilities1 and the families and communities that they support4 7b7 ,purposes ,the purposes of this ,act are as follows3 7#a7 ,to increase the capacity of the direct care professional workforce to ensure that older individuals1 people with disabilities1 and their families receive the services they need in the settings of their choice as they deserve to live healthy1 independent lives4 7#b7 ,to increase compensation so that direct care professionals are paid a living wage and have access to essential job benefits1 and so that direct care professional jobs are good jobs4 7#c7 ,to ensure that direct care professionals are treated with respect1 provided with a safe working environment1 protected from exploitation1 and fairly compensated for the skilled work they do4 7#d7 ,to improve access to and quality of long-term care1 including collecting meaningful and actionable data on the direct care professional workforce and the people they support4 7#e7 ,to eliminate the race1 gender1 sexual orientation1 age1 and gender identity disparities that exist across the direct care professional workforce4 7#f7 ,to strengthen the direct care professional workforce in order to support the #ec1jjj1jjj 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 homes1 communities1 and residential settings4 #c4 ,definitions ,in this ,act3 7#a7 ,activities of daily living ,the term activities of daily living means basic1 personal1 everyday activities1 including tasks such as eating1 toileting1 grooming1 dressing1 bathing1 and transferring4 7#b7 ,aging and disability resource center ,the term ,aging and ,disability ,resource ,center has the meaning given such term in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#c7 ,apprenticeship program ,the term apprenticeship program means an apprenticeship program registered under the ,act of ,august #af1 #aicg 7commonly known as the ,national ,apprenticeship ,act2 #ej ,stat4 #ffd1 chapter #ffc2 #bi ,u4,s4,c4 #ej et seq471 including any requirement1 standard1 or rule promulgated under such ,act4 7#d7 ,appropriate committees of ,congress ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,finance of the ,senate2 7,b7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7,c7 the ,special ,committee on ,aging of the ,senate2 7,d7 the ,committee on ,ways and ,means of the ,house of ,representatives2 7,e7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 and 7,f7 the ,committee on ,education and ,workforce of the ,house of ,representatives4 7#e7 ,area agency on aging ,the term area agency on aging has the meaning given such term in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#f7 ,assisted living facility ,the term assisted living facility means an adult care facility that-- 7,a7 is a residential care setting licensed and regulated by the ,state in which the facility is located 7or1 if there is no ,state law providing for such licensing and regulation by the ,state1 by the municipality or other political subdivision in which the facility is located72 7,b7 7i7 makes available to residents supportive services to assist the residents in carrying out activities of daily living2 7ii7 provides #bd-;hour on-site monitoring1 personal care planning1 food services1 and personal care2 and 7iii7 may make available to residents home health care services1 such as nursing and therapy2 and 7,c7 provides dwelling units for residents1 each of which may contain a full kitchen1 bedroom1 and bathroom1 and which includes common rooms and other facilities appropriate for the provision of supportive services to the residents of the facility4 7#g7 ,certified nursing assistant ,the term certified nursing assistant means a nurse aide who has completed a ,state-approved training and competency evaluation program4 7#h7 ,commerce ,except as provided in section #cca1 the term commerce has the meaning given such term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7#i7 ,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 degree1 including ,tribal ,colleges or ,universities receiving grants under section #caf of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;c7 that offer a #b-year program for completion of such degree and ,state public institutions of higher education that offer such a #b-year program4 7#aj7 ,developmental disability ,the term developmental disability has the meaning given such term in section #ajb of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejjb74 7#aa7 ,direct care professional ,the term direct care professional means-- 7,a7 a personal or home care aide2 7,b7 a home and community-based services worker2 7,c7 a direct support professional2 7,d7 a certified nursing assistant2 7,e7 a nurse aide or nursing assistant2 7,f7 a respite care provider2 7,g7 a paid family caregiver2 7,h7 a home health aide2 7,i7 a private duty nurse2 or 7,j7 any other individual providing relevant services 7as determined by the ,secretary of ,health and ,human ,services7 for compensation1 in the course of the profession of such individual1 at a long-term care setting to a resident of such setting4 7#ab7 ,direct care professional manager ,the term direct care professional manager means a person who is a manager1 or supervisory staff1 with coaching1 training1 managerial1 supervisory1 or other oversight responsibilities of direct care professionals4 7#ac7 ,direct care professional workforce ,the term direct care professional workforce means the broad workforce of direct care professionals across all long-term care settings4 7#ad7 ,disability ,the term disability1 except as provided in paragraph 7#aj71 has the meaning given such term in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#ae7 ,domestic partner 7,a7 ,in general ,the term domestic partner1 with respect to an individual1 means another individual with whom the individual is in a committed relationship4 7,b7 ,committed relationship defined ,the term committed relationship for purposes of subparagraph 7,a7-- 7i7 means a relationship between #b individuals1 each at least #ah years of age1 in which both individuals share responsibility for a significant measure of each other's common welfare2 and 7ii7 includes any such relationship between #b individuals1 including individuals of the same sex1 that is granted legal recognition by a ,state or political subdivision of a ,state as a marriage or analogous relationship1 including a civil union or domestic partnership4 7#af7 ,employ ,the term employ has the meaning given the term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7#ag7 ,employee2 employer ,except as provided in section #cca1 the terms employee and employer have the meanings given such terms in section #c of such ,act4 7#ah7 ,home and community-based services ,the term home and community-based services means any of the following 7whether provided on a fee-for-service1 risk1 or other basis73 7,a7 ,home health care services authorized under paragraph 7#g7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a774 7,b7 ,personal care services authorized under paragraph 7#bd7 of such section4 7,c7 ,,pace services authorized under paragraph 7#bf7 of such section4 7,d7 ,home and community-based services authorized under subsections 7b71 7c71 7i71 7j71 and 7k7 of section #aiae of such ,act 7#db ,u4,s4,c4 #acifn71 such services authorized under a waiver under section #aaae of such ,act 7#db ,u4,s4,c4 #acae71 and such services provided through coverage authorized under section #aicg of such ,act 7#db ,u4,s4,c4 #acifu-#g74 7,e7 ,case management services authorized under section #aije7;a77#ai7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ai77 and section #aiae7;g7 of such ,act 7#db ,u4,s4,c4 #acifn7g774 7,f7 ,rehabilitative services1 including those related to behavioral health1 described in section #aije7;a77#ac7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#ac774 7,g7 ,such other services specified by the ,secretary of ,health and ,human ,services4 7#ai7 ,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 7c7 or 7i7 of section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7 or1 as relevant1 demonstration projects authorized under section #aaae of such ,act 7#db ,u4,s4,c4 #acae71 are provided to individuals enrolled for medical assistance under a ,state plan under title ,,xix 7or under a waiver of such a plan74 7#bj7 ,home and community-based services worker ,the term home and community-based services worker-- 7,a7 means an individual who provides home and community-based services for compensation2 and 7,b7 may include individuals described in subparagraph 7,a7 who are physical therapists1 occupational therapists1 or speech or language therapists4 7#ba7 ,indian ,tribe2 ,tribal organization ,the terms ,indian ,tribe and ,tribal organization have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#bb7 ,institution of higher education ,the term institution of higher education means-- 7,a7 an institution of higher education defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja72 or 7,b7 an institution of higher education defined in section #ajb7;a77#a77;,b7 of such ,act 7#bj ,u4,s4,c4 #ajjb7;a77#a77;,b774 7#bc7 ,instrumental activities of daily living ,the term instrumental activities of daily living means tasks that are not necessary for fundamental functioning1 but allow an individual to live independently in a community of daily living4 ,such tasks include-- 7,a7 housekeeping and room cleaning2 7,b7 meal preparation2 7,c7 taking medications2 7,d7 laundry2 7,e7 transportation2 7,f7 shopping for groceries1 clothing1 or other items2 7,g7 managing communications1 such as using the telephone2 7,h7 managing finances2 7,i7 writing letters2 and 7,j7 obtaining appointments4 7#bd7 ,local educational agency ,the term local educational agency has the meaning given the term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#be7 ,long-term care services ,the term long-term care services means any services provided by a direct care professional in a long-term care setting4 7#bf7 ,long-term care setting ,the term long-term care setting means-- 7,a7 a nursing home2 7,b7 a home and community-based services setting2 7,c7 an assisted living facility2 7,d7 an intermediate care facility2 7,e7 a ,state home1 as defined in section #aja7ai7 of title #ch1 ,united ,states ,code2 7,f7 a ,tribal nursing home operated pursuant to an ,indian health program 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 7,g7 a private home2 7,h7 a respite setting2 or 7,i7 any other setting in which an individual provides relevant services 7as determined by the ,secretary of ,health and ,human ,services71 in the course of the profession of such individual1 to a resident of such setting4 7#bg7 ,medicaid program ,the term ,medicaid program means1 with respect to a ,state1 the ,state program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7including any waiver or demonstration under such title or under section #aaae of such ,act 7#db ,u4,s4,c4 #acae7 relating to such title74 7#bh7 ,nurse aide ,the term nurse aide has the meaning given such term in section #aiai7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7b77#e774 7#bi7 ,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 staff1 which may include performing duties such as-- 7,a7 monitoring of the health status1 feeding1 bathing1 dressing1 grooming1 toileting1 or ambulation of patients or residents in a health facility or nursing home2 and 7,b7 medication administration and other health-related tasks of patients in a health facility or nursing home4 7#cj7 ,nursing home ,the term nursing home means-- 7,a7 a nursing facility as defined in section #aiai7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7a772 or 7,b7 a skilled nursing facility as defined in section #ahai7;a7 of such ,act 7#db ,u4,s4,c4 #acie;i-#c7;a774 7#ca7 ,older individual ,the term older individual has the meaning given the term in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#cb7 ,personal or home care aide 7,a7 ,in general ,the term personal or home care aide means an individual who helps older individuals and people with serious illness1 physical disability1 cognitive impairment 7including ,alzheimer's disease or other dementias1 a developmental disability1 or another disability involving a mental impairment7 to live in their own home or a residential care facility 7such as a nursing home1 assisted living facility1 or any other facility the ,secretary of ,health and ,human ,services determines appropriate that is not described in subparagraph 7,b77i77 by providing personal care services for compensation4 7,b7 ,personal care services ,for purposes of subparagraph 7,a71 the term personal care services means assistance or services-- 7i7 provided to an individual who is not an inpatient or resident of a hospital or institution for mental disease2 and 7ii7 that enable the recipient to accomplish activities of daily living or instrumental activities of daily living4 7#cc7 ,secondary school ,the term secondary school has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#cd7 ,self-directed care professional ,the term self-directed care professional 7also known as an independent provider7-- 7,a7 means a direct care professional who is employed by an individual who is an older individual1 a person with a disability1 or a representative of such older individual or person with a disability1 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 services2 and 7,b7 includes paid family caregivers4 7#ce7 ,state ,the term ,state1 except as otherwise provided in this ,act1 has the meaning given such term for purposes of title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#cf7 ,state educational agency ,the term ,state educational agency has the meaning given the term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#cg7 ,urban ,indian organization ,the term urban ,indian organization has the meaning given the term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7#ch7 ,workforce ,innovation and ,opportunity ,act terms ,the terms career pathway1 career planning1 in-demand industry sector or occupation1 individual with a barrier to employment1 local board1 on-the-job training1 recognized postsecondary credential1 region1 and ,state board have the meanings given such terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#ci7 ,work-based learning ,the term work-based learning has the meaning given such term in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf 7#bj ,u4,s4,c4 #bcjb74 ,i ,improving ,reimbursement #aja4 ,additional support for ,medicaid long-term care services provided by direct care professionals ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ii7 and inserting 7ii71 and 7kk72 and 7#b7 by adding at the end the following new subsection3 7kk7 ,additional support for long-,term care services provided by direct care professionals 7#a7 ,in general ,notwithstanding subsections 7b7 and 7ff71 in the case of a ,state that satisfies the conditions described in paragraph 7#b71 for each fiscal quarter during the period of fiscal years #bjbf through #bjce1 the ,federal medical assistance percentage otherwise determined for such ,state under such subsection 7b7 or 7ff7 shall1 after the application of any other increase to the ,federal medical assistance percentage for the ,state and quarter applicable under any other provision of law1 be increased by #aj percentage points 7but not to exceed #ie percent7 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 quarter4 7#b7 ,requirements ,as a condition for receipt of the increase under paragraph 7#a7 to the ,federal medical assistance percentage determined for a ,state1 the ,state shall submit to the ,secretary1 at such time and in such manner as specified by the ,secretary1 an application that includes1 in addition to such other information as the ,secretary shall require-- 7,a7 a description of which activities described in paragraph 7#d7 that a ,state plans to implement and a description of how it plans to implement such activities2 7,b7 assurances that all ,federal funds attributable to the increase under paragraph 7#a7 will be-- 7i7 expended by the ,state in accordance with this subsection not later than ,september #cj1 #bjcg2 and 7ii7 used-- 7,i7 to implement the activities described in paragraph 7#d72 7,,ii7 to supplement1 and not supplant1 the level of ,state funds expended for long-term care services provided by direct care professionals under the ,state plan 7or under a waiver of such plan7 as of the date of enactment of this subsection2 and 7,,iii7 to increase reimbursement rates for long-term care services provided by direct care professionals under the ,state plan 7or under a waiver of such plan7 to a level that will support recruitment and retention of a sufficient workforce to provide such services under the ,state plan 7or waiver72 7,c7 assurances that the ,state will use a portion of the ,federal funds attributable to the increase under paragraph 7#a7 to ensure greater service capacity1 including reducing waiting lists and improving compensation1 benefits1 working conditions1 and training for direct care professionals and direct care managers2 and 7,d7 assurances that the ,state will conduct adequate oversight and ensure the validity of such data as may be required by the ,secretary4 7#c7 ,approval of application ,not later than #ij days after the date of submission of an application of a ,state under paragraph 7#b71 the ,secretary shall certify if the application is complete4 ,upon certification that an application of a ,state is complete1 the application shall be deemed to be approved for purposes of this section4 7#d7 ,activities to improve the direct care professional workforce 7,a7 ,in general ,a ,state shall work with community partners such as ,area ,agencies on ,aging1 centers for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc1 nonprofit long-term care services providers1 and other entities to implement some or all of the purposes described in subparagraph 7,b74 7,b7 ,focused areas of improvement ,the purposes described in this paragraph1 with respect to a ,state1 are the following3 7i7 ,to increase rates for service provider agencies that employ direct care professionals 7including independent providers in a self-directed or consumer-directed model7 to provide long-term care services under the ,state plan 7or under a waiver of such plan71 provided that any service provider agency or individual that receives payment under such an increased rate increases the compensation it pay its direct care professionals4 7ii7 ,to provide paid sick leave1 paid family leave1 and paid medical leave for direct care professionals4 7iii7 ,to provide hazard pay1 overtime pay1 and shift differential pay for direct care professionals4 7iv7 ,to improve stability of direct care professional jobs1 including consistent hours1 scheduling1 pay1 and benefit eligibility4 7v7 ,to provide home and community-based services to individuals who are on waiting lists for programs approved under sections #aaae or #aiae4 7vi7 ,to purchase emergency supplies and equipment1 which may include items not typically covered under the ,state plan 7or under a waiver of such plan71 such as personal protective equipment1 necessary to enhance access to services and to protect the health and well-being of direct care professionals4 7vii7 ,to pay for the travel of direct care professionals to conduct their job responsibilities4 7viii7 ,to recruit new direct care professionals4 7ix7 ,to pay for training for direct care professionals1 including apprenticeship programs4 7x7 ,to pay for assistive technologies1 staffing1 and training to facilitate eligible individuals' communication1 and other costs incurred in order to facilitate community integration and ensure an individual's person-centered service plan is fully implemented4 7xi7 ,to prepare information and public health and educational materials in accessible formats 7including formats accessible to people with low literacy or intellectual disabilities about prevention1 treatment1 recovery1 and other aspects of communicable diseases and threats to the health of individuals who are enrolled for medical assistance under the ,state plan 7or under a waiver of such plan771 their families1 and the general community served by agencies described in clause 7i74 7xii7 ,to protect the health and safety of direct care professionals during public health emergencies and natural disasters4 7xiii7 ,to pay for interpreters to assist in providing long-term care services to individuals under the ,state plan 7or under a waiver of such plan7 and to inform the general public about communicable diseases and other public health threats4 7xiv7 ,to pay for other expenses deemed appropriate by the ,secretary to enhance1 expand1 or strengthen long-term care services under the ,state plan 7or under a waiver of such plan74 7#e7 ,reporting requirements 7,a7 ,state reporting requirements ,not later than ,december #ca1 #bjbh1 and every #b years thereafter until ,december #ca1 #bjdj1 any ,state with respect to which an application is approved by the ,secretary pursuant to paragraph 7#c7 shall submit a report to the ,secretary that contains the following information3 7i7 ,activities and programs that were funded using ,federal funds attributable to the increase to the ,federal medical assistance percentage of the ,state under paragraph 7#a74 7ii7 ,the number of individuals enrolled under the ,state plan 7or under a waiver of such plan7 who were served by such activities and programs4 7iii7 ,a detailed accounting of all spending of funds attributable to the increase to the ,federal medical assistance percentage of the ,state under paragraph 7#a7 by the ,state and by any providers with whom the ,state entered into contracts or agreements to fulfill the requirements of this subsection4 7,b7 ,non-application of the paperwork reduction act ,chapter #ce of title #dd1 ,united ,states ,code 7commonly referred to as the ,paperwork ,reduction ,act of #aiie71 shall not apply to the provisions of this subsection4 7#f7 ,enforcement 7,a7 ,in general ,if the ,secretary determines that a ,state with respect to which an application is approved pursuant to paragraph 7#c7 has failed to comply with the requirements of this subsection 7including the requirement that all ,federal funds attributable to the increase to the ,federal medical assistance percentage of the ,state under paragraph 7#a7 be spent in accordance with paragraph 7#d77 for any quarter during the period of fiscal years described in paragraph 7#a71 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 7#a7 for such quarter4 7,b7 ,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 subsection4 7#g7 ,evaluation ,not later than #bjbh and annually until #bjcg1 the ,secretary1 in conjunction with the ,secretary of ,labor1 shall evaluate the implementation and outcomes of this subsection on the availability of staff to cover shifts in all long-term care settings serving1 worker credentials and skills1 and worker compensation through a contract with an external evaluator who has experience with evaluation related to people with disabilities and older individuals4 7#h7 ,definitions ,in this subsection3 7,a7 ,direct care professional ,the term direct care professional has the meaning given such term in section #c of the ,long-,term ,care ,workforce ,support ,act4 7,b7 ,home and community-based services ,the term home and community-based services means any of the following3 7i7 ,home health care services authorized under paragraph 7#g7 of subsection 7a74 7ii7 ,personal care services authorized under paragraph 7#bd7 of such subsection4 7iii7 ,,pace services authorized under paragraph 7#bf7 of such subsection4 7iv7 ,home and community-based services authorized under subsections 7b71 7c71 7i71 7j71 and 7k7 of section #aiae1 such services authorized under a waiver under section #aaae1 and such services through coverage authorized under section #aicg4 7v7 ,case management services authorized under subsection 7a77#ai7 of this section and section #aiae7;g74 7vi7 ,rehabilitative services1 including those related to behavioral health1 described in subsection 7a77#ac7 of this section4 7vii7 ,such other services specified by the ,secretary4 4 #ajb4 ,additional support for ,medicaid long-term care services and direct care professionals 7a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to ,states for the purpose of supporting and strengthening services provided by direct care professionals across direct care settings and improving recruitment1 compensation1 and retention of the direct care professional workforce4 7b7 ,application ,not later than #f months after the date of enactment of this ,act1 each ,state that seeks to receive a grant under this section shall submit an application1 in such form and manner as the ,secretary shall require1 to the ,secretary that includes-- 7#a7 information on how the ,state will use grant funds to improve long-term care services and the recruitment1 compensation1 and retention of direct care professionals in a manner that maximizes the independence of people with disabilities and older individuals1 limits unnecessary institutionalization1 and supports people living in residential settings2 7#b7 specifies the proportion of grant funds that the ,state plans to spend on activities to support long-term professional care workers in nursing homes1 home health settings1 and home and community-based services settings1 respectively2 7#c7 a plan for sustaining the work at the conclusion of the grant period2 and 7#d7 such other information as the ,secretary shall require4 7c7 ,grant ,amounts ,the ,secretary shall award each ,state that submits an application to the ,secretary that meets the requirements of subsection 7b7 a #e-year grant in an amount that bears the same proportion to the amount appropriated under subsection 7e7 as-- 7#a7 the number of individuals who are enrolled for medical assistance under the ,medicaid program of the ,state involved 7as determined by the ,secretary using the most recent data available as of the date of enactment of this ,act72 bears to 7#b7 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 7b74 7d7 ,use of grant funds 7#a7 ,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 subsection4 7#b7 ,supplement1 not supplant ,a ,state shall use funds from a grant awarded under this section to supplement1 and not supplant1 the level of ,state funds expended for services in long-term care settings through programs in effect as of ,january #a1 #bjbf4 7#c7 ,required implementation of certain activities ,the ,state shall use funds from a grant awarded under this section to implement and evaluate1 or supplement the implementation of1 activities 7which shall include the activities described in paragraph 7#d77 to enhance1 expand1 or strengthen long-term care services and to improve compensation to the workforce that provides such services4 7#d7 ,activities to strengthen and expand the direct care professional workforce 7,a7 ,in general ,the ,state strengthens and expands the direct care professional workforce that provides services across long-term care settings by-- 7i7 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 program2 7ii7 requiring that a percentage of all payments for long-term care services that are made under the ,state ,medicaid program1 including base payments and supplemental payments1 improve compensation1 benefits1 working conditions1 and training for direct care professionals and direct care managers2 and 7iii7 updating1 developing1 and adopting qualification standards and training opportunities for the continuum of direct care professionals1 including programs for independent direct care professionals and agency direct care professionals1 as well as unique programs4 7,b7 ,payment rates ,in carrying out subparagraph 7,a77i71 the ,state shall-- 7i7 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 professionals2 7ii7 update payment rates under the ,state ,medicaid program for long-term care services1 including home and community-based services1 nursing home services1 skilled nursing facility services1 and intermediate care facility services at least every #b years through a transparent process involving meaningful input from stakeholders1 in which the majority of stakeholders are recipients of such services1 families1 direct care professionals1 family caregivers1 chosen representatives of direct care workers1 aging1 disability1 and workforce advocates1 long-term care providers1 and may also include health plans2 and 7iii7 ensure that1 with respect to any increases in the payment rates under the ,state ,medicaid program for long-term care services-- 7,i7 at a minimum1 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 7ii72 7,,ii7 such payment rate increases are incorporated into payment rates for such services provided under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 by a managed care entity 7as defined in section #aicb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;a77#a77;,b77 or a prepaid inpatient health plan or prepaid ambulatory health plan1 as defined in section #dch4b of title #db1 ,code of ,federal ,regulations 7or any successor regulation771 under a contract with the ,state2 7,,iii7 such payment rate increases are appropriately distributed across settings1 populations1 and services so as to promote independence of people with disabilities and older individuals1 not result in increased institutionalization1 and assists in the facilitation of rebalancing the ,medicaid program towards the least restrictive settings appropriate for individuals receiving services2 and 7,,iv7 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 services4 7e7 ,appropriation ,there is appropriated to the ,secretary for awarding grants under this section an amount equal to #ajj1jjj1jjj1jjj4 7f7 ,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 individuals4 #ajc4 ,making permanent the ,state option to extend protection under ,medicaid for recipients of home and community-based services against spousal impoverishment 7a7 ,in general ,section #aibd7;h77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#e7;h77#a77;,a77 is amended by striking is described in section #aijb7;a77#aj77;,a77ii77,,vi7 and inserting the following3 is eligible for medical assistance for home and community-based services provided under subsection 7c71 7d71 or 7i7 of section #aiae1 under a waiver approved under section #aaae1 or who is eligible for such medical assistance by reason of being determined eligible under section #aijb7;a77#aj77;,c7 or by reason of section #aijb7;f7 or otherwise on the basis of a reduction of income based on costs incurred for medical or other remedial care1 or who is eligible for medical assistance for home and community-based attendant services and supports under section #aiae7k74 7b7 ,conforming amendment ,section #bdjd of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acifr-#e note7 is amended by striking ,september #cj1 #bjbg and inserting the date of enactment of the ,long-,term ,care ,workforce ,support ,act4 #ajd4 ,permanent extension of money follows the person rebalancing demonstration 7a7 ,in general ,subsection 7h77#a7 of section #fjga of the ,deficit ,reduction ,act of #bjje 7#db ,u4,s4,c4 #acif;a note7 is amended-- 7#a7 in subparagraph 7,k71 by striking 2 and and inserting a semicolon2 7#b7 in subparagraph 7,l71 by striking through #bjbg4 and inserting through #bjbf2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,m7 #ejj1jjj1jjj for each fiscal year after fiscal year #bjbf4 4 7b7 ,redistribution of unexpended grant awards ,subsection 7e77#b7 of section #fjga of the ,deficit ,reduction ,act of #bjje 7#db ,u4,s4,c4 #acif;a note7 is amended by adding at the end the following new sentence3 ,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 section44 ,,ii ,training1 ,recruitment1 ,career ,advancement1 and ,worker ,supports ,a ,improving ,workforce ,training #a ,grants for ,supporting the ,direct ,care ,professional ,workforce #bja4 ,definitions ,in this chapter3 7#a7 ,eligible entity ,the term eligible entity means an entity-- 7,a7 that is-- 7i7 a ,state2 7ii7 a labor organization1 joint labor-management organization1 or employer of direct care professionals2 7iii7 a nonprofit entity with experience in aging1 disability1 or supporting the rights and interests of1 the training of1 or educating direct care professionals2 7iv7 an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization2 7v7 a community or technical college or other institution of higher education2 or 7vi7 a consortium of entities listed in any of clauses 7i7 through 7v72 7,b7 that agrees1 as applicable with respect to the type of grant the entity is seeking under this chapter and the activities supported through such grant1 to include as advisors and trainers in such activities-- 7i7 older individuals2 7ii7 people with disabilities2 7iii7 direct care professionals2 and 7iv7 family members of such individuals1 persons1 or professionals2 and 7,c7 that agrees to consult with the ,state ,medicaid agency of the ,state 7or each ,state7 served by the grant on the grant activities1 to the extent that such agency 7or each such agency7 is not the eligible entity4 7#b7 ,project participant ,the term project participant means an individual participating in a project or activity assisted with a grant under this chapter1 including 7as applicable for the category of the grant7 a direct care professional or an individual training to be such a professional4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,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 chapter1 such as transportation1 child care1 dependent care1 housing1 workplace accommodations1 employee benefits such as paid sick leave and child care1 workplace health and safety protections1 wages and overtime pay1 and needs-related payments4 #bjb4 ,authority to award grants 7a7 ,grants 7#a7 ,in general ,not later than #ab months after the date of enactment of this ,act1 the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,secretary of ,labor1 and the ,secretary of ,education1 shall award grants described in paragraph 7#b7 to eligible entities4 ,a grant awarded under this section may be in more than #a category described in such paragraph4 7#b7 ,categories of grants ,the categories of grants described in this paragraph are each of the following3 7,a7 ,direct care professionals grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for direct care professionals who are not described in subparagraph 7,b71 7,c71 or 7,d71 including through education or training programs for such professionals or individuals seeking to become such professionals4 7,b7 ,direct care professional managers grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for direct care professional managers1 including through education or training programs for such managers or individuals seeking to become such managers4 7,c7 ,self-directed care professionals grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for self-directed care professionals1 including through education or training programs for such professionals or individuals seeking to become such professionals4 7,d7 ,home and community-based services grants ,grants to eligible entities to create and carry out projects to recruit1 retain1 or provide advancement opportunities for home and community-based services workers providing services and supports to older individuals1 or people with disabilities1 who are eligible for coverage under a ,state ,medicaid program4 7#c7 ,projects for advancement opportunities ,not less than #cj 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 professionals4 7b7 ,treatment of continuation activities ,an eligible entity that carries out activities described in subsection 7a77#b7 prior to receipt of a grant under this chapter may use such grant to continue carrying out such activities1 and1 in using such grant to continue such activities1 shall be treated as an eligible entity carrying out a project through a grant under this chapter4 #bjc4 ,project plans 7a7 ,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 7including for activities to be continued as described in section #bjb7;b77 with the grant4 ,such project plan shall be submitted at such time1 in such manner1 and containing such information as the ,secretary may require4 7b7 ,contents ,a project plan submitted by an eligible entity under subsection 7a7 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 grant4 ,such information may include 7as applicable7 the following3 7#a7 ,demographic information regarding the population in the ,state1 city or municipality1 or region to be served by the project1 including a description of the populations likely to need services provided by direct care professionals1 such as people with disabilities and older individuals4 7#b7 ,projections of unmet need for services provided by direct care professionals based on enrollment waiting lists under home and community-based waivers under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 or section #aiae7;c7 of such ,act 7#db ,u4,s4,c4 #acifn7c77 and other relevant data to the extent practicable and feasible1 such as direct care professional workforce vacancy rates and crude separation rates and the number of direct care professionals1 including such professionals who are managers or supervisors1 in the ,state or region to be served by the project4 7#c7 ,an advisory committee to advise the eligible entity on activities to be carried out through the grant4 ,such advisory committee-- 7,a7 shall include-- 7i7 older individuals and people with disabilities receiving services from the direct care professionals targeted by the project2 7ii7 organizations representing the rights and interests of people receiving services by the direct care professionals targeted by the project2 7iii7 individuals who are direct care professionals targeted by the project and organizations representing the rights and interests of such direct care professionals2 7iv7 as applicable1 employers of individuals described in clause 7iii7 and labor organizations representing such individuals2 7v7 representatives of the ,state ,medicaid agency1 the ,state agency defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 the ,state developmental disabilities office1 and the ,state mental health agency1 in the ,state 7or each ,state7 to be served by the project2 7vi7 parents or caregivers of children with disabilities or chronic conditions2 and 7vii7 representatives reflecting diverse racial1 cultural1 ethnic1 geographic1 socioeconomic1 and gender identity and sexual orientation perspectives2 and 7,b7 may include any other individuals or entities listed in paragraph 7#ab74 7#d7 ,current or projected job openings for1 or relevant labor market information related to1 the direct care professionals targeted by the project in the ,state or region to be served by the project1 and the geographic scope of the workforce to be served by the project4 7#e7 ,specific efforts and strategies that the project will undertake to reduce barriers to recruitment1 retention1 or advancement of the direct care professionals targeted by the project1 including an assurance that such efforts will include-- 7,a7 an assessment of the wages or other compensation or benefits necessary to recruit and retain the direct care professionals targeted by the project2 7,b7 a description of the project's projected compensation or benefits for the direct care professionals targeted by the project at the ,state or local level1 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 project2 and 7,c7 a description of the projected impact of workplace safety issues on the recruitment and retention of direct care professionals targeted by the project1 including the availability of personal protective equipment4 7#f7 ,in the case of a project offering an education or training program for direct care professionals1 a description of such program 7including how the core competencies identified by the ,centers for ,medicare ,medicaid ,services will be incorporated1 curricula1 models1 and standards used under the program1 and any associated recognized postsecondary credentials for which the program provides preparation1 as applicable71 which shall include an assurance that such program will provide to each project participant in such program-- 7,a7 relevant training regarding the rights of recipients of long-term care services1 including their rights to-- 7i7 receive services in integrated settings that provide access to the broader community2 7ii7 exercise self-determination2 7iii7 be free from all forms of abuse1 neglect1 or exploitation2 and 7iv7 person-centered planning and practices1 including participation in planning activities2 7,b7 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 law2 7,c7 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 project2 7,d7 an apprenticeship program1 work-based learning1 or on-the-job training opportunities2 7,e7 supervision or mentoring2 and 7,f7 for any on-the-job training portion of the program1 a progressively increasing1 clearly defined schedule of wages to be paid to each such participant that-- 7i7 is consistent with skill gains or attainment of a recognized postsecondary credential received as a result of participation in or completion of such program2 7ii7 ensures the entry wage is not less than the greater of-- 7,i7 the minimum wage required under section #f7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf7;a772 or 7,,ii7 the applicable minimum wage required by other applicable ,federal or ,state law1 or a collective bargaining agreement2 and 7iii7 does not use a certificate under section #ad7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bad7;c774 7#g7 ,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 project4 7#h7 ,the supportive services and benefits to be provided to the project participants in order to support the employment1 retention1 or career advancement of the direct care professionals targeted by the project4 7#i7 ,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 project4 7#aj7 ,how the eligible entity will collect and submit to the ,secretary direct care professional workforce data and outcomes of the project4 7#aa7 ,how the project-- 7,a7 will-- 7i7 provide adequate and safe equipment and facilities for training and supervision1 including a safe work environment free from discrimination1 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 professionals2 7ii7 incorporate remote training and education opportunities or technology-supported opportunities2 7iii7 for training and education curricula1 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 curricula2 7iv7 use outreach1 recruitment1 and retention strategies designed to reach and retain a diverse workforce2 7v7 incorporate methods to monitor satisfaction with project activities for project participants and individuals receiving services from such participants2 and 7vi7 incorporate core competencies identified by the ,centers for ,medicare ,medicaid ,services2 and 7,b7 may incorporate continuing education programs and specialty training1 with a specific focus on-- 7i7 trauma-informed care2 7ii7 behavioral health2 7iii7 developmental disabilities or other disabilities involving mental impairment2 7iv7 co-occurring behavioral health conditions and a disability described in clause 7iii72 7v7 ,alzheimer's and dementia care2 7vi7 infection prevention and control measures2 7vii7 chronic disease management2 7viii7 age-related conditions2 and 7ix7 the use of supportive or assistive technology4 7#ab7 ,how the eligible entity will consult throughout the implementation of the project1 or coordinate the project with1 each of the following3 7,a7 ,older individuals and people with disabilities4 7,b7 ,the ,state ,medicaid agency1 the ,state agency defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 and the ,state developmental disabilities office for the ,state 7or each ,state7 to be served by the project4 7,c7 ,the local board and ,state board for each region1 or ,state1 to be served by the project4 7,d7 ,in the case of a project that carries out an education or training program1 a nonprofit organization with demonstrated experience in the development or delivery of curricula or coursework4 7,e7 ,a nonprofit organization1 including a labor organization1 that fosters the professional development and collective engagement of the direct care professionals targeted by the project4 7,f7 ,organizations representing the rights and interests of people receiving services by the direct care professionals targeted by the project4 7,g7 ,area agencies on aging4 7,h7 ,centers for independent living1 as described in part ,c of chapter ,i of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7,i7 ,the ,state ,council on ,developmental ,disabilities 7as such term is used in subtitle ,b of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejba et seq477 for the ,state 7or each ,state7 to be served by the project4 7,j7 ,aging and ,disability ,resource ,centers4 7,k7 ,a nonprofit ,state provider association that represents providers who employ the direct care professionals targeted by the project1 where such associations exist4 7,l7 ,an entity that employs the direct care professionals targeted by the project4 7,m7 ,university ,centers for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,service supported under subtitle ,d of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejfa et seq474 7,n7 ,the ,state protection and advocacy system described in section #adc of such ,act 7#db ,u4,s4,c4 #aejdc7 of the ,state 7or each ,state7 to be served by the project4 7,o7 ,direct care professionals1 and direct care professional workforce organizations1 representing underserved communities1 including communities of color4 7,p7 ,individuals employed or working as the direct care professionals targeted by the project4 7,q7 ,representatives of such professionals4 7,r7 ,individuals receiving services from such professionals4 7,s7 ,the families of such professionals4 7,t7 ,the families of individuals receiving services from such professionals4 7,u7 ,individuals receiving education or training to become such professionals4 7#ac7 ,outreach efforts to individuals for participation in such project1 including targeted outreach efforts to-- 7,a7 individuals who are recipients of assistance under a ,state program funded under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq47 or individuals who are eligible for such assistance2 and 7,b7 individuals with a barrier to employment4 7c7 ,considerations ,in selecting eligible entities to receive a grant under this chapter1 the ,secretary shall ensure-- 7#a7 equitable geographic and demographic diversity1 including by selecting recipients serving rural areas and selecting recipients serving urban areas2 and 7#b7 that selected eligible entities will serve areas where the occupation of direct care professional1 or a related occupation1 is an in-demand industry sector or occupation4 #bjd4 ,uses of funds2 supplement1 not supplant 7a7 ,uses of funds 7#a7 ,in general ,each eligible entity receiving a grant under this chapter shall use the funds of such grant to carry out at least #a project described in section #bjb7;a77#b74 7#b7 ,administrative costs ,each eligible entity receiving a grant under this chapter shall not use more than #e percent of the funds of such grant for costs associated with the administration of activities under this chapter4 7#c7 ,direct support ,each eligible entity receiving a grant under this chapter shall use not less than #e 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 activities4 7b7 ,supplement1 not supplant ,an eligible entity receiving a grant under this chapter shall use such grant only to supplement1 and not supplant1 the amount of funds that1 in the absence of such grant1 would be available to address the recruitment1 training and education1 retention1 and advancement of direct care professionals1 in the ,state or region served by the eligible entity4 7c7 ,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 #bjc7;a7 of the ,labor-,management ,reporting and ,disclosure ,act of #aiei 7#bi ,u4,s4,c4 #dcc7;a774 7d7 ,authorization of appropriations ,there are authorized to be appropriated for grants under section #bjb1 #ejj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #b ,other workforce training grants #bje4 ,workforce investment activities grants for domestic workers 7a7 ,definitions ,in this section3 7#a7 ,domestic services ,the term domestic services-- 7,a7 means services-- 7i7 of a household nature2 7ii7 provided in interstate commerce2 and 7iii7 performed by an individual in or about a private home 7permanent or temporary72 and 7,b7 includes services performed by individuals such as companions1 housekeepers1 nurses1 home health aides1 or personal or home care aides4 7#b7 ,domestic worker ,the term domestic worker-- 7,a7 means1 except as provided in subparagraph 7,b71 an individual1 including an employee1 who is compensated directly or indirectly for the performance of domestic services2 and 7,b7 does not include-- 7i7 an individual who is a family member1 friend1 neighbor1 or parent of a child and who provides child care for the child in the child's home2 and 7ii7 any employee described in section #ac7;a77#ae7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bac7;a77#ae774 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,labor1 in consultation with the ,secretary of ,education and the ,secretary of ,health and ,human ,services4 7#d7 ,supportive services2 training services2 workforce investment activities ,the terms supportive services1 training services1 and workforce investment activities have the meanings given the terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7b7 ,national grant program for domestic workers ,every #c years1 the ,secretary shall1 on a competitive basis1 make grants to1 or enter into contracts with1 eligible entities to carry out the activities described in subsection 7d74 ,the ,secretary shall make the grants1 or enter into the contracts1 for periods of #d years4 7c7 ,eligibility 7#a7 ,eligible entities ,to be eligible to receive a grant or enter into a contract under this section1 an entity-- 7,a7 shall have experience working with older individuals or people with disabilities2 and 7,b7 shall be-- 7i7 7,i7 a nonprofit organization that is described in paragraph 7#c71 7#e71 or 7#f7 of section #eja7;c7 of the ,internal ,revenue ,code of #aihf1 and exempt from taxation under section #eja7;a7 of such ,code2 7,,ii7 an organization with a board of directors1 at least one-half of the members of which is comprised of-- 7aa7 domestic workers2 or 7bb7 representatives of an organization of such workers1 including such workers who are direct care professionals1 which organization is independent from all businesses1 organizations1 corporations1 or individuals that would pursue any financial interest in conflict with that of the workers2 7,,iii7 an organization that is independent as described in subclause 7,,ii77bb72 and 7,,iv7 an organization that has expertise in domestic work and the workforce of domestic workers1 including such workers who are direct care professionals2 7ii7 an eligible provider of training services listed pursuant to section #abb7;d7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #caeb7;d772 or 7iii7 an entity that carries out an apprenticeship program4 7#b7 ,program plan 7,a7 ,in general ,to be eligible to receive a grant or enter into a contract under this section1 an entity described in paragraph 7#a7 shall submit to the ,secretary of ,labor a plan that describes a #d-year strategy for meeting the needs of domestic workers1 including such workers who are direct care professionals1 in the area to be served by such entity4 7,b7 ,contents ,such plan shall-- 7i7 describe the domestic worker population1 which shall include domestic workers who provide long-term care services1 to be served and identify the needs of such population to be served for workforce investment activities and related assistance1 which may include employment and supportive services2 7ii7 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 conditions1 including improved employment standards and opportunities in the field of domestic work2 7iii7 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 careers2 and 7iv7 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 professionals1 including-- 7,i7 training regarding the rights of recipients of long-term care services1 including the rights of such recipients to-- 7aa7 receive services in integrated settings that provide access to the broader community2 7bb7 exercise self-determination2 7cc7 be free from all forms of abuse1 neglect1 or exploitation2 and 7dd7 receive person-centered planning and practices1 including through the participation of such recipients in planning activities2 7,,ii7 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 law2 and 7,,iii7 training regarding the provision of culturally competent and disability-competent supports to recipients of long-term care services4 7#c7 ,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 ,secretary4 7d7 ,authorized activities ,funds made available under this section shall be used to carry out workforce investment activities and provide related assistance for domestic workers1 including such workers who are direct care professionals1 which may include-- 7#a7 outreach1 employment1 training services1 educational assistance1 digital literacy assistance1 ,english language and literacy instruction1 worker safety training1 supportive services1 school dropout prevention and recovery activities1 individual career services1 and career pathways2 7#b7 follow-up services for those individuals placed in employment2 7#c7 development or education as needed by domestic workers1 including domestic workers who are direct care professionals2 7#d7 customized career and technical education in occupations that will lead to higher wages1 enhanced benefits1 and long-term employment in domestic work or another area2 and 7#e7 the creation or maintenance of employment and training-related placement services1 including digital placement services4 7e7 ,funding allocation ,from the funds appropriated and made available to carry out this section1 the ,secretary shall reserve not more than #a percent for discretionary purposes related to carrying out this section1 such as providing technical assistance to eligible entities4 7f7 ,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 section4 ,the performance report for an eligible entity shall include1 with respect to each such program 7referred to in this subsection as a program of study7 of such entity-- 7#a7 information specifying the levels of performance achieved with respect to the primary indicators of performance described in subclauses 7,i7 through 7,v7 of section #aaf7;b77#b77;,a77i7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;b77#b77;,a77i77 with respect to all individuals engaging in the program of study2 7#b7 the total number of individuals exiting from the program of study2 7#c7 the total number of participants who received training services through the program2 7#d7 the total number of participants who exited from training services1 disaggregated by the type of entity that provided the training services1 during the most recent program year and the #c preceding program years2 7#e7 the average cost per participant for the participants who received training services1 disaggregated by the type of entity that provided the training services1 during the most recent program year and the #c preceding program years2 and 7#f7 information on indicators specified by the ,secretary concerning the impact of the training services on the wages1 skills1 recruitment1 and retention of participants4 7g7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #bjf4 ,direct care professional career advancement demonstration projects 7a7 ,in general ,section #bjjh of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;g7 is amended-- 7#a7 by adding at the end the following new subsection3 7e7 ,direct care professional career advancement demonstration projects 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,labor1 shall award1 from the amount appropriated under paragraph 7#d71 grants to eligible entities to conduct demonstration projects that are designed to provide eligible individuals with opportunities for education1 training1 and career advancement as a direct care professional1 including as a personal or home care aide1 home health aide1 or nursing aide or assistant4 7#b7 ,definitions ,in this subsection3 7,a7 ,eligible entity ,the term eligible entity has the meaning given such term in subsection 7a74 7,b7 ,eligible individual ,the term eligible individual means an individual-- 7i7 whose income does not exceed #bjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved2 and 7ii7 who is employed as a direct care professional who-- 7,i7 has at least #cj percent patient volume 7as estimated in accordance with a methodology established by the ,secretary7 attributable to individuals who are receiving medical assistance under title ,,xix2 or 7,,ii7 is employed by an agency that is a provider of personal or home care services that has at least #cj percent of the agency's patient volume 7as so estimated7 attributable to such individuals4 7,c7 ,direct care professional ,the term direct care professional has the meaning given such term in section #c of the ,long-,term ,care ,workforce ,support ,act4 7#c7 ,requirements 7,a7 ,prioritization of projects that support rural areas1 underserved areas1 and women1 individuals from communities of color1 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-- 7i7 eligible individuals in rural areas 7as defined in section #bjjg7;f77#e772 7ii7 eligible individuals in underserved urban areas 7including urban health professional shortage areas 7as defined in section #ccb of the ,public ,health ,service ,act72 7iii7 eligible individuals who are women1 who are from communities of color1 or who belong to other underserved and diverse populations such as ,asian1 ,pacific ,islander1 ,native ,american1 or ,alaska ,native communities2 and 7iv7 eligible individuals with disabilities4 7,b7 ,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 #gej1jjj for each year that the entity conducts such project4 7,c7 ,reports 7i7 ,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 project4 7ii7 ,evaluation ,the ,administrator of the ,health ,resources and ,services ,administration shall evaluate the demonstration projects conducted under this subsection4 ,such evaluation shall include identification of successful activities for creating opportunities for developing and sustaining1 particularly with respect to low-income individuals and direct care professionals1 a health or human services professions workforce that has accessible opportunities for career advancement1 that meets high standards for education1 training1 certification1 and professional development1 that provides increased wages and affordable benefits1 including health care coverage1 that are responsive to the workforce's needs1 and that is responsive to the needs of diverse racial and ethnic communities4 7iii7 ,report to ,congress ,not later than #a year after the demonstration projects conducted under this subsection conclude1 the ,secretary shall submit a final report to ,congress on such demonstration projects that includes-- 7,i7 the result of the evaluation conducted under clause 7ii72 7,,ii7 recommendations for best practices2 and 7,,iii7 such recommendations for legislation or administrative actions as the ,secretary deems appropriate4 7iv7 ,additional report ,not later than #a year after the demonstration projects conducted under this subsection conclude1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 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 available1 a report on the activities and results of such projects4 ,such report shall describe-- 7,i7 the number and geographic distribution of the grants awarded under this subsection2 7,,ii7 the participation of underrepresented and economically disadvantaged participants in demonstration projects conducted under this subsection2 and 7,,iii7 recommendations for program revisions to achieve the desired program outcome4 7#d7 ,appropriation ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 4 7b7 ,incentive payments for long-,term care services furnished by direct care professionals who complete certain training ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7aa7 ,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 #a1 #bjbf1 by a direct care professional who has successfully completed education or training under a demonstration project under section #bjjh7;e71 in addition to the amount of payment that would otherwise be made for such services under this part1 there also shall be paid an amount equal to #be percent of the payment amount for the service under this part to be paid to the direct care professional4 4 #bjg4 ,pathways to health careers ,effective ,october #a1 #bjbf1 title ,,xx of the ,social ,security ,act 7#db ,u4,s4,c4 #acig-acign-#ac7 is amended by adding at the end the following3 ,d ,career ,pathways through ,health ,profession ,opportunity ,grants #bjga4 ,career ,pathways through ,health ,profession ,opportunity ,grants 7a7 ,application requirements ,an eligible entity desiring a grant under this section for a project shall submit to the ,secretary an application for the grant1 that includes the following3 7#a7 ,a description of how the applicant will use a career pathways approach to train eligible individuals for health professions1 including direct care professionals1 that will put eligible individuals on a career path to an occupation that pays well1 under the project4 7#b7 ,a description of the adult basic education and literacy activities1 work readiness activities1 training activities1 and case management1 career coaching1 and mentoring support services that the applicant will use to assist eligible individuals to gain work experience1 connection to employers1 and job placement1 and a description of the plan for recruiting1 hiring1 and training staff to provide the case management1 mentoring1 and career coaching services1 under the project directly or through local governmental1 apprenticeship1 educational1 or charitable institutions4 7#c7 ,a demonstration that the applicant has experience working with low-income populations1 or a description of the plan of the applicant to work with a partner organization that has the experience4 7#d7 ,a plan for providing post-employment support and ongoing training as part of a career pathway under the project4 7#e7 ,a description of the support services that the applicant will provide under the project1 including a plan for how child care and transportation support services will be guaranteed and1 if the applicant will provide a cash stipend or wage supplement1 how the stipend or supplement would be calculated and distributed4 7#f7 ,a certification by the applicant that the project development included-- 7,a7 consultation or commitment to consult with a local workforce development board2 7,b7 consideration of registered apprenticeship and pre-apprenticeship models2 7,c7 consideration of career pathway programs in the ,state in which the project is to be conducted2 and 7,d7 a review of the ,state plan under section #ajb or #ajc of the ,workforce ,innovation and ,opportunity ,act4 7#g7 ,a description of the availability and relevance of recent labor market information and other pertinent evidence of in-demand jobs or worker shortages4 7#h7 ,a certification that the applicant will directly provide or contract for the training services described in the application4 7#i7 ,a commitment by the applicant that1 if the grant is made to the applicant1 the applicant will-- 7,a7 during the planning period for the project1 provide the ,secretary with any information needed by the ,secretary to establish adequate data reporting and administrative structure for the project2 7,b7 hire a person to direct the project not later than the end of the planning period applicable to the project2 7,c7 accept all technical assistance offered by the ,secretary with respect to the grant2 7,d7 participate in peer technical assistance conferences as are regularly scheduled by the ,secretary2 and 7,e7 provide all data required by the ,secretary under subsection 7g74 7b7 ,additional application element ,in considering applications for a grant under this section1 the ,secretary shall require qualified applicants to have at least #a of the following application elements3 7#a7 ,applications submitted by applicants to whom a grant was made under this section or any predecessor to this section4 7#b7 ,applications submitted by applicants who have business and community partners in each of the following categories3 7,a7 ,state and local government agencies and social service providers1 including a ,state or local entity that administers a ,state program funded under part ,a of this title4 7,b7 ,institutions of higher education1 apprenticeship programs1 and local workforce development boards4 7,c7 ,health care employers1 home and community-based services agencies1 health care industry or sector partnerships1 labor unions1 and labor-management partnerships4 7#c7 ,applications that include opportunities for mentoring or peer support1 and make career coaching available1 as part of the case management plan4 7#d7 ,applications which describe a project that will serve a rural area in which-- 7,a7 the community in which the individuals to be enrolled in the project reside is located2 7,b7 the project will be conducted2 or 7,c7 an employer partnership that has committed to hiring individuals who successfully complete all activities under the project is located4 7#e7 ,applications that include a commitment to providing project participants with a cash stipend or wage supplement4 7#f7 ,applications submitted by applicants who are serving or situated in communities of color and other underserved communities4 7#g7 ,applications which have an emergency cash fund to assist project participants financially in emergency situations4 7c7 ,grants 7#a7 ,competitive grants 7,a7 ,grant authority 7i7 ,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 ,secretary1 to conduct a project designed to train low-income individuals for allied health professions1 health information technology1 physician assistants1 nursing assistants1 licensed practical_/vocational nurse1 registered nurse1 advanced practice nurse1 direct care professionals1 and other professions considered part of a health care career pathway model4 7ii7 ,guarantee of grantees in each ,state and the ,district of ,columbia ,for each grant cycle1 the ,secretary shall award a grant under this paragraph to at least #b eligible entities in each ,state that is not a territory1 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 grant4 ,if1 for a grant cycle1 there are fewer than #b such eligible entities in a ,state that have submitted applications with a high likelihood of success1 the ,secretary shall identify qualified eligible applicants located elsewhere1 that are otherwise approved but un-funded1 and issue a ,substitution of ,grant and tailored technical assistance4 ,in the preceding sentence1 the term issue a ,substitution of ,grant means1 in a case in which an approved grantee does not complete its full project period1 or in which there are fewer than #b qualified grantees per ,state with a high likelihood of success1 substitute an applicant located in another ,state that was approved but un-funded during the competition for the award for the award recipient4 7,b7 ,guarantee of grants for indian populations ,the ,secretary shall award a grant under this paragraph to at least #aj eligible entities that are an ,indian tribe1 a tribal organization1 or a tribal college or university1 to the extent there are a sufficient number of applications submitted by the entities that meet the requirements applicable with respect to such a grant4 7,c7 ,guarantee of grantees in the territories ,the ,secretary shall award a grant under this paragraph to at least #b eligible entities that are located in a territory1 to the extent there are a sufficient number of applications submitted by the entities that meet the requirements applicable with respect to such a grant4 7#b7 ,grant cycle ,the grant cycle under this section shall be not less than #e years1 with a planning period of not more than the first #ab months of the grant cycle4 ,during the planning period1 the amount of the grant shall be in such lesser amount as the ,secretary determines appropriate4 7d7 ,use of grant 7#a7 ,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 grant4 7#b7 ,support to be provided 7,a7 ,required support ,a project for which a grant is made under this section shall include the following3 7i7 ,an assessment for adult basic skill competency1 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 training1 through means including the following3 7,i7 ,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 program4 7,,ii7 ,offering resources to enable project participants to continue advancing adult basic skill proficiency while enrolled in a career pathway program4 7,,iii7 ,embedding adult basic skill maintenance as part of ongoing post-graduation career coaching and mentoring4 7ii7 ,a guarantee that child care and transportation are available and affordable support services for project participants through means such as the following3 7,i7 ,referral to1 and assistance with1 enrollment in a subsidized child care program4 7,,ii7 ,direct payment to a child care provider if a slot in a subsidized child care program is not available or reasonably accessible4 7,,iii7 ,payment of co-payments or associated fees for child care and transportation4 7iii7 ,case management plans that include career coaching 7with the option to offer appropriate peer support and mentoring opportunities to help develop soft skills and social capital71 which may be offered on an ongoing basis before1 during1 and after initial training as part of a career pathway model4 7iv7 ,a plan to provide project participants with transportation through means such as the following3 7,i7 ,referral to1 and assistance with enrollment in1 a subsidized transportation program4 7,,ii7 ,if a subsidized transportation program is not reasonably available1 direct payments to subsidize transportation costs4 7,b7 ,transportation ,for purposes of this paragraph1 the term transportation includes public transit1 or gasoline for a personal vehicle if public transit is not reasonably accessible or available4 7,c7 ,allowed support ,the goods and services provided under a project for which a grant is made under this section may include the following3 7i7 ,a cash stipend4 7ii7 ,a reserve fund for financial assistance to project participants in emergency situations4 7iii7 ,tuition1 certification exam fees1 and training materials such as books1 software1 uniforms1 shoes1 connection to the internet1 hair nets1 and personal protective equipment4 7iv7 ,in-kind resource donations such as interview clothing and conference attendance fees4 7v7 ,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 goals4 7vi7 ,other support services as deemed necessary for family well-being1 success in the project1 and progress toward career goals4 7#c7 ,training ,the number of hours of training provided to an eligible individual under a project for which a grant is made under this section1 for a recognized postsecondary credential 7including an industry-recognized credential1 and a certificate awarded by a local workforce development board71 which is awarded in recognition of attainment of measurable technical or occupational skills necessary to gain employment or advance within an occupation1 shall be-- 7,a7 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 conducted2 or 7,b7 if there is no such requirement1 such number of hours of training as the ,secretary finds is necessary to achieve that skill level4 7#d7 ,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 ,,iv1 at least #aj percent of the eligible individuals to whom support is provided under the project shall meet the income eligibility requirements under that ,state program1 without regard to whether the individuals receive benefits or services directly under that ,state program4 7#e7 ,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 individual4 7#f7 ,prohibition ,an entity to which a grant is made under this section shall not use the grant for purposes of entertainment1 except that case management and career coaching services may include celebrations of specific career-based milestones such as completing a semester1 graduation1 or job placement4 7e7 ,technical assistance 7#a7 ,in general ,the ,secretary shall provide technical assistance-- 7,a7 to assist eligible entities in applying for grants under this section2 7,b7 that is tailored to meet the needs of grantees at each stage of the administration of projects for which grants are made under this section2 7,c7 that is tailored to meet the specific needs of ,indian tribes1 tribal organizations1 and tribal colleges and universities2 7,d7 that is tailored to meet the specific needs of the territories2 7,e7 that is tailored to meet the specific needs of applicants1 eligible entities1 and grantees1 in carrying out dedicated career pathway projects pursuant to subsection 7h72 and 7,f7 to facilitate the exchange of information among eligible entities regarding best practices and promising practices used in the projects4 7#b7 ,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 section4 ,the preceding sentence shall not be interpreted to require any such conference to be held in person4 7f7 ,evaluation of dedicated career pathways 7#a7 ,in general ,the ,secretary shall1 by grant1 contract1 or interagency agreement1 conduct rigorous and well-designed evaluations of the dedicated career pathway projects carried out pursuant to subsection 7h74 7#b7 ,requirement applicable to second chance career pathway ,in the case of a project of the type described in subsection 7i71 the evaluation shall include identification of successful activities for creating opportunities for developing and sustaining1 particularly with respect to low-income individuals with arrest or conviction records1 a health professions workforce that has accessible entry points1 that meets high standards for education1 training1 certification1 and professional development1 and that provides increased wages and affordable benefits1 including health care coverage1 that are responsive to the needs of the workforce4 7g7 ,reports ,as a condition of funding1 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 project1 and1 on the conclusion of the project1 a final report on the activities4 7h7 ,second chance career pathway 7#a7 ,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 demand4 7#b7 ,duration ,a grant awarded under this subsection shall have the same grant cycle as is provided in subsection 7c77#b71 and as a condition of funding the grantee shall comply with all data reporting requirements associated with the grant cycle4 7#c7 ,application requirements ,an entity seeking a grant under this subsection for a project shall submit to the ,secretary an application for the grant1 that includes the following3 7,a7 ,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 7which policies or laws shall include appeals processes and other opportunities to demonstrate rehabilitation to obtain licensure and approval to work in the proposed health careers71 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 career4 7,b7 ,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 records4 7,c7 ,a demonstration that the applicant has experience working with low-income populations1 or a description of the plan of the applicant to work with a partner that has the experience4 7,d7 ,an identification of promising innovations or best practices that can be used to provide the training4 7,e7 ,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 hired4 7,f7 ,a plan for recruiting students who are eligible individuals into the project4 7,g7 ,a plan for providing post-employment support and ongoing training as part of a career pathway under the project4 7#d7 ,support to be provided ,a recipient of a grant under this subsection for a project shall provide-- 7,a7 access to legal assistance for project participants for the purpose of addressing arrest or conviction records and associated workforce barriers2 7,b7 assistance with programs and activities deemed necessary to address arrest or conviction records as an employment barrier2 and 7,c7 required supportive services described in subsection 7d77#b77;,a7 to participants who need the services1 and may expend funds on eligible supportive services described in subsection 7d77#b77;,b74 7i7 ,definitions ,in this section3 7#a7 ,allied health profession ,the term allied health profession has the meaning given in section #gii;,b7#e7 of the ,public ,health ,service ,act4 7#b7 ,career pathway ,the term career pathway has the meaning given that term in section #c7g7 of the ,workforce ,innovation and ,opportunity ,act4 7#c7 ,direct care professional ,the term direct care professional has the meaning given such term in section #c of the ,long-,term ,care ,workforce ,support ,act4 7#d7 ,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 application3 7,a7 ,a local workforce development board established under section #ajg of the ,workforce ,innovation and ,opportunity ,act4 7,b7 ,a ,state or territory1 a political subdivision of a ,state or territory1 or an agency of a ,state1 territory1 or such a political subdivision1 including a ,state or local entity that administers a ,state program funded under part ,a of this title4 7,c7 ,an ,indian tribe1 a tribal organization1 or a tribal college or university4 7,d7 ,an institution of higher education 7as defined in the ,higher ,education ,act of #aife74 7,e7 ,a hospital 7as defined in section #ahfa7;e774 7,f7 ,a high-quality skilled nursing facility4 7,g7 ,a ,federally qualified health center 7as defined in section #ahfa7;aa77#d774 7,h7 ,a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf1 a labor organization1 or an entity with shared labor-management oversight1 that has a demonstrated history of providing health profession training to eligible individuals4 7,i7 ,an opioid treatment program 7as defined in section #ahfa7;jjj77#b771 and other comprehensive addiction care providers4 7,j7 ,a home and community-based services provider agency4 7#e7 ,eligible individual ,the term eligible individual means an individual whose family income does not exceed #bjj percent of the ,federal poverty level and has not been charged with or convicted of a violent crime or financial fraud 7as determined by the ,secretary74 7#f7 ,federal poverty level ,the term ,federal poverty level means the poverty line 7as defined in section #fgc7b7 of the ,omnibus ,budget ,reconciliation ,act of #aiha1 including any revision required by such section applicable to a family of the size involved74 7#g7 ,indian tribe2 tribal organization ,the terms ,indian tribe and tribal organization have the meaning given the terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b74 7#h7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja or #ajb7;a77#a77;,b7 of the ,higher ,education ,act of #aife4 7#i7 ,territory ,the term territory means the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 7#aj7 ,tribal college or university ,the term tribal college or university has the meaning given the term in section #caf7;b7 of the ,higher ,education ,act of #aife4 7j7 ,evaluation ,the ,secretary of ,health and ,human ,services1 in conjunction with the ,secretary of ,labor1 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 individuals4 7k7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,secretary-- 7#a7 #cah1gej1jjj for grants under subsection 7c77#a77;,a7 for each of fiscal years #bjbf through #bjcj2 7#b7 #ag1jjj1jjj for grants under subsection 7c77#a77;,b7 for each of fiscal years #bjbf through #bjcj2 7#c7 #ba1bej1jjj for grants under subsection 7c77#a77;,c7 for each of fiscal years #bjbf through #bjcj2 7#d7 #be1ejj1jjj for projects conducted under subsection 7h7 for each of fiscal years #bjbf through #bjcj2 7#e7 #be1ejj1jjj1 plus all amounts referred to in paragraphs 7#a7 through 7#d7 of this subsection that remain unused after all grant awards are made for the fiscal year1 for each of fiscal years #bjbf through #bjcj1 for the provision of technical assistance and administration2 and 7#f7 #ag1jjj1jjj for each of fiscal years #bjbf through #bjcj for studying the effects of the projects for which a grant is made under this section1 and for administration1 for the purpose of supporting the rigorous evaluation of the projects1 and supporting the continued study of the short-1 medium-1 and long-term effects of all such projects1 including the effectiveness of new or added elements of the projects4 4 #bjh4 ,increasing workforce diversity in allied health professionals and direct support professionals ,title ,,vii of the ,public ,health ,service ,act is amended-- 7#a7 by redesignating part ,g 7#db ,u4,s4,c4 #bie;j et seq47 as part ,h2 and 7#b7 by inserting after part ,f 7#db ,u4,s4,c4 #bie;h et seq47 the following new part3 ,g ,increasing workforce diversity in allied health professionals and direct care professionals #ghc4 ,scholarships and stipends 7a7 ,in general ,the ,secretary may award grants and contracts to eligible entities to increase educational opportunities in the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals for eligible individuals by-- 7#a7 providing student scholarships or stipends1 including for-- 7,a7 completion of an accelerated degree program2 7,b7 completion of an associate's1 bachelor's1 master's1 or doctoral degree program2 and 7,c7 entry by a diploma or associate's degree practitioner into a bridge or degree completion program2 7#b7 providing assistance for completion of prerequisite courses or other preparation necessary for acceptance for enrollment in the eligible entity2 7#c7 carrying out activities to increase the retention of students in #a or more programs in the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals2 and 7#d7 building or strengthening career pipeline programs1 including those for high school students1 older workers and retirees1 veterans1 and other displaced workers4 7b7 ,consideration of recommendations ,in carrying out subsection 7a71 the ,secretary shall take into consideration the recommendations of national organizations representing the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals1 including the ,american ,physical ,therapy ,association1 the ,american ,occupational ,therapy ,association1 the ,american ,speech-,language-,hearing ,association1 the ,american ,association for ,respiratory ,care1 the ,american ,academy of ,audiology1 the ,academy of ,doctors of ,audiology1 and the ,national ,alliance for ,direct ,support ,professionals4 7c7 ,required information and conditions for award recipients 7#a7 ,in general ,the ,secretary may require recipients of awards under this section to report to the ,secretary concerning the annual admission1 retention1 and graduation rates for eligible individuals in programs of the recipient leading to a degree in any of the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals4 7#b7 ,falling rates ,if any of the rates reported by a recipient under paragraph 7#a7 fall below the average for such recipient over the #b years preceding the year covered by the report1 the recipient shall provide the ,secretary with plans for immediately improving such rates4 7#c7 ,ineligibility ,a recipient described in paragraph 7#b7 shall be ineligible for continued funding under this section if the plan of the recipient fails to improve the rates within the #a-year period beginning on the date such plan is implemented4 7d7 ,evaluation 7#a7 ,in general ,in accordance with paragraph 7#b71 the ,secretary1 in conjunction with the ,secretary of ,labor1 shall evaluate the implementation and outcomes of this section on the recruitment and retention in long-term care settings of certified nursing assistants1 physical therapists1 occupational therapists1 audiologists1 speech-language pathologists1 respiratory therapists1 direct support professionals1 and any other direct care professionals determined by the ,secretary4 7#b7 ,external evaluator ,the ,secretary shall conduct the evaluation under paragraph 7#a7 through a contract with an external evaluator who has experience with evaluation related to people with disabilities and older individuals4 7e7 ,definitions ,in this section3 7#a7 ,direct care professional2 disability ,the terms direct care professional and disability have the meanings given such terms in section #c of the ,long-,term ,care ,workforce ,support ,act4 7#b7 ,eligible entity ,the term eligible entity means an education program that-- 7,a7 is accredited by-- 7i7 the ,council on ,academic ,accreditation in ,audiology and ,speech-,language ,pathology or the ,accreditation ,commission for ,audiology ,education2 7ii7 the ,commission on ,accreditation in ,physical ,therapy ,education2 7iii7 the ,accreditation ,council for ,occupational ,therapy ,education2 7iv7 the ,commission on ,accreditation for ,respiratory ,care2 or 7v7 the ,national ,alliance for ,direct ,support ,professionals ,certification ,program2 and 7,b7 is carrying out a program for recruiting and retaining students underrepresented in the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals 7including racial or ethnic minorities1 students with disabilities1 or students from disadvantaged backgrounds74 7#c7 ,eligible individual ,the term eligible individual means an individual who-- 7,a7 is a member of a class of persons who are underrepresented in the professions of physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 and direct care professionals1 including-- 7i7 individuals who are racial or ethnic minorities2 or 7ii7 individuals who are from disadvantaged backgrounds2 7,b7 has a financial need for a scholarship or stipend2 and 7,c7 is enrolled 7or accepted for enrollment7 at a physical therapy1 occupational therapy1 respiratory therapy1 audiology1 speech-language pathology1 or direct care professionals program as a full-time student at an eligible entity4 7#d7 ,individualized education program ,the term individualized education program has the meaning given such term in section #fjb of the ,individuals with ,disabilities ,education ,act4 7#e7 ,long-term care setting ,the term long-term care setting has the meaning given such term in section #c of the ,long-,term ,care ,workforce ,support ,act4 7#f7 ,older individual ,the term older individual has the meaning given such term in section #ajb of the ,older ,americans ,act of #aife4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 4 ,b ,improving ,workforce ,recruitment #baa4 ,technical assistance center for building the direct care professional workforce 7a7 ,grant program authorized 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award a grant1 on a competitive basis1 to an eligible partnership described in subsection 7b7 to create a national technical assistance center 7referred to in this section as the ,center7 for supporting direct care professional workforce creation1 training and education1 recruitment1 retention1 and advancement1 including through the activities under subsection 7c74 7#b7 ,consultation ,the ,center shall carry out activities under this section in consultation with the ,secretary of ,labor1 the ,secretary of ,education1 the ,secretary of ,veterans ,affairs1 the ,administrator of the ,administration for ,community ,living1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,administrator of the ,health ,resources and ,services ,administration1 and the heads of other entities as necessary4 7b7 ,eligible partnerships 7#a7 ,in general ,an eligible partnership described in this subsection is a partnership of #c or more of the following3 7,a7 ,an institution of higher education4 7,b7 ,a disability-led organization4 7,c7 ,an organization focusing on older individuals4 7,d7 ,an organization focusing on direct care professionals4 7,e7 ,an organization that represents service provider agencies that employ direct care professionals4 7,f7 ,an organization1 including a labor organization1 that fosters professional development4 7,g7 ,a ,university ,center for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,service supported under subtitle ,d of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejfa et seq474 7,h7 ,an agency implementing a ,state protection and advocacy system described in section #adc of such ,act 7#db ,u4,s4,c4 #aejdc74 7,i7 ,a ,state ,council on ,developmental ,disabilities 7as such term is used in subtitle ,b of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejba et seq4774 7,j7 ,an organization representing a center for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7,k7 ,an organization representing veterans4 7,l7 ,an organization representing parents or caregivers of children with disabilities or chronic conditions4 7,m7 ,any other entity the ,secretary designates as important to improving the direct care professional workforce4 7#b7 ,applications ,to be eligible for a grant under this section1 an eligible partnership described in paragraph 7#a7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,activities ,the ,center may-- 7#a7 develop recommendations for training and education curricula for direct care professionals1 which such recommendations may include recommendations for curricula for higher education1 postsecondary credentials1 and programs with community and technical colleges2 7#b7 develop learning and dissemination strategies to-- 7,a7 engage ,states and other entities in activities supported under this section and best practices for supporting the direct care professional workforce2 and 7,b7 distribute findings from activities supported by the grant under this section2 7#c7 explore the national data gaps1 workforce shortage areas1 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 occupation2 and 7#d7 recommend career development and advancement opportunities for direct care professionals1 which may include occupational frameworks1 national standards1 recruitment campaigns1 pre-apprenticeship and on-the-job training opportunities1 apprenticeship programs1 career pathways1 specializations or certifications1 educational information about career opportunities in long-term care settings1 or other activities4 7d7 ,advisory council 7#a7 ,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 7#b7 for service on the advisory council4 7#b7 ,individuals ,the individuals described in this paragraph include-- 7,a7 older individuals and people with disabilities2 7,b7 organizations representing the rights and interests of people receiving services from direct care professionals2 7,c7 individuals who are direct care professionals and organizations representing the rights and interests of direct care professionals2 7,d7 as applicable1 employers of individuals described in subparagraph 7,c7 and labor organizations representing such individuals2 7,e7 representatives of ,state ,medicaid agencies1 ,state agencies defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 ,state developmental disabilities offices1 and ,state mental health agencies2 7,f7 representatives reflecting diverse racial1 cultural1 ethnic1 geographic1 socioeconomic1 and gender identity and sexual orientation perspectives2 7,g7 representatives of local boards and ,state boards2 7,h7 a nonprofit organization with demonstrated experience in the development or delivery of curricula or coursework2 7,i7 a nonprofit organization1 including a labor organization1 that fosters the professional development and collective engagement of direct care professionals2 7,j7 area agencies on aging2 7,k7 centers for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq472 7,l7 representatives of ,state ,councils on ,developmental ,disabilities 7as such term is used in subtitle ,b of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejba et seq4772 7,m7 representatives of ,aging and ,disability ,resource ,centers2 7,n7 representatives of nonprofit ,state provider associations that represents providers who employ direct care professionals2 7,o7 representatives of entities that employ direct care professionals2 7,p7 representatives of ,university ,centers for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,service supported under subtitle ,d of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejfa et seq472 7,q7 representatives of ,state protection and advocacy systems described in section #adc of such ,act 7#db ,u4,s4,c4 #aejdc72 and 7,r7 representatives of direct care professional organizations representing underserved communities1 including communities of color4 7e7 ,authorization of appropriations ,there are authorized to be appropriated #aj1jjj1jjj to carry out this section for each of fiscal years #bjbf through #bjcj4 #bab4 ,report on efforts to enhance the direct care professional workforce ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to the appropriate committees of ,congress1 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 workforce1 including the extent to which programs and activities authorized under titles ,,vii and ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bib et seq42 #db ,u4,s4,c4 #bif et seq47 address-- 7#a7 increasing nursing faculty who are trained in geriatric nursing2 7#b7 increasing individuals preparing for careers in or advanced degrees in geriatric nursing or long-term care2 7#c7 increasing direct care professionals2 7#d7 the extent to which the ,department coordinates with other ,federal departments regarding programs designed to improve the direct care professional workforce2 and 7#e7 recommendations for best practices4 #bac4 ,comprehensive geriatric education ,section #hfe of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bih7 is amended-- 7#a7 in subsection 7a71 by striking the elderly and inserting older individuals2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a71 by striking the elderly and inserting older individuals2 7,b7 in paragraph 7#b71 by striking treatment and all that follows and inserting health care needs of older individuals22 and 7,c7 in paragraph 7#e71 by striking the elderly population and inserting older individuals2 7#c7 in subsection 7d7-- 7,a7 in the heading1 by striking ,eligible ,entity and inserting ,definitions2 7,b7 by striking ,for purposes of this section1 the term and inserting 8,for purposes of this section3 7#a7 ,eligible entity ,the term 2 and 7,c7 by adding at the end the following3 7#b7 ,older individual ,the term older individual has the meaning given such term in section #ajb of the ,older ,americans ,act of #aife4 2 and 7#d7 in subsection 7e71 by striking years and all that follows and inserting years #bjbf through #bjcj44 #bad4 ,review of the availability and quality of apprenticeship programs in long-term care settings ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,labor1 in coordination with the ,secretary of ,health and ,human ,services1 shall submit a report to the appropriate committees of ,congress that-- 7#a7 identifies the extent of vacancies at employers that employ direct care professionals at the ,state and local levels within the direct care professional workforce1 including with respect to vacancies of direct care professionals2 7#b7 review existing apprenticeship programs in the direct care professional workforce2 7#c7 provide recommendations on the design of apprenticeship programs in the direct care professional workforce1 including about potential funding opportunities1 potential apprenticeship program sponsors1 and a national competency-based occupational framework2 and 7#d7 identify opportunities for coordination with other ,state and local entities1 including ,state educational agencies1 local educational agencies1 career and technical education programs1 institutions of higher education1 ,state agencies with responsibility for administering a ,state ,medicaid program1 and labor management organizations1 to create apprenticeship programs and other ways to incorporate associate and bachelor's degrees in apprenticeship programs4 #bae4 ,rural health workforce grant program ,part ,d of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid et seq47 is amended by adding at the end the following3 #gfj;,a4 ,rural health workforce grant program 7a7 ,definitions ,in this section3 7#a7 ,carl ,d4 ,perkins ,career and ,technical ,education ,act definitions ,the terms career and technical education1 career guidance and academic counseling1 and program of study have the meanings given the terms in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf4 7#b7 ,,esea definitions ,the terms elementary school1 local educational agency1 and secondary school have the meanings given the terms in section #haja of the ,elementary and ,secondary ,education ,act of #aife4 7#c7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #ajb of the ,higher ,education ,act of #aife4 7#d7 ,long-term ,care ,workforce ,support ,act ,the terms direct care professional and direct care professional workforce have the meanings given such terms in section #c of the ,long-,term ,care ,workforce ,support ,act4 7#e7 ,workforce innovation and opportunity act definitions ,the terms career pathway1 industry or sector partnership1 and local board have the meanings given the terms in section #c of the ,workforce ,innovation and ,opportunity ,act4 7b7 ,authorization of grants 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,secretary of ,education1 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 careers4 7#b7 ,grant amount ,each grant awarded under this section shall be in an amount that is not more than #bej1jjj per year4 7#c7 ,grant period ,each grant awarded under this section shall be for a period not to exceed #e years4 7c7 ,eligible entities 7#a7 ,in general ,to be eligible to receive a grant under this section1 an entity shall meet the following requirements3 7,a7 ,be a consortium consisting of a local educational agency and at least #b of the following3 7i7 ,an institution of higher education that provides a recognized postsecondary credential in health care4 7ii7 ,a health care practice1 facility1 or provider organization4 7iii7 ,a ,state1 ,indian ,tribe or ,tribal organization1 or a local governmental entity4 7iv7 ,a local board4 7v7 ,an industry or sector partnership4 7vi7 ,a nonprofit organization representing the interests of underserved rural communities and rural health care4 7vii7 ,an area health education center4 7viii7 ,a rural health clinic4 7ix7 ,any other entity as determined appropriate by the ,secretary4 7,b7 ,submit an application to the ,secretary at such time1 in such manner1 and containing such information that the ,secretary may require1 including a plan for the long-term tracking of participants supported by the grant under this section4 7#b7 ,matching funds ,in order to ensure the institutional commitment of an entity to a program supported by a grant under this section1 to be eligible to receive such a grant1 the ,secretary may require the entity seeking such grant to agree to make available 7directly or through contributions from ,state1 county or municipal governments1 or the public or private sector7 recurring non-,federal contributions in cash or in kind 7including plant1 equipment1 or services7 towards the costs of operating the program in an amount that is equal to not less than #ej percent of the total costs of operating such program4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities that-- 7#a7 include in its consortium-- 7,a7 an entity that has demonstrated alignment with a ,state plan or local application developed under the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf2 7,b7 a high-need local educational agency1 as defined in section #bjj of the ,higher ,education ,act of #aife1 or a local educational agency eligible to receive assistance under part ,b of title ,v of the ,elementary and ,secondary ,education ,act of #aife2 7,c7 an institution of higher education at which at least #cj percent of the enrolled students are ,federal ,pell ,grant recipients2 7,d7 a minority-serving institution of higher education described in any of paragraphs 7#a7 through 7#g7 of section #cga7;a7 of the ,higher ,education ,act of #aife2 or 7,e7 a local educational agency that serves the greatest number of students2 and 7#b7 provide a plan to sustain the program funded under the grant beyond the period of the grant4 7e7 ,use of funds2 requirements ,an eligible entity receiving a grant under this section shall use the grant funds to establish1 improve1 or expand an underserved rural community training program for elementary school students and secondary school students that meets the following requirements3 7#a7 ,carrying out program planning1 including-- 7,a7 development and support of a coordinating body to organize1 administer1 and oversee the activities of the consortium2 7,b7 conducting a needs analysis using data1 including community demographics1 workforce estimates1 and capacity of training programs to direct work of the consortium2 and 7,c7 developing a regional articulation plan that benefits students with respect to reducing barriers to program entry1 reducing time to graduation1 and lower cost training options4 7#b7 ,carrying out age-appropriate education activities and promotion of the program that align with section #ace7;b77#a7 of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf1 including-- 7,a7 engaging students in underserved rural communities in elementary school for exposure to health career workforce opportunities1 and including direct care professionals in educational opportunities as practicable2 7,b7 exposing secondary school students in underserved rural communities to health career workforce opportunities available in their communities1 including by providing career guidance and academic counseling on such opportunities2 7,c7 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 communities2 7,d7 providing age-appropriate mentoring1 academic enrichment1 or support for elementary school and secondary school students in underserved rural communities1 carried out by health care professionals or peers2 7,e7 enrolling secondary school students 7including those in underserved rural communities7 in health care career and technical education programs of study or career pathways in underserved rural communities2 7,f7 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 communities2 7,g7 providing financial supplemental support for student transportation to1 and housing at1 the program site1 as appropriate2 and 7,h7 such other activities as the ,secretary determines appropriate4 7#c7 ,each such program shall be carried out for a term of not less than #e years4 7f7 ,technical assistance ,the ,administrator of the ,health ,resources and ,services ,administration shall1 directly or indirectly1 provide technical assistance to grant recipients for purposes of carrying out the programs described in subsection 7e74 7g7 ,reporting 7#a7 ,annual reporting by recipients 7,a7 ,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 grant1 based on criteria the ,secretary determines appropriate1 including the program selection of students who participated in the program4 7,b7 ,contents ,each report required under subparagraph 7,a7 shall include any data requested by the ,secretary1 which may include1 as appropriate1 the number of participants and the demographics of such participants served by the program supported by the grant1 including the number of participants who enrolled in the program and withdrew prior to completion of the program4 7#b7 ,reports to congress 7,a7 ,annual reports ,not later than #b years after the date of enactment of this section1 and annually thereafter until all programs supported through a grant under this section are completed1 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 programs4 7,b7 ,grant cycle final report ,not later than ,september #cj1 #bjca1 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 workforce4 7h7 ,regulations ,the ,secretary shall1 by regulation1 define the term underserved rural community for purposes of this section4 7i7 ,supplement not supplant ,any eligible entity receiving funds under this section shall use such funds to supplement1 not supplant1 any other ,federal1 ,state1 and local funds that would otherwise be expended by such entity to carry out the activities described in this section4 7j7 ,evaluation 7#a7 ,in general ,the ,secretary1 in conjunction with the ,secretary of ,labor1 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 professionals4 7#b7 ,external evaluator ,the ,secretary shall conduct the evaluation under paragraph 7#a7 through a contract with an external evaluator who has experience with evaluation related to workforce development and people with disabilities and older individuals4 7k7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 4 ,c ,providing career advancement opportunities2 assessment of worker well-being #bba4 ,assessment of direct care professional well-being 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,director of the ,national ,institute for ,occupational ,safety and ,health of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and the ,administrator of the ,health ,resources and ,services ,administration1 shall-- 7#a7 not later than #a year after the date of enactment of this ,act1 develop a research-based tool for assessing direct care professional well-being1 as described in subsection 7b72 and 7#b7 not less frequently than biennially1 collect data on worker well-being using the tool developed pursuant to paragraph 7#a7 and make such data publicly available as described in subsection 7c74 7b7 ,assessment tool ,the tool for the assessment of direct care professional well-being developed under subsection 7a77#a7 shall-- 7#a7 include the use of an anonymous1 validated survey of direct care professionals2 7#b7 at a minimum1 assess and include the views of such professionals on-- 7,a7 workplace policies and culture1 including meaningful engagement of such professionals2 7,b7 workplace physical environment and safety2 7,c7 circumstances outside of work for such professionals2 and 7,d7 the physical and mental health status of such professionals2 and 7#c7 be developed with input from direct care professionals1 older individuals1 people with disabilities1 and family members of older individuals and people with disabilities4 7c7 ,public availability of aggregate data and the assessment tool ,the ,secretary shall-- 7#a7 make available1 through a publicly available data repository1 aggregated and de-identified data collected by the assessment of direct care professional well-being under subsection 7a72 7#b7 make the assessment tool developed under subsection 7a77#a7 publicly available in a format that allows employers1 researchers1 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 professionals2 and 7#c7 conduct outreach to employers1 researchers1 and other relevant entities to increase awareness of the availability of the tool for the assessment of the well-being of direct care professionals4 7d7 ,burden on participants ,in developing the assessment tool under subsection 7a77#a71 the ,secretary shall minimize the burden of the data collection process on direct care professionals4 7e7 ,confidentiality ,the ,secretary shall ensure that the assessment tool developed under subsection 7a77#a71 the process of data collection under subsection 7a71 and the publicly available data under subsection 7c77#a71 do not involve the collection or disclosure of any individually identifiable information regarding the direct care professionals who are being assessed4 7f7 ,rule of construction ,nothing in this section shall be construed to require that the assessment tool developed under subsection 7a77#a7 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 7#db ,u4,s4,c4 #acie et seq47 or a ,state ,medicaid program4 7g7 ,report ,not later than #b years after the date of enactment of this ,act1 and biennially thereafter1 the ,secretary shall-- 7#a7 submit to ,congress a report on the findings of the assessment under subsection 7a71 including any recommendations to address direct care professional well-being2 and 7#b7 make such report publicly available on the website of the ,centers for ,disease ,control and ,prevention4 7h7 ,definition of well-,being ,for purposes of this section1 the term well-being1 with respect to a direct care professional1 means the quality of life with respect to the health and work-related environment of such professional as related to organizational and psychosocial factors4 7i7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to carry out this section #f1jjj1jjj for each of fiscal years #bjbf through #bjca4 #bbb4 ,national ,direct ,care ,professional ,training ,standards ,commission 7a7 ,establishment 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall establish the ,national ,direct ,care ,professional ,training ,standards ,commission 7referred to in this section as the ,commission7 to advise the ,secretary on-- 7,a7 developing national direct care professional training standards described in paragraph 7#b7 to recommend to ,states to implement2 and 7,b7 providing support for ,states in implementing such standards4 7#b7 ,standards ,the standards under this subsection shall be-- 7,a7 competency-based2 7,b7 industry-recognized2 and 7,c7 portable across settings and ,states4 7#c7 ,membership ,the ,commission shall include representatives from the following3 7,a7 ,an organization representing older individuals4 7,b7 ,an organization led by people with disabilities4 7,c7 ,an organization representing the rights and interests of people receiving services from direct care professionals4 7,d7 ,an organization 7other than a labor organization7 representing direct care professionals4 7,e7 ,labor organizations representing direct care professionals4 7,f7 ,an organization representing ,state ,medicaid agencies1 ,state agencies defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 ,state developmental disabilities offices1 and ,state mental health agencies4 7,g7 ,an organization representing local boards and ,state boards4 7,h7 ,an organization representing area agencies on aging4 7,i7 ,an organization representing centers for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7,j7 ,an organization representing ,state ,councils on ,developmental ,disabilities 7as such term is used in subtitle ,b of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejba et seq4774 7,k7 ,an organization representing ,aging and ,disability ,resource ,centers4 7,l7 ,an organization representing nonprofit ,state provider associations4 7,m7 ,an organization representing entities that employ direct care professionals4 7,n7 ,an organization representing ,university ,centers for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,service supported under subtitle ,d of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejfa et seq474 7,o7 ,an organization representing ,state protection and advocacy systems described in section #adc of such ,act 7#db ,u4,s4,c4 #aejdc74 7,p7 ,representatives of direct care professional organizations representing underserved communities1 including communities of color4 7,q7 ,representatives reflecting diverse racial1 cultural1 ethnic1 geographic1 socioeconomic1 and gender identity and sexual orientation perspectives4 7#d7 ,period of appointment2 vacancies 7,a7 ,in general ,a member of the ,commission shall be appointed for the life of the ,commission4 7,b7 ,vacancies ,a vacancy in the ,commission-- 7i7 shall not affect the powers of the ,commission2 and 7ii7 shall be filled in the same manner as the original appointment4 7#e7 ,meetings 7,a7 ,initial meeting ,not later than #ahj days after the date on which all members of the ,commission have been appointed1 the ,commission shall hold the first meeting of the ,commission4 7,b7 ,frequency ,the ,commission shall meet at the call of the ,chairperson4 7,c7 ,quorum ,a majority of the members of the ,commission shall constitute a quorum1 but a lesser number of members may hold hearings4 7#f7 ,chairperson and vice chairperson ,the ,commission shall select a ,chairperson and ,vice ,chairperson from among the members of the ,commission4 7b7 ,duties 7#a7 ,study ,the ,commission shall conduct a thorough study of all matters relating to direct care professional training standards4 7#b7 ,recommendations ,the ,commission shall develop recommendations on-- 7,a7 national training standards for direct care professionals that meet the requirements under subsection 7a77#b72 and 7,b7 methods for supporting ,states in implementing such standards4 7#c7 ,report ,not later than #c years after the date of enactment of this ,act1 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 ,commission1 together with the recommendations of the ,commission for such legislation and administrative actions as the ,commission considers appropriate4 7c7 ,powers of ,commission 7#a7 ,hearings ,the ,commission may hold such hearings1 sit and act at such times and places1 take such testimony1 and receive such evidence as the ,commission considers advisable to carry out this section4 7#b7 ,information from ,federal agencies 7,a7 ,in general ,the ,commission may secure directly from a ,federal department or agency such information as the ,commission considers necessary to carry out this section4 7,b7 ,furnishing information ,on request of the ,chairperson of the ,commission1 the head of the department or agency shall furnish the information to the ,commission4 7#c7 ,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 ,government4 7#d7 ,gifts ,the ,commission may accept1 use1 and dispose of gifts or donations of services or property4 7d7 ,commission personnel matters 7#a7 ,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 #ecae of title #e1 ,united ,states ,code1 for each day 7including travel time7 during which the member is engaged in the performance of the duties of the ,commission4 7#b7 ,travel expenses ,a member of the ,commission shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for employees of agencies under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from their homes or regular places of business in the performance of services for the ,commission4 7#c7 ,staff 7,a7 ,in general ,the ,chairperson of the ,commission may1 without regard to the civil service laws 7including regulations71 appoint and terminate an executive director and such other additional personnel as may be necessary to enable the ,commission to perform its duties1 except that the employment of an executive director shall be subject to confirmation by the ,commission4 7,b7 ,compensation ,the ,chairperson of the ,commission may fix the compensation of the executive director and other personnel without regard to chapter #ea and subchapter ,,iii of chapter #ec of title #e1 ,united ,states ,code1 relating to classification of positions and ,general ,schedule pay rates1 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 #ecaf of that title4 7#d7 ,detail of government employees ,a ,federal ,government employee may be detailed to the ,commission without reimbursement1 and such detail shall be without interruption or loss of civil service status or privilege4 7#e7 ,procurement of temporary and intermittent services ,the ,chairperson of the ,commission may procure temporary and intermittent services under section #caji7;b7 of title #e1 ,united ,states ,code1 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 #ecaf of that title4 7e7 ,termination of commission ,the ,commission shall terminate #ij days after the date on which the ,commission submits the report required under subsection 7b77#c74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ejj1jjj for fiscal year #bjbf1 to remain available1 without fiscal year limitation1 until expended4 ,d ,increasing supports for the existing direct care professional workforce #bca4 ,mental health services 7a7 ,programs ,to promote mental health among direct care professionals 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall award grants1 contracts1 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 professionals4 7#b7 ,eligibility ,to be eligible to receive an award under this subsection1 an entity shall be-- 7,a7 a ,state2 7,b7 a labor organization1 joint labor management organization1 or employer of direct care professionals2 7,c7 a nonprofit entity with experience in aging1 disability1 or supporting the rights and interests of1 the training of1 or educating direct care professionals2 or 7,d7 an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization4 7#c7 ,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 professionals1 which may include-- 7,a7 improving awareness among direct care professionals about risk factors for1 and signs of1 suicide and mental health or substance use disorders1 in accordance with evidence-based or evidence-informed practices2 7,b7 establishing new1 or enhancing existing1 evidence-based or evidence-informed programs for preventing suicide and improving mental health and resiliency among direct care professionals2 7,c7 establishing new1 or enhancing existing1 peer-support programs for direct care professionals2 or 7,d7 providing-- 7i7 mental health care2 7ii7 follow-up services or care by a licensed or certified mental health professional 7including by means of telehealth72 or 7iii7 a referral for such services or care by such a professional1 as appropriate4 7#d7 ,priority ,in awarding grants1 contracts1 and cooperative agreements under this subsection1 the ,secretary shall give priority to an eligible entity in-- 7,a7 a rural area2 or 7,b7 an area where the number of direct care professional vacancies1 in the year of the application1 is greater than #cj percent of the total number of direct care professional positions in the area4 7b7 ,training grants 7#a7 ,in general ,the ,secretary may establish a program to award grants to eligible entities to support the inclusion1 in direct care professional preparation programs and in training1 continuing education1 or professional development programs for direct care professionals1 of evidence-based or evidence-informed strategies-- 7,a7 to address mental and substance use disorders of direct care professionals2 and 7,b7 to improve mental health and resiliency among direct care professionals4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity shall be-- 7,a7 an institution of higher education2 7,b7 a ,state or local government2 7,c7 an ,indian ,tribe or ,tribal organization2 7,d7 a public or private nonprofit entity determined appropriate by the ,secretary2 or 7,e7 a consortia of entities described in any of subparagraphs 7,a7 through 7,d71 including such entities promoting multidisciplinary approaches4 7c7 ,grant terms ,a grant1 contract1 or cooperative agreement awarded under subsection 7a7 or 7b7 shall be for a period of #c years4 7d7 ,application submission ,an entity seeking an award under subsection 7a7 or 7b7 shall submit an application to the ,secretary at such time1 in such manner1 and accompanied by such information as the ,secretary may require4 7e7 ,annual report ,an entity receiving an award under subsection 7a7 or 7b7 shall submit to the ,secretary an annual report evaluating the activities supported by the award4 7f7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #bcb4 ,dissemination of best practices with respect to mental health of direct care professionals ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 identify evidence-based or evidence-informed best practices-- 7,a7 for preventing suicide and improving mental health and resiliency among direct care professionals2 and 7,b7 for training direct care professionals in appropriate strategies to promote their mental health2 and 7#b7 disseminate those best practices to the appropriate committees of ,congress4 #bcc4 ,education and awareness initiative encouraging use of mental health and substance use disorder services by direct care professionals 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in consultation with relevant stakeholders1 including medical professional associations1 shall establish a national evidence-based or evidence-informed education and awareness initiative-- 7#a7 with the goal of preventing suicide1 mental health conditions1 and substance use disorders of direct care professionals1 to-- 7,a7 encourage direct care professionals to seek support and care for their mental health or substance use concerns2 7,b7 help such professionals identify risk factors associated with suicide and mental health conditions2 and 7,c7 help such professionals learn how best to respond to such risk factors2 and 7#b7 to address stigma associated with seeking mental health and substance use disorder services4 7b7 ,reporting ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall provide to the appropriate committees of ,congress an update on the activities and outcomes of the initiative under subsection 7a71 including a description of quantitative and qualitative metrics used to evaluate such activities and outcomes4 #bcd4 ,direct care professional training grants ,section #bjda of the ,social ,security ,act 7#db ,u4,s4,c4 #acigm7 is amended to read as follows3 #bjda4 ,direct care professional training grants 7a7 ,in general 7#a7 ,state entitlement 7,a7 ,in general ,each ,state shall be entitled to receive from the ,secretary for each fiscal year specified in subsection 7e7 a grant in an amount equal to the amount allotted to the ,state under subparagraph 7,b74 7,b7 ,state allotments 7i7 ,in general ,subject to clauses 7ii71 7iii71 and 7iv7 the amount allotted to a ,state under this subparagraph for a fiscal year shall be equal to the product of-- 7,i7 the available amount for the fiscal year2 and 7,,ii7 the ratio of-- 7aa7 the number of ,state residents who have attained #fj years of age or are under a disability 7as defined in section #baf7;i77#a771 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 set2 divided by 7bb7 the total number of such residents of all ,states4 7ii7 ,limitation ,the amount allotted to a ,state under this subparagraph for a fiscal year shall be not less than #j4be percent of the available amount for the fiscal year4 7iii7 ,adjustment of state allotments ,subject to clause 7ii71 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 ,states4 7iv7 ,redeterminations 7,i7 ,frequency ,the ,secretary shall make the determination referred to in clause 7i77,,ii77aa7 every #e years4 7,,ii7 ,limitation ,subject to clause 7ii71 the amount allotted to a ,state under this subparagraph1 on the basis of such a determination1 for a fiscal year after fiscal year #bjcj shall be-- 7aa7 not less than #ij percent of the amount of the grant made to the ,state under this subparagraph for the preceding fiscal year2 and 7bb7 not more than #aaj percent of the amount referred to in item 7aa74 7#b7 ,grants to indian tribes and tribal organizations 7,a7 ,in general ,the ,secretary1 in consultation with the ,secretary of the ,interior1 shall make grants in accordance with this section to ,indian tribes and tribal organizations who operate at least #a eligible setting4 7,b7 ,grant formula ,the ,secretary1 in consultation with the ,secretary of the ,interior1 shall devise a formula for distributing among ,indian tribes and tribal organizations the amount required to be reserved by subsection 7e7 for each fiscal year4 7#c7 ,sub-grants ,a ,state1 ,indian tribe1 or tribal organization to which an amount is paid under this section may use the amount to make sub-grants to local organizations1 including community organizations1 local non-profits1 elder rights and justice groups1 and workforce development boards for any purpose described in paragraph 7#a7 or 7#b7 of subsection 7b74 7b7 ,use of funds 7#a7 ,required uses ,a ,state1 ,indian tribe1 or tribal organization to which an amount is paid under this section shall use the amount to-- 7,a7 provide wage subsidies to eligible individuals2 7,b7 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 7f77#b77;,a72 7,c7 guarantee affordable and accessible child care for eligible individuals1 including help with referrals1 co-pays1 or other direct assistance2 and 7,d7 provide assistance where necessary with obtaining appropriate transportation1 including public transportation if available1 or gas money if public transportation is unavailable or impractical based on work hours or location4 7#b7 ,authorized uses ,a ,state1 ,indian tribe1 or tribal organization to which an amount is paid under this section may use the amount to-- 7,a7 establish a reserve fund for financial assistance to eligible individuals in emergency situations2 7,b7 provide in-kind resource donations1 such as interview clothing and conference attendance fees2 7,c7 provide assistance with programs and activities1 including legal assistance1 deemed necessary to address arrest or conviction records that are an employment barrier2 7,d7 support employers operating an eligible setting in the ,state1 ,indian tribe1 or tribal organization in providing employees with not less than #b weeks of paid leave per year2 or 7,e7 provide other support services the ,secretary deems necessary to allow for successful recruitment and retention of workers4 7#c7 ,provision of funds only for the benefit of eligible individuals in eligible settings ,a ,state1 ,indian tribe1 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 individual4 7#d7 ,nonsupplantation ,a ,state1 ,indian tribe1 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 setting4 7#e7 ,obligation deadline ,a ,state1 ,indian tribe1 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 #b years after the end of the fiscal year4 7c7 ,administration ,a ,state1 ,indian tribe1 or tribal organization to which a grant is made under this section shall reserve not more than #aj percent of the grant to-- 7#a7 administer subgrants in accordance with this section2 7#b7 provide technical assistance and support for applying for and accessing such a subgrant opportunity2 7#c7 publicize the availability of the subgrants2 7#d7 carry out activities to increase the supply of eligible individuals2 and 7#e7 provide technical assistance to help subgrantees find and train individuals to provide the services for which they are contracted4 7d7 ,reports 7#a7 ,state reports ,not less frequently than annually1 each ,state1 ,indian tribe1 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 report1 which shall include-- 7,a7 the total amount expended in the ,state for each type of use described in paragraph 7#a7 or 7#b7 of subsection 7b72 7,b7 the total number of non-,state organizations in the ,state to which grant funds were provided1 and the amount so provided to each such organization2 7,c7 the change in the number of individuals working in each job category described in subsection 7f77#b77;,a7 in an eligible setting in the ,state2 7,d7 the average duration of employment for each such job category2 7,e7 the average annual wage of workers in each job category described in subsection 7f77#b77;,a7 in an eligible setting in the ,state2 7,f7 the average amount of paid time off to which a worker in each job category described in subsection 7f77#b77;,a7 in an eligible setting in the ,state is entitled by their contract2 and 7,g7 such other data elements as the ,secretary deems relevant4 7#b7 ,report to ,congress ,not later than #c years after the date of the enactment of this section1 and every #d years thereafter1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 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 report1 which shall include-- 7,a7 the total amount expended by each ,state1 ,indian tribe1 or tribal organization for each type of use described in paragraph 7#a7 or 7#b7 of subsection 7b72 7,b7 the total number of non-,state or non-tribal organizations in each ,state1 ,indian tribe1 or tribal organization to which grant funds were provided1 and the amount so provided to each such non-,state or non-tribal organization2 7,c7 the change in the number of individuals working in each job category described in subsection 7f77#b77;,a7 in an eligible setting2 7,d7 the average duration of employment for each such job category1 by ,state1 ,indian tribe1 or tribal organization2 7,e7 the average annual wage of workers in each job category described in subsection 7f77#b77;,a7 in an eligible setting2 7,f7 the average amount of paid time off to which a worker in each job category described in subsection 7f77#b77;,a7 in an eligible setting is entitled by their contract2 and 7,g7 such other data elements as the ,secretary deems relevant4 7e7 ,appropriation ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary #djj1jjj1jjj for each of fiscal years #bjbf through #bjcj to carry out this section1 of which #b percent shall be reserved for grants to ,indian tribes and tribal organizations4 7f7 ,definitions ,in this section3 7#a7 ,available amount ,the term available amount means1 with respect to a fiscal year1 the amount specified in subsection 7e7 that remains after the reservation required by such subsection for the fiscal year1 plus all amounts remitted to the ,secretary under subsection 7b77#e7 that have not been reallotted under subsection 7a77#a77;,b77iii74 7#b7 ,eligible individual ,the term eligible individual means an individual who-- 7,a7 7i7 is a qualified home health aide1 as defined in section #dhd4hj7;a7 of title #db1 ,code of ,federal ,regulations2 7ii7 is a nurse aide approved by the ,state as meeting the requirements of sections #dhc4aej through #dhc4aed of such title1 and is listed in good standing on the ,state nurse aide registry2 7iii7 is a personal care aide approved by the ,state1 and furnishes personal care services1 as defined in section #ddj4afg of such title2 7iv7 is a qualified hospice aide1 as defined in section #dah4gf of such title2 7v7 is a licensed practical nurse or a licensed or certified social worker2 7vi7 is receiving training to be certified or licensed as such an aide1 nurse1 or social worker2 or 7vii7 is any other direct care professional2 and 7,b7 provides 7or1 in the case of a trainee1 intends to provide7 services as such an aide1 nurse1 or social worker in an eligible setting4 7#c7 ,eligible setting ,the term eligible setting means-- 7,a7 a skilled nursing facility1 as defined in section #ahai2 7,b7 a nursing facility1 as defined in section #aiai2 7,c7 a home health agency1 as defined in section #ahia2 7,d7 a setting approved to deliver home or community-based services authorized under ,state options described in subsection 7c7 or 7i7 of section #aiae or1 as relevant1 demonstration projects authorized under section #aaae2 7,e7 a hospice1 as defined in section #ahad2 7,f7 another long-term care setting2 or 7,g7 a tribal assisted living facility4 7#d7 ,tribal organization ,the term tribal organization has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 4 #bce4 ,credit for certain health care professionals 7a7 ,in general ,subpart ,c of part ,,iv of subchapter ,a of chapter #a of the ,internal ,revenue ,code of #aihf is amended by inserting after section #cf the following new section3 #cf;,a4 ,credit for certain health care professionals 7a7 ,allowance of credit ,in the case of an individual who is a health care professional described in subsection 7b7 with respect to the taxable year1 there shall be allowed a credit of #e1jjj against the tax imposed by this subtitle for such taxable year4 7b7 ,health care professionals described ,a health care professional described in this subsection1 with respect to any taxable year1 is any individual who1 at any time during such taxable year1 is-- 7#a7 a practitioner1 as defined in section #ahdb7;b77#ah77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c771 providing services for compensation as such practitioner in a long-term care setting1 7#b7 a certified nursing assistant providing services for compensation as such assistant in a long-term care setting1 7#c7 a licensed practical nurse1 or registered professional nurse1 providing services for compensation as such a nurse in a long-term care setting1 7#d7 a home health aide providing services for compensation as such aide in a long-term care setting1 7#e7 a personal or home care aide providing services for compensation as such aide in a long-term care setting1 or 7#f7 a direct care professional1 who is not otherwise described in any of paragraphs 7#a7 through 7#e71 providing services for compensation as such professional in a long-term care setting4 7c7 ,definitions ,for purposes of this section1 the terms direct care professional1 long-term care setting1 and personal or home care aide have the meanings given such terms in section #c of the ,long-,term ,care ,workforce ,support ,act4 4 7b7 ,conforming amendments 7#a7 ,section #fbaa7;b77#d77;,a7 of the ,internal ,revenue ,code of #aihf is amended by inserting 1 #cf;,a after #cf4 7#b7 ,the table of section for subpart ,c of part ,,iv of subchapter ,a of chapter #a such ,code is amended by amending by inserting after the item relating to section #cf the following new item3 ,sec4 #cf;,a4 ,credit for certain health care professionals4 4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjbd4 #bcf4 ,direct ,care ,professional ,workforce ,equity ,technical ,assistance ,center 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in consultation with the ,secretary of ,labor1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the heads of other entities as necessary1 shall establish a national technical assistance center to-- 7#a7 address inequities and disparities facing the direct care professional workforce2 and 7#b7 ensure that long-term care settings are meeting the unique demographic1 cultural1 and linguistic needs of the community in which such settings are situated and the community of workers within such settings4 7b7 ,activities ,the ,center may-- 7#a7 maintain a centralized online hub of equity-focused direct care professional workforce resources2 7#b7 conduct studies and develop trainings and resources on the inequities facing direct care professionals and enhancing diversity1 equity1 inclusion1 and accessibility among long-term care settings2 7#c7 develop equity-specific tools and resources to support ,state and local governments in building an equitable direct care professional workforce2 7#d7 design and inform interventions in the direct care professional workforce that reduce disparities and promote equity within the direct care professional workforce2 7#e7 convene experts in the direct care professional workforce1 including direct care professionals1 to develop equity-based resources2 and 7#f7 collaborate with organizations representing people with disabilities1 older individuals1 people of color1 women1 immigrants1 and ,,lgbt communities1 and others as determined by the ,secretary4 7c7 ,reporting ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall provide to the appropriate committees of ,congress an update on the activities and outcomes of the initiative under subsection 7a74 7d7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated to the ,secretary #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 ,,iii ,workforce labor protections ,a ,long-term ,care ,workforce ,wage ,theft ,prevention and ,wage ,recovery ,act #cja4 ,definitions ,in this subtitle3 7#a7 ,administrator ,the term the ,administrator means the ,administrator of the ,wage and ,hour ,division of the ,department of ,labor4 7#b7 ,community partner ,the term community partner means any stakeholder with a commitment to enforcing wage and hour laws and preventing abuses of such laws1 including any-- 7,a7 ,state department of labor2 7,b7 attorney general of a ,state or other similar authorized official of a political subdivision thereof2 7,c7 law enforcement agency2 7,d7 consulate2 7,e7 employee or advocate of employees1 including a labor organization1 community- and faith-based organization1 business association1 disability organization1 older individual organization1 or nonprofit legal aid organization2 7,f7 academic institution that plans1 coordinates1 and implements programs and activities to prevent wage and hour violations and recover unpaid wages1 damages1 and penalties2 or 7,g7 any municipal agency responsible for the enforcement of local wage and hour laws4 7#c7 ,community partnership ,the term community partnership means a partnership between-- 7,a7 a working group consisting of community partners2 and 7,b7 the ,department of ,labor4 7#d7 ,covered employee ,the term covered employee means a direct care professional working in a long-term care setting4 7#e7 ,covered employer ,the term covered employer means an employer who employs covered employees to work in or provide services in a long-term care setting4 7#f7 ,eligible entity ,the term eligible entity means an entity that is any of the following3 7,a7 ,a nonprofit organization1 including such an organization that is a community-based organization1 faith-based organization1 disability organization1 older individuals organization1 or labor organization1 that provides services and support to employees1 including assisting such employees in recovering unpaid wages4 7,b7 ,an employer4 7,c7 ,a business association4 7,d7 ,an institution of higher education1 as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7,e7 ,a partnership between any of the entities described in subparagraphs 7,a7 through 7,d74 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7#h7 ,strategic enforcement ,the term strategic enforcement means the process by which the ,secretary-- 7,a7 targets highly noncompliant industries1 as identified by the ,secretary1 using industry-specific structures to influence1 and ultimately reform1 networks of interconnected employers2 7,b7 analyzes regulatory regimes under which specific industries operate2 and 7,c7 modifies the enforcement approach of such regulatory regimes in order to ensure the greatest impact4 7#i7 ,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 ,labor1 including any provision of this ,act enforced by such division4 7#aj7 ,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 ,labor1 including any provision of this ,act enforced by such division4 #cjb4 ,direct care professional workforce wage theft prevention and wage recovery grant program 7a7 ,in general ,the ,secretary1 acting through the ,administrator1 shall provide grants to eligible entities to assist such entities in enhancing the enforcement of wage and hour laws1 in accordance with this section and consistent with the purposes of this ,act4 7b7 ,grants ,a grant provided under this section shall be designed to-- 7#a7 support an eligible entity in establishing and supporting the activities described in subsection 7c77#a72 and 7#b7 develop community partnerships to expand and improve cooperative efforts between enforcement agencies and members of the community to-- 7,a7 prevent and reduce wage and hour violations2 and 7,b7 assist covered employees in recovering back pay for any such violations4 7c7 ,use of funds 7#a7 ,permissible activities ,the grants described in this section shall assist eligible entities in establishing and supporting activities that include-- 7,a7 disseminating information and conducting outreach and training to educate covered employees about their rights under wage and hour laws2 7,b7 conducting educational training for covered employers about their obligations under wage and hour laws2 7,c7 conducting orientations and trainings jointly with officials of the ,wage and ,hour ,division of the ,department of ,labor2 7,d7 providing assistance to covered employees in filing claims of wage and hour violations2 7,e7 assisting enforcement agencies in conducting investigations1 including in the collection of evidence and recovering back pay2 7,f7 monitoring compliance with wage and hour laws2 7,g7 performing joint visitations to worksites that violate wage and hour laws with officials from the ,wage and ,hour ,division of the ,department of ,labor2 7,h7 establishing networks for education1 communication1 and participation in the workplace and community2 7,i7 evaluating the effectiveness of programs designed to prevent wage and hour violations and enforce wage and hour laws2 7,j7 recruiting and hiring of staff and volunteers2 7,k7 production and dissemination of outreach and training materials2 7,l7 creation of a phone1 short message service1 web1 or other technology-based communication for reporting covered employee emergencies1 wage theft1 or labor violations1 seeking emergency services1 or seeking support or guidance in lieu of emergency services2 and 7,m7 any other activities as the ,secretary may reasonably prescribe through notice and comment rulemaking4 7#b7 ,prohibited activities ,notwithstanding paragraph 7#a71 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 rulemaking4 7d7 ,term of grants ,each grant made under this section shall be available for expenditure for a period that is not to exceed #c years4 7e7 ,applications 7#a7 ,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 subsection4 7#b7 ,partnerships ,in the case of an eligible entity that is a partnership described in section #cja7d77;,e71 the eligible entity may submit a joint application that designates a single entity as the lead entity for purposes of receiving and disbursing funds4 7#c7 ,contents ,an application under this subsection shall include-- 7,a7 a description of a plan for the program that the eligible entity proposes to carry out with a grant under this section1 including a long-term strategy and detailed implementation plan that reflects expected participation of1 and partnership with1 community partners2 7,b7 information on the prevalence of wage and hour violations in each community or ,state of the eligible entity2 7,c7 information on any industry or geographic area targeted by the plan for such program2 7,d7 information on the type of outreach and relationship building that will be conducted under such program2 7,e7 information on the training and education that will be provided to covered employees and covered employers under such program2 and 7,f7 the method by which the eligible entity will measure results of such program4 7f7 ,selection 7#a7 ,competitive basis ,in accordance with this subsection1 the ,secretary shall1 on a competitive basis1 select grant recipients from among eligible entities that have submitted an application under subsection 7e74 7#b7 ,priority ,in selecting grant recipients under paragraph 7#a71 the ,secretary shall give priority to eligible entities that-- 7,a7 serve covered employees in the long-term care industry or geographic area that is most highly at risk for noncompliance with wage and hour violations1 as identified by the ,secretary2 and 7,b7 demonstrate past and ongoing work to prevent wage and hour violations or to recover unpaid wages4 7#c7 ,other considerations ,in selecting grant recipients under paragraph 7#a71 the ,secretary shall also consider-- 7,a7 the prevalence of ongoing community support for each eligible entity1 including financial and other contributions2 and 7,b7 the eligible entity's past and ongoing partnerships with other organizations4 7g7 ,memoranda of understanding 7#a7 ,in general ,not later than #fj days after receiving a grant under this section1 the grant recipient shall negotiate and finalize with the ,secretary a memorandum of understanding that sets forth specific goals1 objectives1 strategies1 and activities that will be carried out under the grant by such recipient through a community partnership4 7#b7 ,signatures ,a representative of the grant recipient 7or1 in the case of a grant recipient that is an eligible entity described in section #cja7d77;,e71 a representative of each entity that composes the grant recipient7 and the ,secretary shall sign the memorandum of understanding under this subsection4 7#c7 ,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 grant4 7h7 ,performance evaluations 7#a7 ,in general ,each grant recipient under this section shall develop procedures for reporting1 monitoring1 measuring1 and evaluating the activities of each program or project funded under this section4 7#b7 ,guidelines ,the procedures required under paragraph 7#a7 shall be in accordance with guidelines established by the ,secretary4 7i7 ,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 7g71 the ,secretary may revoke or suspend 7in whole or in part7 the funding of the grant4 7j7 ,use of components 7#a7 ,in general ,in addition to the ,wage and ,hour ,division1 the ,secretary 7acting through the ,administrator7 may use any division or agency of the ,department of ,labor in carrying out this subtitle4 7#b7 ,consultation with ,,hhs ,the ,secretary may consult with the ,secretary of ,health and ,human ,services 7acting through the ,administrator for ,community ,living7 to carry out this subtitle4 7k7 ,evaluation ,the ,secretary of ,health and ,human ,services1 in conjunction with the ,secretary of ,labor1 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 services4 7l7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this subtitle #ej1jjj1jjj for each of fiscal years #bjbf through #bjcj1 to remain available until expended4 ,b ,direct care professional rights #caa4 ,definitions 7a7 ,fair labor standards act definitions ,in this subtitle-- 7#a7 the terms enterprise1 enterprise engaged in commerce or in the production of goods for commerce1 and person have the meanings given such terms in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc72 and 7#b7 the term regular rate has the meaning given such term in section #g7;e7 of such ,act 7#bi ,u4,s4,c4 #bjg7;e774 7b7 ,other definitions ,in this subtitle3 7#a7 ,child ,the term child-- 7,a7 means an individual who is under #ah years of age2 and 7,b7 includes an individual described in subparagraph 7,a7 who is-- 7i7 a biological1 foster1 or adopted child2 7ii7 a stepchild2 7iii7 a child of a domestic partner2 7iv7 a legal ward2 or 7v7 a child of a person standing in loco parentis4 7#b7 ,covered entity ,the term covered entity-- 7,a7 means any person or agency who provides compensation directly or indirectly to a direct care professional for the performance of long-term care services2 and 7,b7 includes-- 7i7 a person acting directly or indirectly in the interest of the entity in relation to a direct care professional2 7ii7 an employer of a direct care professional2 and 7iii7 an agency that contracts with an agency to provide direct care professionals4 7#c7 ,medicaid ,,hcbs-eligible older individual ,the term ,medicaid ,,hcbs-eligible older individual means an individual who-- 7,a7 is #fj years of age or older2 and 7,b7 is eligible for and enrolled for medical assistance for any of the following services 7whether provided on a fee-for-service1 risk1 or other basis7 under a ,state ,medicaid program1 and includes an individual who becomes eligible for medical assistance under a ,state ,medicaid program when removed from a waiting list3 7i7 ,home health care services authorized under paragraph 7#g7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a774 7ii7 ,personal care services authorized under paragraph 7#bd7 of such section4 7iii7 ,,pace services authorized under paragraph 7#bf7 of such section4 7iv7 ,home and community-based services authorized under subsections 7b71 7c71 7i71 7j71 and 7k7 of section #aiae of such ,act 7#db ,u4,s4,c4 #acifn71 such services authorized under a waiver under section #aaae of such ,act 7#db ,u4,s4,c4 #acae71 and such services provided through coverage authorized under section #aicg of such ,act 7#db ,u4,s4,c4 #acifu-#g74 7v7 ,case management services authorized under section #aije7;a77#ai7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ai77 and section #aiae7;g7 of such ,act 7#db ,u4,s4,c4 #acifn7g774 7vi7 ,rehabilitative services1 including those related to behavioral health1 described in section #aije7;a77#ac7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#ac774 7vii7 ,such other services specified by the ,secretary of ,health and ,human ,services4 7#d7 ,on-call shift ,the term on-call shift means any time a covered entity expects a direct care professional to-- 7,a7 be available to work2 and 7,b7 wait to contact1 or be contacted by1 the covered entity1 or a designee of the entity1 to determine whether the direct care professional shall report to work during such time4 7#e7 ,parent ,the term parent1 with respect to a direct care professional1 means-- 7,a7 a biological1 foster1 or adoptive parent of a direct care professional2 7,b7 a stepparent of a direct care professional2 7,c7 parent-in-law of a direct care professional2 7,d7 parent of a domestic partner of a direct care professional2 or 7,e7 a legal guardian or other person who stood in loco parentis to the direct care professional when the worker was a child4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7#g7 ,shared living arrangement ,the term shared living arrangement means a living arrangement involving-- 7,a7 not more than #b individuals who are a person with a disability or a ,medicaid ,,hcbs-eligible older individual1 except if #a or more of the individuals are related to each other 7by blood or a close association that is equivalent to a family relationship72 7,b7 an individual providing services for compensation and living in the private home of the recipient of such services2 7,c7 an individual receiving funding through a ,state ,medicaid program or another publicly funded program2 7,d7 a stipend or room and board as the primary form of payment for the individual providing such services2 and 7,e7 the individual receiving such services having the final decision regarding who is the provider of such services living with the individual1 through a consumer-driven matching process that includes relationship building1 person-centered planning as defined by the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and an assessment of individual compatibility4 7#h7 ,spouse ,the term spouse has the meaning given such term by the marriage laws of the ,state in which the marriage was celebrated4 #cab4 ,written agreements 7a7 ,covered direct care professional ,in this section1 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 #h hours per week4 7b7 ,requirement ,each covered entity shall provide a written agreement in accordance with this section to each covered direct care professional who is provided compensation1 directly or indirectly1 by the covered entity for the performance of long-term care services4 7c7 ,written agreement requirements 7#a7 ,in general ,a written agreement required under this section shall-- 7,a7 be signed and dated by the covered direct care professional and the covered entity2 7,b7 be written in a language easily and fully understood by the covered direct care professional and the covered entity1 which may be in multiple languages if the covered direct care professional and the entity do not easily and fully understand the same language2 and 7,c7 include the contents described in subsection 7d74 7#b7 ,copy ,a copy of the written agreement required under this section shall be provided to the covered direct care professional not later than #e calendar days after the date on which the covered direct care professional is hired by the covered entity4 7d7 ,contents of the written agreement 7#a7 ,in general ,the contents described in this subsection shall include each of the following3 7,a7 ,the full name1 address1 and contact information of the covered entity1 including1 as appropriate1 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 professional4 7,b7 ,the address for the location where the covered direct care professional will be providing long-term care services for the covered entity4 7,c7 ,all responsibilities to be performed by the covered direct care professional for the covered entity1 and the regularity in which such responsibilities are to be performed4 7,d7 ,the regular rate of pay of the covered direct care professional for any work week1 including any overtime compensation due4 7,e7 ,the day of the week when the covered direct care professional will be paid4 7,f7 ,the required working hours for any work week1 including-- 7i7 the time of day and day of week the work of the covered direct care professional begins2 7ii7 meal and rest breaks described in section #caf2 7iii7 time off2 7iv7 the work schedule of the covered direct care professional at the time of hire1 including-- 7,i7 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 entity2 or 7,,ii7 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 week1 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 week1 including1 at minimum-- 7aa7 the average number of hours the covered direct care professional will be expected to work for the entity each week during a typical #ij-;day period2 7bb7 whether the covered direct care professional can expect to work any on-call shifts for the entity2 7cc7 a subset of days the covered direct care professional can typically expect to work 7or to be scheduled as off from work7 for the entity2 and 7dd7 the amount of notice that the entity will provide to the covered direct care professional in advance of scheduled work hours 7as defined in section #cac7;a771 which shall not be less than #gb hours before such scheduled work hours are to begin 7except during a period described in subparagraph 7,a7 of section #cac7;e77#a71 in a case described in subparagraph 7,b7 of such section1 or in the case of a shared living arrangement71 and the manner in which such notice shall be provided2 7v7 the reporting time pay policy described in section #cac7;c72 and 7vi7 the right to request and receive a change to scheduled work hours due to personal events as described in section #cad4 7,g7 ,if applicable1 any policies of the covered entity with respect to the covered direct care professional for paying for or providing reimbursement for-- 7i7 health insurance2 7ii7 transportation1 meals1 or lodging2 and 7iii7 any fees or costs associated with the long-term care services provided by the covered direct care professional for the entity4 7,h7 ,if applicable1 any policies of the covered entity with respect to the covered direct care professional for-- 7i7 annual or other pay increases2 7ii7 severance pay2 and 7iii7 providing materials or equipment related to the performance of long-term care services by the covered direct care professional1 including 7if applicable7 any cleaning supplies provided by the entity4 7,i7 ,information about policies1 procedures1 and equipment related to safety and emergencies4 7,j7 ,the policy of the covered entity pertaining to notice of termination of the covered direct care professional by the entity4 7,k7 ,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-- 7i7 the circumstances under which the covered entity may enter the designated living space of the covered direct care professional2 7ii7 the circumstances under which the covered direct care professional1 in a shared living arrangement1 may enter the designated living space of the covered entity2 and 7iii7 a description of certain circumstances the covered entity determines as cause for-- 7,i7 immediate termination of the covered direct care professional2 and 7,,ii7 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 #dh hours after notice of the termination4 7,l7 ,any additional benefits afforded to the covered direct care professional by the covered entity4 7,m7 ,the process for the covered direct care professional to raise or address grievances with respect to1 or breaches of1 the written agreement4 7,n7 ,the process used by the covered entity to change any policy described in subparagraphs 7,a7 through 7,m71 including addressing additional compensation if responsibilities are added to those described in subparagraph 7,c71 after the date on which the written agreement is provided to the covered direct care professional4 7#b7 ,prohibitions ,a written agreement required under this section may not-- 7,a7 contain-- 7i7 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 professional2 or 7ii7 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 services2 and 7,b7 be construed to waive the rights or protections of a covered direct care professional under ,federal1 ,state1 or local law4 7e7 ,timing 7#a7 ,initial agreement ,a covered entity shall provide a written agreement required under this section-- 7,a7 to each covered direct care professional hired after the date of enactment of this ,act1 prior to the first day the covered direct care professional performs long-term care services for the entity2 and 7,b7 to each covered direct care professional hired on or prior to the date of enactment of this ,act1 #ij days after such date of enactment4 7#b7 ,subsequent agreements ,not later than #cj 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 section1 the entity shall provide the covered direct care professional with an updated agreement in accordance with this section4 7f7 ,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 #c years from the date on which the covered direct care professional is no longer working for the entity4 7g7 ,model written agreements 7#a7 ,in general ,not later than #f months after the date of enactment of this ,act1 the ,secretary shall establish and make available templates for model written agreements under this section4 7#b7 ,requirements ,a model written agreement required under paragraph 7#a7 shall-- 7,a7 be available in multiple languages commonly understood by covered direct care professionals1 including all languages in which the ,secretary1 acting through the ,administrator of the ,wage and ,hour ,division1 translates the basic information fact sheet published by the ,administrator2 and 7,b7 not include any agreement described in subsection 7d77#b77;,a74 #cac4 ,fair scheduling practices 7a7 ,definitions ,in this section3 7#a7 ,covered direct care professional ,the term covered direct care professional has the meaning given the term in section #cab7;a74 7#b7 ,scheduled work hours ,the term scheduled work hours means the hours on a specified day during which a direct care professional is1 through a written agreement or schedule1 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 services4 7b7 ,requirement for notice of covered direct care professional ,in the case of a covered direct care professional1 the covered entity shall provide the covered direct care professional notice of the scheduled work hours of such covered direct care professional through-- 7#a7 a written agreement described in subclause 7,i7 of section #cab7;d77#a77;,f77iv7 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 week2 or 7#b7 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 7,,ii7 of such section1 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 entity4 7c7 ,requirements for changes to scheduled work hours and reporting time pay ,a covered entity shall-- 7#a7 communicate in writing 7which may be in an electronic form7 any change to the scheduled work hours of a direct care professional1 including any on-call shifts1 not less than #gb hours before the direct care professional is scheduled to begin work2 and 7#b7 pay a direct care professional-- 7,a7 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 hours2 or 7,b7 at a rate of #a_/b 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 #gb hours prior to the commencement of such scheduled work hours1 unless the entity-- 7i7 is an individual with a disability relying on the direct care professional for disability supports and services 7or an entity supporting an individual with a disability72 and 7ii7 requests the direct care professional to consent to work alternative1 equivalent scheduled work hours within a #g-;day period and the direct care professional consents to work such alternative1 equivalent hours4 7d7 ,right ,to decline schedule changes 7#a7 ,in general ,in the case of a covered direct care professional1 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 #cab7;d77#a77;,f77iv77,i7 or are identified as hours outside of the good faith estimate under section #cab7;d77#a77;,f77iv77,,ii77cc71 the hiring entity shall obtain the written consent of the worker to work such hours prior to the commencement of such work4 7#b7 ,consent ,the consent required under paragraph 7#a7 may be transmitted electronically to the covered entity4 7e7 ,exceptions 7#a7 ,in general ,notwithstanding any provision in this section1 the requirements under subsection 7c7 shall not apply-- 7,a7 during any period in which the operations of the covered entity cannot begin or continue due to-- 7i7 a fire1 flood1 or other natural disaster2 7ii7 a major disaster or emergency declared by the ,president under section #dja or #eja1 respectively1 of the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eagj1 #eaia7 or a state of emergency declared by a ,governor of a ,state or chief official of a unit of local government2 or 7iii7 a severe weather condition that poses a threat to worker safety2 or 7,b7 in a case in which-- 7i7 the direct care professional voluntarily requested in writing a change to the scheduled work hours of the direct care professional2 or 7ii7 the covered entity changes the scheduled work hours of a direct care professional due to-- 7,i7 a medical emergency requiring emergency medical treatment or hospitalization2 7,,ii7 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 #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d72 or 7,,iii7 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 support4 7#b7 ,shared living arrangement ,notwithstanding any provision in this section1 the requirements under this section shall not apply to a shared living arrangement4 7f7 ,effective date ,this section shall take effect on the date that is #b years after the date of enactment of this ,act4 #cad4 ,right to request and receive temporary changes to scheduled work hours due to personal events 7a7 ,definitions ,in this section3 7#a7 ,covered direct care professional ,the term covered direct care professional has the meaning given the term in section #cab7;a74 7#b7 ,domestic violence ,the term domestic violence has the meaning given the term in section #cca4 7#c7 ,personal event ,the term personal event1 with respect to a covered direct care professional1 means-- 7,a7 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 relationship2 7,b7 an event resulting from the obligation of a covered direct care professional to attend a legal proceeding or hearing for subsistence benefits1 including benefits under the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 or under a ,state program for temporary assistance for needy families established under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 to which the covered direct care professional1 or an individual related to the covered direct care professional as described in subparagraph 7,a71 is a party or witness2 or 7,c7 any circumstance that would constitute a basis for permissible use of safe time1 or family1 medical1 or sick leave1 as determined based on the policy of the covered entity4 7#d7 ,safe time ,the term safe time1 with respect to a covered direct care professional1 means an absence from work of the covered direct care professional resulting from domestic violence1 sexual assault1 or stalking1 if the absence is to-- 7,a7 seek medical attention for the covered direct care professional or a child1 parent1 spouse1 or domestic partner of the covered direct care professional1 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 relationship1 in order to recover from physical or psychological injury or disability caused by domestic violence1 sexual assault1 or stalking2 7,b7 obtain1 or assist a child1 parent1 spouse1 domestic partner1 or other individual described in subparagraph 7,a7 in obtaining1 services from a victim services organization2 7,c7 obtain1 or assist a child1 parent1 spouse1 domestic partner1 or other individual described in subparagraph 7,a7 in obtaining1 psychological or other counseling2 7,d7 seek relocation for the covered direct care professional or a child1 parent1 spouse1 domestic partner1 or other individual described in subparagraph 7,a72 or 7,e7 take legal action1 including preparing for or participating in any civil or criminal legal proceeding related to or resulting from domestic violence1 sexual assault1 or stalking1 of the covered direct care professional or a child1 parent1 spouse1 domestic partner1 or other individual described in subparagraph 7,a74 7#e7 ,scheduled work hours ,the term scheduled work hours has the meaning given such term in section #cac7;a71 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 professional4 7#f7 ,sexual assault2 stalking ,the terms sexual assault and stalking have the meanings given such terms in section #cca4 7#g7 ,temporary change ,the term temporary change1 with respect to a change in the scheduled work hours of a covered direct care professional1 means a limited alteration in the hours or dates that1 or locations where1 a covered direct care professional is scheduled to work1 including through using paid time off1 trading or shifting work hours1 or using short-term unpaid leave4 7b7 ,request 7#a7 ,in general ,in accordance with this subsection1 for each calendar year1 a covered entity shall1 upon request of a covered direct care professional1 grant to the covered direct care professional not less than-- 7,a7 #b requests for a temporary change1 covering not more than #a business day per request1 to the scheduled work hours of the covered direct care professional due to a personal event2 or 7,b7 #a request for a temporary change1 covering not more than #b business days1 to the scheduled work hours of the covered direct care professional due to a personal event4 7#b7 ,notification of request 7,a7 ,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-- 7i7 notify the covered entity1 or direct supervisor1 of such covered direct care professional1 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 event2 7ii7 make a proposal for the temporary change to the scheduled work hours of the covered direct care professional1 unless the covered direct care professional seeks leave without pay2 and 7iii7 subject to subparagraph 7,b71 not be required to initially submit the request in writing4 7,b7 ,written record 7i7 ,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 shall1 as soon as practicable and not later than #b 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 hours1 submit a written record of such request indicating-- 7,i7 the date for which the change was requested2 and 7,,ii7 that the request was made due to a personal event4 7ii7 ,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 changes4 7c7 ,response ,a covered entity who receives a request under subsection 7b7 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 practicable4 ,such entity shall not be initially required to respond to such request in writing4 ,if such entity does not initially respond to the requested schedule change in writing1 the entity shall1 as soon as practicable and not later than #a week after the requested schedule change1 provide the direct care professional with a written record of the response to the requested schedule change4 7d7 ,effective date ,this section shall take effect on the date that is #b years after the date of enactment of this ,act4 #cae4 ,privacy 7a7 ,in general ,a covered entity shall not-- 7#a7 monitor or record a direct care professional while such direct care professional is-- 7,a7 using restroom or bathing facilities2 7,b7 in the private living quarters of the direct care professional2 or 7,c7 engaging in any activities associated with the dressing1 undressing1 or changing of clothes of the direct care professional2 7#b7 subject to subsection 7b71 restrict or interfere with1 or monitor1 the private communications of such direct care professional2 or 7#c7 take possession of any documents or other personal effects of such direct care professional4 7b7 ,private communications ,a covered entity may-- 7#a7 permit the use of private communication in nonemergency situations1 only as preapproved by each individual's person-centered planning team2 7#b7 restrict1 interfere with1 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 plan2 and 7#c7 establish reasonable restrictions on the private communications of a direct care professional while such direct care professional is performing work for the entity4 7c7 ,relation to other laws ,this section shall not preclude liability under any other law4 7d7 ,definition of private communications ,in this section1 the term private communications means any communication through telephone or internet services1 including sending and receiving communications by text message1 social media1 electronic mail1 and telephone1 with an entity or individual other than the covered entity4 #caf4 ,breaks for meals and rest 7a7 ,meal breaks 7#a7 ,in general ,except as provided in subsection 7c71 a covered entity shall not require a direct care professional to work more than #e hours for such hiring entity without an uninterrupted meal break of not less than #cj minutes4 ,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 7b74 7#b7 ,rate of pay ,a covered entity shall pay a direct care professional for a meal break under paragraph 7#a7 at the regular rate of pay of the direct care professional1 unless the direct care professional is relieved of all duty for not less than #cj minutes during the meal break and is permitted to leave the work site during such break4 7#c7 ,paid meal break ,except as provided in subsection 7c71 for any paid meal break required under paragraph 7#b71 a covered entity-- 7,a7 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 #cj minutes2 and 7,b7 shall not impede or discourage a direct care professional from taking such meal break4 7b7 ,rest breaks 7#a7 ,in general ,except as provided in subsection 7c71 for every #d hours of work that a direct care professional is scheduled to perform for a covered entity1 the entity shall allow the direct care professional a rest break of not less than #aj uninterrupted minutes in which the direct care professional is relieved of all duties related to providing long-term care services to the entity4 ,the entity shall allow such rest break to occur during the first #c hours of consecutive work performed by the direct care professional for the entity4 7#b7 ,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 7#a7 at the regular rate of pay of the direct care professional4 ,the hiring entity shall not impede or discourage a direct care professional from taking such break4 7c7 ,exceptions 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#d71 a covered entity may provide an on duty-meal break or on duty rest break1 only in lieu of an uninterrupted meal or rest break otherwise required under subsection 7a7 or 7b71 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 care4 7#b7 ,on-duty breaks 7,a7 ,definition of on-duty ,in this subsection1 the term on-duty1 with respect to a meal break under subsection 7a7 or a rest break under subsection 7b71 means such a break in which the direct care professional-- 7i7 is not relieved of all duties of the direct care professional for the covered entity2 and 7ii7 may1 to the extent possible given the duties of the direct care professional for the covered entity1 engage in personal activities1 such as resting1 eating a meal1 drinking a beverage1 making a personal telephone call1 or making other personal choices4 7,b7 ,authorization 7i7 ,in general ,in a case described in paragraph 7#a71 the direct care professional may still take an on-duty meal or rest break under subsection 7a7 or 7b71 respectively1 if-- 7,i7 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 entity2 7,,ii7 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 7ii72 and 7,,iii7 the terms of such on-duty meal or rest break are consistent with the terms of an applicable collective bargaining agreement1 if one exists4 7ii7 ,written agreement ,the written agreement under clause 7i7-- 7,i7 shall be voluntary and not a condition of hire1 continued employment1 scheduling1 or assignment2 7,,ii7 shall not waive1 reduce1 or conflict with any rights provided under a collective bargaining agreement applicable to the direct care professional or applicable ,state or local law2 and 7,,iii7 shall be separately executed and not incorporated into a general employment agreement4 7iii7 ,revokability ,a direct care professional may revoke an agreement under clause 7i7 at any time without prior notice to the covered entity4 7#c7 ,shared living arrangement ,the requirements under this section shall not apply in the case of a shared living arrangement4 7#d7 ,rule of construction ,nothing in this subsection shall be construed to-- 7,a7 supersede1 preempt1 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 section2 or 7,b7 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 section4 #cag4 ,prohibited acts 7a7 ,interference with rights ,it shall be unlawful for any person to interfere with1 restrain1 or deny the exercise of1 or the attempt to exercise1 any right provided under this subtitle1 including-- 7#a7 discharging or in any manner discriminating against 7including retaliating against7 any direct care professional for-- 7,a7 exercising1 or attempting to exercise1 any right provided under this subtitle2 or 7,b7 engaging in concerted activities for the purpose of collective bargaining or mutual aid or protection1 regardless of whether such activities are with direct care professionals of different employers or direct care professionals at different worksites2 and 7#b7 discriminating against any direct care professional by using the exercise of a right provided under this subtitle as a negative factor in an employment action1 such as an action involving hiring1 promotion1 or changing work hours or number of shifts1 or a disciplinary action4 7b7 ,retaliation protection ,it shall be unlawful for any covered entity to discharge1 demote1 suspend1 reduce the work hours of1 take any other adverse employment action against1 threaten to take an adverse employment action against1 or in any other manner discriminate against a direct care professional with respect to compensation1 terms1 conditions1 or privileges of employment because the direct care professional 7or any person acting pursuant to the request of the direct care professional71 whether at the initiative of the direct care professional or in the ordinary course of the direct care professional's duties-- 7#a7 opposes any practice made unlawful under this subtitle2 7#b7 asserts any claim or right under this subtitle2 7#c7 assists a direct care professional in asserting such claim or right2 7#d7 informs any direct care professional about this subtitle2 7#e7 requests a change to the written agreement described in section #cab2 7#f7 requests a change in scheduled work hours described in section #cad1 or any other schedule change1 without regard to the eligibility of such direct care professional to receive any such change2 7#g7 7,a7 files an action1 or institutes or causes to be instituted any proceeding1 under or related to this subtitle2 7,b7 gives1 or is about to give1 any information in connection with any inquiry or proceeding relating to any right provided under this subtitle2 or 7,c7 testifies1 or is about to testify1 in any inquiry or proceeding relating to any right provided under this subtitle2 and 7#h7 engages in concerted activities for the purpose of collective bargaining or mutual aid or protection1 regardless of whether such activities are with direct care professionals of different employers or direct care professionals at different worksites4 7c7 ,immigration-,related actions as discrimination ,for purposes of subsections 7a7 and 7b71 discrimination with respect to compensation1 terms1 conditions1 or privileges of employment occurs if a person undertakes any of the following activities 7unless such activity is legal conduct undertaken at the express and specific direction or request of the ,federal ,government73 7#a7 ,reporting1 or threatening to report1 the citizenship or immigration status of a direct care professional1 or the suspected citizenship or immigration status of a family member of such an individual1 to a ,federal1 ,state1 or local agency4 7#b7 ,requesting more or different documents than those required under section #bgd;,a7b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #acbd;a7b771 or refusing to honor documents that on their face appear to be genuine4 7#c7 ,using the ,federal ,e-,verify system to check employment status in a manner not required under section #bgd;,a7b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #acbd;a7b77 or any memorandum governing use of the ,e-,verify system4 7#d7 ,filing1 or threatening to file1 a false police report relating to the immigration status of a direct care professional1 or a family member of a direct care professional4 7#e7 ,contacting1 or threatening to contact1 immigration authorities relating to the immigration status of a direct care professional1 or a family member of a direct care professional4 7d7 ,presumption of retaliation 7#a7 ,in general ,for the purposes of subsections 7a7 and 7b71 proof that a person discharged an individual1 or discriminated against an individual with respect to compensation1 terms1 conditions1 or privileges of employment1 within #ij days of the individual involved asserting any claim or right under this subtitle1 or assisting any other individual in asserting such a claim or right1 shall raise a presumption that the discharge or discrimination was in retaliation as prohibited under subsection 7a7 or 7b71 as the case may be4 7#b7 ,rebuttal ,the presumption under paragraph 7#a7 may be rebutted by clear and convincing evidence that such discharge or discrimination was taken for another permissible reason4 #cah4 ,enforcement authority 7a7 ,in general 7#a7 ,application ,in this subsection-- 7,a7 the term covered entity means a covered entity described in subsection 7e77#a77;,a72 and 7,b7 the term direct care professional means a direct care professional described in subsection 7e77#d77;,a74 7#b7 ,investigative authority 7,a7 ,in general ,to ensure compliance with the provisions of this subtitle1 or any regulation or order issued under this subtitle1 the ,secretary shall have the investigative authority provided under section #aa7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;a771 with respect to covered entities1 direct care professionals1 and other individuals affected4 7,b7 ,obligation to keep and preserve records ,a covered entity shall make1 keep1 and preserve records pertaining to compliance with this subtitle in accordance with section #aa7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;c77 and in accordance with regulations prescribed by the ,secretary4 7,c7 ,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 #ab-month period1 unless the ,secretary-- 7i7 has reasonable cause to believe there may exist a violation of this subtitle1 including any regulation or order issued under this subtitle2 or 7ii7 is investigating a charge under paragraph 7#d74 7,d7 ,subpoena authority ,for the purposes of any investigation under this paragraph1 the ,secretary shall have the subpoena authority provided under section #i of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bji74 7#c7 ,civil action by direct care professionals 7,a7 ,right of action ,an action to recover the damages or equitable relief prescribed in subparagraph 7,b7 may be maintained against a covered entity by one or more direct care professionals1 or a representative for and on behalf of the direct care professionals and any other direct care professionals that may be similarly situated4 7,b7 ,liability ,a covered entity that violates this subtitle shall be liable to a direct care professional aggrieved by the violation1 except as provided in subparagraphs 7,c7 and 7,d71 for-- 7i7 damages equal to-- 7,i7 the amount of-- 7aa7 any wages1 salary1 employment benefits1 or other compensation denied or lost by reason of the violation2 or 7bb7 in a case in which wages1 salary1 employment benefits1 or other compensation have not been denied or lost1 any actual monetary losses sustained1 or the costs reasonably related to damage to or loss of property1 or any other injury to the person1 reputation1 character1 or feelings1 sustained by a direct care professional as a direct result of the violation1 or any injury to another person sustained as a direct result of the violation1 by the covered entity2 7,,ii7 the interest on the amount described in subclause 7,i7 calculated at the prevailing rate2 7,,iii7 an additional amount as liquidated damages2 and 7,,iv7 such other legal relief as may be appropriate2 7ii7 such equitable relief as may be appropriate1 including employment1 reinstatement1 and promotion2 and 7iii7 a reasonable attorney's fee1 reasonable expert witness fees1 and other costs of the action4 7,c7 ,meal and rest breaks ,in the case of a violation of section #caf1 the covered entity involved shall be liable under subparagraph 7,b7-- 7i7 for the amount of damages described in subclauses 7,i71 7,,ii71 and 7,,iii7 of subparagraph 7,b77i72 and 7ii7 under subparagraph 7,b77i77,,iv71 for each such violation1 for an amount equal to #a hour of pay at the direct care professional's regular rate of compensation 7but not more than #b hours of such pay for each workday for which the covered entity is in violation of such section74 7,d7 ,written agreements ,in the case of a violation of section #cab1 the covered entity involved shall be liable1 under subparagraph 7,b77i77,i71 for an amount equal to #e1jjj4 7,e7 ,venue ,an action under this paragraph may be maintained in any ,federal or ,state court of competent jurisdiction4 7#d7 ,action by the secretary 7,a7 ,administrative action 7i7 ,in general ,subject to clause 7ii71 and subparagraphs 7,c7 and 7,d7 of paragraph 7#c71 the ,secretary shall receive1 investigate1 and attempt to resolve complaints of violations of this subtitle in the same manner that the ,secretary receives1 investigates1 and attempts to resolve complaints of violations of sections #f1 #g1 and #ae7;a77#c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf1 #bjg1 and #bae7;a77#c771 including the ,secretary's authority to supervise payment of wages and compensation under section #af7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baf7;c774 7ii7 ,violations generally ,the ,secretary may assess a civil penalty against a covered entity that violates any section of this subtitle-- 7,i7 of not more than #ae1jjj for any first violation of any such section by such covered entity2 and 7,,ii7 of not more than #be1jjj for any subsequent violation of any such section by such covered entity4 7,b7 ,administrative review ,any aggrieved direct care professional who takes exception to an order issued by the ,secretary under subparagraph 7,a7 may request review of and a decision regarding such order by an administrative law judge4 ,in reviewing the order1 the administrative law judge may hold an administrative hearing concerning the order1 in accordance with the requirements of sections #eed1 #eef1 and #eeg of title #e1 ,united ,states ,code4 ,such hearing shall be conducted expeditiously4 ,if no aggrieved direct care professional requests such review within #fj days after the order is issued under subparagraph 7,a71 the order shall be considered to be a final order that is not subject to judicial review4 7,c7 ,civil action ,the ,secretary may bring an action in any court of competent jurisdiction to recover amounts described in paragraph 7#c77;,b7 on behalf of a direct care professional aggrieved by a violation of this subtitle4 7,d7 ,sums recovered 7i7 ,in general ,any sums recovered by the ,secretary under subparagraph 7,c7 shall be held in a special deposit account and shall be paid1 on order of the ,secretary1 directly to each direct care professional aggrieved by the violation for which the action was brought4 ,any such sums not paid to a direct care professional because of inability to do so within a period of #c years shall be deposited into the ,treasury of the ,united ,states as a miscellaneous receipt4 7ii7 ,civil penalty ,any sums recovered by the ,secretary under subparagraph 7,a77ii7 shall be deposited into the general fund of the ,treasury of the ,united ,states as a miscellaneous receipt4 7#e7 ,limitation 7,a7 ,in general ,except as provided in subparagraph 7,b71 an action may be brought under paragraph 7#c71 7#d71 or 7#f7 not later than #b years after the date of the last event constituting the alleged violation for which the action is brought4 7,b7 ,willful violation ,in the case of an action brought for a willful violation of this subtitle1 such action may be brought not later than #c years after the date of the last event constituting the alleged violation for which such action is brought4 7,c7 ,commencement ,an action shall be considered commenced under paragraph 7#c71 7#d71 or 7#f7 for the purposes of this paragraph on the date on which the complaint is filed under such paragraph 7#c71 7#d71 or 7#f74 7#f7 ,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 jurisdiction1 for cause shown1 in an action brought by a direct care professional or the ,secretary-- 7,a7 to restrain violations of this subtitle1 including the withholding of a written agreement from a direct care professional as required under section #cab1 or of any withholding of payment of wages1 salary1 employment benefits1 or other compensation1 plus interest1 found by the court to be due to a direct care professional under this subtitle2 or 7,b7 to award such other equitable relief as may be appropriate1 including employment1 reinstatement1 and promotion1 for a violation of this subtitle4 7#g7 ,solicitor of labor ,the ,solicitor of ,labor may appear for and represent the ,secretary on any litigation brought under paragraph 7#d7 or 7#f74 7#h7 ,government ,accountability ,office and ,library of ,congress ,notwithstanding any other provision of this subsection1 in the case of the ,government ,accountability ,office and the ,library of ,congress1 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 ,congress4 7b7 ,employees covered by ,congressional ,accountability ,act of #aiie ,the powers1 remedies1 and procedures provided in the ,congressional ,accountability ,act of #aiie 7#b ,u4,s4,c4 #acja et seq47 to the ,board 7as defined in section #aja of that ,act 7#b ,u4,s4,c4 #acja771 or any person1 alleging a violation of section #bjb7;a77#a7 of that ,act 7#b ,u4,s4,c4 #acab7;a77#a77 shall be the powers1 remedies1 and procedures this ,act provides to that ,board1 or any person1 alleging an unlawful employment practice in violation of this subtitle against a direct care professional described in subsection 7e77#d77;,b74 7c7 ,employees covered by chapter #e of title #c1 ,united ,states ,code ,the powers1 remedies1 and procedures provided in chapter #e of title #c1 ,united ,states ,code1 to the ,president1 the ,merit ,systems ,protection ,board1 or any person1 alleging a violation of section #dab7;a77#a7 of that title1 shall be the powers1 remedies1 and procedures this ,act provides to the ,president1 that ,board1 or any person1 respectively1 alleging an unlawful employment practice in violation of this subtitle against a direct care professional described in subsection 7e77#d77;,c74 7d7 ,employees covered by chapter #fc of title #e1 ,united ,states ,code ,the powers1 remedies1 and procedures provided in title #e1 ,united ,states ,code1 to an employing agency1 provided in chapter #ab of that title to the ,merit ,systems ,protection ,board1 or provided in that title to any person1 alleging a violation of chapter #fc of that title1 shall be the powers1 remedies1 and procedures this ,act provides to that agency1 that ,board1 or any person1 respectively1 alleging an unlawful employment practice in violation of this subtitle against a direct care professional described in subsection 7e77#d77;,d74 7e7 ,definition ,in section #cag and this section1 except as otherwise provided in this subsection3 7#a7 ,covered entity ,notwithstanding section #caa1 the term covered entity means a covered entity-- 7,a7 as defined in section #caa7;b7 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 7i7 or 7ii7 of subparagraph 7,a71 and subparagraph 7,b71 of paragraph 7#b72 7,b7 as defined in section #caa7;b7 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 7,a77iii7 and 7,b7 of paragraph 7#b72 7,c7 as defined in section #caa7;b7 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 7,a77iv7 and 7,b7 of paragraph 7#b72 and 7,d7 as defined in section #caa7;b7 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 7,a77v7 and 7,b7 of paragraph 7#b74 7#b7 ,employer ,notwithstanding section #caa1 for purposes of paragraph 7#a71 the term employer means a person who is-- 7,a7 7i7 any person who is not covered under another clause of this subparagraph2 7ii7 an entity employing a ,state employee described in section #cjd7;a7 of the ,government ,employee ,rights ,act of #aiia2 7iii7 an employing office1 as defined in section #aja of the ,congressional ,accountability ,act of #aiie2 7iv7 an employing office1 as defined in section #daa7;c7 of title #c1 ,united ,states ,code2 or 7v7 an employing agency covered under subchapter ,v of chapter #fc of title #e1 ,united ,states ,code2 and 7,b7 engaged in commerce or the production of goods for commerce or is an enterprise engaged in commerce or in the production of goods for commerce4 7#c7 ,employment ,notwithstanding section #c1 the term employment includes work as a direct care professional4 7#d7 ,direct care professional ,notwithstanding section #c1 the term direct care professional means-- 7,a7 direct care professional 7as defined in such section7 who is compensated for the performance of long-term care services by an entity described in paragraph 7#a77;,a72 7,b7 direct care professional 7as defined in such section7 who is compensated for the performance of long-term care services by an entity described in paragraph 7#a77;,b72 7,c7 direct care professional 7as defined in such section7 who is compensated for the performance of long-term care services by an entity described in paragraph 7#a77;,c72 and 7,d7 direct care professional 7as defined in such section7 who is compensated for the performance of long-term care services by an entity described in paragraph 7#a77;,d74 #cai4 ,effect on existing employment benefits and other laws 7a7 ,in general ,nothing in this subtitle shall-- 7#a7 supersede a provision in a collective bargaining agreement2 7#b7 be construed to diminish the obligation of a covered entity to comply with any contract1 collective bargaining agreement1 or employment benefit program or plan that provides greater rights or benefits to direct care professionals than the rights established under this subtitle2 or 7#c7 be construed to discourage or prevent a covered entity from adopting a contract1 collective bargaining agreement1 or employment benefit program or plan that provides greater rights or benefits to direct care professionals than the rights established under this subtitle4 7b7 ,other laws ,nothing in this subtitle shall-- 7#a7 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 law1 or to otherwise comply with any other law2 7#b7 preempt1 limit1 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 subtitle2 or 7#c7 diminish the rights1 privileges1 or remedies of any direct care professional under any ,federal or ,state law or under any collective bargaining agreement4 7c7 ,no waivers ,the rights and remedies in this subtitle may not be waived by a direct care professional through any agreement1 policy1 or form1 or as a condition of employment4 ,c ,workplace ,violence ,prevention for ,health ,care and ,social ,services ,workers ,act #cba4 ,workplace ,violence ,prevention ,standard 7a7 ,interim final standard 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,labor shall issue an interim final standard on workplace violence prevention-- 7,a7 to require certain employers in the health care and social service sectors1 and certain employers in sectors that conduct activities similar to the activities in the health care and social service sectors1 to develop and implement a comprehensive workplace violence prevention plan and carry out other activities or requirements described in section #cbc to protect health care workers1 social service workers1 and other personnel from workplace violence2 7,b7 that shall1 at a minimum1 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 #bjae and adhere to the requirements of this subtitle2 and 7,c7 that provides for a period determined appropriate by the ,secretary1 not to exceed #a year1 during which the ,secretary shall prioritize technical assistance and advice consistent with section #ba7;d7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fgj7;d77 to employers subject to the standard with respect to compliance with the standard4 7#b7 ,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 subsection3 7,a7 ,the requirements applicable to occupational safety and health standards under section #f7;b7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7;b774 7,b7 ,the requirements of chapters #e and #f of title #e1 ,united ,states ,code4 7,c7 ,subchapter ,i of chapter #ce of title #dd1 ,united ,states ,code 7commonly referred to as the ,paperwork ,reduction ,act74 7,d7 ,executive ,order ,no4 #abhff 7#eh ,fed4 ,reg4 #eagce2 relating to regulatory planning and review71 as amended4 7#c7 ,notice and comment ,notwithstanding paragraph 7#b77;,b71 the ,secretary shall1 prior to issuing the interim final standard under this subsection1 provide notice in the ,federal ,register of the interim final standard and a #cj-;day period for public comment4 7#d7 ,effective date of interim standard ,the interim final standard shall-- 7,a7 take effect on a date that is not later than #cj days after issuance1 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 date2 7,b7 be enforced in the same manner and to the same extent as any standard promulgated under section #f7;b7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7;b772 and 7,c7 be in effect until the final standard described in subsection 7b7 becomes effective and enforceable4 7#e7 ,failure to promulgate ,if an interim final standard described in paragraph 7#a7 is not issued not later than #a year of the date of enactment of this ,act1 the provisions of section #cbc shall be in effect and enforced in the same manner and to the same extent as any standard promulgated under section #f7;b7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7;b77 until such provisions are superseded in whole by an interim final standard issued by the ,secretary that meets the requirements of paragraph 7#a74 7b7 ,final standard 7#a7 ,proposed standard ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,labor shall1 pursuant to section #f of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee71 promulgate a proposed standard on workplace violence prevention-- 7,a7 for the purposes described in subsection 7a77#a77;,a72 and 7,b7 that shall include1 at a minimum1 requirements contained in the interim final standard required under subsection 7a74 7#b7 ,final standard ,not later than #db months after the date of enactment of this ,act1 the ,secretary shall issue a final standard on such proposed standard that shall-- 7,a7 provide no less protection than any workplace violence standard adopted by a ,state plan that has been approved by the ,secretary under section #ah of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #ffg71 provided the ,secretary finds that the final standard is feasible on the basis of the best available evidence2 and 7,b7 be effective and enforceable in the same manner and to the same extent as any standard promulgated under section #f7;b7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7;b774 #cbb4 ,scope and application ,in this subtitle3 7#a7 ,covered facility 7,a7 ,in general ,the term covered facility means the following3 7i7 ,any hospital1 including any specialty hospital1 in-patient or outpatient setting1 or clinic operating within a hospital license1 or any setting that provides outpatient services4 7ii7 ,any residential treatment facility1 including any nursing home1 skilled nursing facility1 hospice facility1 ,alzheimer's and dementia care facility1 or other long-term care facility4 7iii7 ,any nonresidential treatment or service setting4 7iv7 ,any medical treatment or social service setting or clinic at a correctional or detention facility4 7v7 ,any community care setting1 including a community-based residential facility1 group home1 and mental health clinic4 7vi7 ,any psychiatric treatment facility4 7vii7 ,any drug abuse or substance use disorder treatment center4 7viii7 ,any independent freestanding emergency center4 7ix7 ,any assisted living facility4 7x7 ,any facility described in clauses 7i7 through 7ix7 operated by a ,federal ,government agency and required to comply with occupational safety and health standards pursuant to part #aifj of title #bi1 ,code of ,federal ,regulations 7as such part is in effect on the date of enactment of this ,act74 7xi7 ,any other facility the ,secretary determines should be covered under the standards promulgated under section #cba4 7,b7 ,exclusion ,the term covered facility does not include an office of a physician1 dentist1 podiatrist1 or any other health practitioner that is not physically located within a covered facility described in clauses 7i7 through 7xi7 of subparagraph 7,a74 7#b7 ,covered services 7,a7 ,in general ,the term covered service means the following services and operations3 7i7 ,any services and operations provided in any field work setting1 including home health care1 home-based hospice1 and home-based social work4 7ii7 ,any emergency services and transport1 including such services provided by firefighters and emergency responders4 7iii7 ,any services described in clauses 7i7 and 7ii7 performed by a ,federal ,government agency and required to comply with occupational safety and health standards pursuant to part #aifj of title #bi1 ,code of ,federal ,regulations 7as such part is in effect on the date of enactment of this ,act74 7iv7 ,any other services and operations the ,secretary determines should be covered under the standards promulgated under section #cba4 7,b7 ,exclusion ,the term covered service does not include child day care services4 7#c7 ,covered employer 7,a7 ,in general ,the term covered employer includes a person 7including a contractor1 a subcontractor1 a temporary service firm1 or an employee leasing entity7 that employs an individual to work at a covered facility or to perform covered services4 7,b7 ,exclusion ,the term covered employer does not include an individual who privately employs1 in the individual's residence1 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 waiver4 7#d7 ,covered employee ,the term covered employee includes an individual employed by a covered employer to work at a covered facility or to perform covered services4 #cbc4 ,requirements for ,workplace ,violence ,prevention ,standard ,each standard described in section #cba shall include1 at a minimum1 the following3 7#a7 ,workplace violence prevention plan ,not later than #f months after the date of promulgation of the interim final standard under section #cba7;a71 or #ah months after the date of enactment of this ,act in a case described in section #cba7;a77#e71 a covered employer shall develop1 implement1 and maintain an effective written workplace violence prevention plan 7in this section referred to as the ,plan7 for covered employees at each covered facility and for covered employees performing a covered service on behalf of such employer1 which meets the following3 7,a7 ,plan development ,each ,plan-- 7i7 shall be developed and implemented with the meaningful participation of direct care professionals1 other employees1 and employee representatives1 for all aspects of the ,plan2 7ii7 shall be tailored and specific to conditions and hazards for the covered facility or the covered service1 including patient-specific risk factors and risk factors specific to each work area or unit2 7iii7 shall include patient-centered1 relationship-based1 trauma-informed1 recovery-oriented practices that are evidence-based2 7iv7 shall be suitable for the size1 complexity1 and type of operations at the covered facility or for the covered service1 and remain in effect at all times2 and 7v7 may be in consultation with stakeholders or experts who specialize in workplace violence prevention1 emergency response1 or other related areas of expertise for all relevant aspects of the ,plan4 7,b7 ,plan content ,each ,plan shall include procedures and methods for the following3 7i7 ,identification of the individual 7including the individual's role with respect to the covered employer7 responsible for implementation of the ,plan4 7ii7 ,with respect to each work area and unit at the covered facility or while covered employees are performing the covered service1 risk assessment and identification of workplace violence risks and hazards to employees exposed to such risks and hazards 7including environmental risk factors and patient-specific risk factors71 and protective factors associated with violence1 which shall be-- 7,i7 informed by past violent incidents specific to such covered facility or such covered service2 and 7,,ii7 conducted with1 at a minimum-- 7aa7 direct care professionals2 7bb7 where applicable1 the representatives of such workers2 and 7cc7 the employer4 7iii7 ,hazard prevention1 engineering controls1 or work practice controls to correct hazards1 in a timely manner1 applying industrial hygiene principles of the hierarchy of controls1 which-- 7,i7 may include security and alarm systems1 adequate exit routes1 monitoring systems1 barrier protection1 established areas for patients and clients1 lighting1 entry procedures1 staffing and working in teams1 and systems to identify and flag clients with a history of violence2 and 7,,ii7 shall ensure that employers correct1 in a timely manner1 hazards identified in any violent incident investigation described in paragraph 7#b7 and any annual report described in paragraph 7#e74 7iv7 ,reporting1 incident response1 and post-incident investigation procedures1 including procedures-- 7,i7 for employees to report workplace violence risks1 hazards1 and incidents2 7,,ii7 for employers to respond to reports of workplace violence2 7,,iii7 for employers to perform a post-incident investigation and debriefing of all reports of workplace violence with the participation of employees and their representatives2 7,,iv7 to provide medical care or first aid to affected employees2 and 7,v7 to provide employees with information about available trauma and related counseling4 7v7 ,procedures for emergency response1 including procedures for threats of mass casualties and procedures for incidents involving a firearm or a dangerous weapon4 7vi7 ,procedures for communicating with and training the covered employees on workplace violence hazards1 threats1 and work practice controls1 the employer's plan1 and procedures for confronting1 responding to1 and reporting workplace violence threats1 incidents1 and concerns1 and employee rights4 7vii7 ,procedures for-- 7,i7 ensuring the coordination of risk assessment efforts1 ,plan development1 and implementation of the ,plan with other employers who have employees who work at the covered facility or who are performing the covered service2 and 7,,ii7 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 control4 7viii7 ,procedures for conducting the annual evaluation under paragraph 7#f74 7,c7 ,availability of plan ,each ,plan shall be made available at all times to the covered employees who are covered under such ,plan4 7#b7 ,violent incident investigation 7,a7 ,in general ,as soon as practicable after a workplace violence incident1 risk1 or hazard of which a covered employer has knowledge1 the employer shall conduct an investigation of such incident1 risk1 or hazard under which the employer shall-- 7i7 review the circumstances of the incident1 risk1 or hazard1 and whether any controls or measures implemented pursuant to the ,plan of the employer were effective2 and 7ii7 solicit input from involved employees1 their representatives1 and supervisors about the cause of the incident1 risk1 or hazard1 and whether further corrective measures 7including system-level factors7 could have prevented the incident1 risk1 or hazard4 7,b7 ,documentation ,a covered employer shall document the findings1 recommendations1 and corrective measures taken for each investigation conducted under this paragraph4 7#c7 ,training and education ,with respect to the covered employees covered under a ,plan of a covered employer1 the employer shall provide training and education to such employees who may be exposed to workplace violence hazards and risks1 which meet the following requirements3 7,a7 ,annual training and education shall include information on the ,plan1 including identified workplace violence hazards1 work practice control measures1 reporting procedures1 recordkeeping requirements1 response procedures1 anti-retaliation policies1 and employee rights4 7,b7 ,additional hazard recognition training shall be provided for supervisors and managers to ensure they-- 7i7 can recognize high-risk situations2 and 7ii7 do not assign employees to situations that predictably compromise the safety of such employees4 7,c7 ,additional training shall be provided for each such covered employee whose job circumstances have changed1 within a reasonable timeframe after such change4 7,d7 ,additional training shall be provided for each such covered employee whose job circumstances require working with victims of torture1 trafficking1 or domestic violence4 7,e7 ,applicable training shall be provided under this paragraph for each new covered employee prior to the employee's job assignment4 7,f7 ,all training shall provide such employees opportunities to ask questions1 give feedback on training1 and request additional instruction1 clarification1 or other follow-up4 7,g7 ,all training shall be provided in-person and by an individual with knowledge of workplace violence prevention and of the ,plan1 except that any annual training described in subparagraph 7,a7 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 impracticable4 7,h7 ,all training shall be appropriate in content and vocabulary to the language1 educational level1 and literacy of such covered employees4 7#d7 ,recordkeeping and access to plan records 7,a7 ,in general ,each covered employer shall-- 7i7 maintain for not less than #e years-- 7,i7 records related to each ,plan of the employer1 including workplace violence risk and hazard assessments1 and identification1 evaluation1 correction1 and training procedures2 7,,ii7 a violent incident log described in subparagraph 7,b7 for recording all workplace violence incidents2 and 7,,iii7 records of all incident investigations as required under paragraph 7#b77;,b72 and 7ii7 7,i7 make such records and logs available1 upon request1 to covered employees and their representatives for examination and copying in accordance with section #aiaj4ajbj of title #bi1 ,code of ,federal ,regulations 7as such section is in effect on the date of enactment of this ,act71 and in a manner consistent with ,,hipaa privacy regulations 7defined in section #aahj7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#i7;b77#c777 and part #b of title #db1 ,code of ,federal ,regulations 7as such part is in effect on the date of enactment of this ,act72 and 7,,ii7 ensure that any such records and logs that may be copied1 transmitted electronically1 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 patient1 resident1 client1 or other individual alleged to have committed a violent incident 7including the individual's name1 address1 electronic mail address1 telephone number1 or social security number1 or other information that1 alone or in combination with other publicly available information1 reveals such individual's identity74 7,b7 ,violent incident log description ,each violent incident log shall-- 7i7 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 employer2 7ii7 be based on a template developed by the ,secretary not later than #a year after the date of enactment of this ,act2 7iii7 include1 at a minimum1 a description of-- 7,i7 the violent incident 7including environmental risk factors present at the time of the incident72 7,,ii7 the date1 time1 and location of the incident1 and the names and job titles of involved employees2 7,,iii7 the nature and extent of injuries to covered employees2 7,,iv7 a classification of the perpetrator who committed the violence1 including whether the perpetrator was-- 7aa7 a patient1 client1 resident1 or customer of a covered employer2 7bb7 a family or friend of a patient1 client1 resident1 or customer of a covered employer2 7cc7 a stranger2 7dd7 a coworker1 supervisor1 or manager of a covered employee2 7ee7 a partner1 spouse1 parent1 or relative of a covered employee2 or 7ff7 any other appropriate classification2 7,v7 the type of violent incident 7such as type #a violence1 type #b violence1 type #c violence1 or type #d violence72 and 7,,vi7 how the incident was abated2 7iv7 not later than #g days after the employer learns of such incident1 contain a record of each violent incident1 which is updated to ensure completeness of such record2 7v7 be maintained for not less than #e years2 and 7vi7 in the case of a violent incident involving a privacy concern case1 protect the identity of employees in a manner consistent with section #aijd4bi7;b7 of title #bi1 ,code of ,federal ,regulations 7as such section is in effect on the date of enactment of this ,act74 7,c7 ,annual summary 7i7 ,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-- 7,i7 with respect to each covered facility1 and each covered service1 for which such a log has been maintained1 include-- 7aa7 the total number of violent incidents2 7bb7 the number of recordable injuries related to such incidents2 and 7cc7 the total number of hours worked by the covered employees for such preceding year2 7,,ii7 be completed on a form provided by the ,secretary2 7,,iii7 be posted for #ij days beginning ,february #a of each year in a manner consistent with the requirements of part #aijd of title #bi1 ,code of ,federal ,regulations 7as such part is in effect on the date of enactment of this ,act71 relating to the posting of summaries of injury and illness logs2 7,,iv7 be located in a conspicuous place or places where notices to employees are customarily posted2 and 7,v7 not be altered1 defaced1 or covered by other material4 7ii7 ,secretary ,not later than #a year after the promulgation of the interim final standard under section #cba7;a71 or #b years after the date of enactment of this ,act in a case described in section #cba7;a77#e71 the ,secretary shall make available a platform for the electronic submission of annual summaries required under this subparagraph4 7#e7 ,annual report 7,a7 ,report to ,secretary ,not later than ,february #ae of each year1 each covered employer shall report to the ,secretary1 on a form provided by the ,secretary1 the frequency1 quantity1 and severity of workplace violence1 and any incident response and post-incident investigation 7including abatement measures7 for the incidents set forth in the annual summary of the violent incident log described in paragraph 7#d77;,c74 7,b7 ,report to ,congress ,not later than #ahj days after ,february #ae of each year1 the ,secretary shall submit to ,congress a summary of the reports received under subparagraph 7,a74 ,the contents of the summary of the ,secretary to ,congress shall not disclose any confidential information4 7#f7 ,annual evaluation ,each covered employer shall conduct an annual written evaluation1 conducted with the full1 active participation of covered employees and employee representatives1 of-- 7,a7 the implementation and effectiveness of the ,plan1 including a review of the violent incident log2 and 7,b7 compliance with training required by each standard described in section #cba1 and specified in the ,plan4 7#g7 ,plan updates ,each covered employer shall incorporate changes to the ,plan1 in a manner consistent with paragraph 7#a77;,a77i7 and based on findings from the most recent annual evaluation conducted under paragraph 7#f71 as appropriate4 7#h7 ,anti-retaliation 7,a7 ,policy ,each covered employer shall adopt a policy prohibiting any person 7including an agent of the employer7 from the discrimination or retaliation described in subparagraph 7,b74 7,b7 ,prohibition ,no covered employer shall discriminate or retaliate against any employee for-- 7i7 reporting a workplace violence incident1 threat1 or concern to1 or seeking assistance or intervention with respect to such incident1 threat1 or concern from1 the employer1 law enforcement1 local emergency services1 or a local1 ,state1 or ,federal ,government agency2 or 7ii7 exercising any other rights under this section4 7,c7 ,enforcement ,this paragraph shall be enforced in the same manner and to the same extent as any standard promulgated under section #f7;b7 of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7;b774 #cbd4 ,rules of construction ,notwithstanding section #ah of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #ffg7-- 7#a7 nothing in this subtitle shall be construed to curtail or limit authority of the ,secretary under any other provision of the law2 7#b7 the rights1 privileges1 or remedies of covered employees shall be in addition to the rights1 privileges1 or remedies provided under any ,federal or ,state law1 or any collective bargaining agreement2 7#c7 nothing in this subtitle shall be construed to limit or prevent health care workers1 social service workers1 and other personnel from reporting violent incidents to appropriate law enforcement2 and 7#d7 nothing in this ,act shall be construed to limit or diminish any protections in relevant ,federal1 ,state1 or local law related to-- 7,a7 domestic violence2 7,b7 stalking2 7,c7 dating violence2 or 7,d7 sexual assault4 #cbe4 ,definitions ,in this subtitle3 7#a7 ,alarm ,the term alarm means a mechanical1 electrical1 or electronic device that does not rely upon an employee's vocalization in order to alert others4 7#b7 ,dangerous weapon ,the term dangerous weapon means an instrument capable of inflicting death or serious bodily injury1 without regard to whether such instrument was designed for that purpose4 7#c7 ,engineering controls 7,a7 ,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 hazard4 7,b7 ,inclusions ,for purposes of reducing workplace violence hazards1 the term engineering controls includes electronic access controls to employee occupied areas1 weapon detectors 7installed or handheld71 enclosed workstations with shatter-resistant glass1 deep service counters1 separate rooms or areas for high-risk patients1 locks on doors1 removing access to or securing items that could be used as weapons1 furniture affixed to the floor1 opaque glass in patient rooms 7which protects privacy1 but allows the health care provider to see where the patient is before entering the room71 closed-circuit television monitoring and video recording1 sight-aids1 and personal alarm devices4 7#d7 ,environmental risk factors 7,a7 ,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 incident4 7,b7 ,clarification ,environmental risk factors may be associated with the specific task being performed or the work area1 such as working in an isolated area1 poor illumination or blocked visibility1 and lack of physical barriers between individuals and persons at risk of committing workplace violence4 7#e7 ,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 incident1 including-- 7,a7 a patient's treatment and medication status1 and history of violence and use of drugs or alcohol2 and 7,b7 any conditions or disease processes of the patient that may cause the patient to experience confusion or disorientation1 be nonresponsive to instruction1 behave unpredictably1 or engage in disruptive1 threatening1 or violent behavior4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7#g7 ,threat of violence ,the term threat of violence means a statement or conduct that-- 7,a7 causes an individual to fear for such individual's safety because there is a reasonable possibility the individual might be physically injured2 and 7,b7 serves no legitimate purpose4 7#h7 ,type #a violence ,the term type #a violence-- 7,a7 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 service2 and 7,b7 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 crime4 7#i7 ,type #b violence ,the term type #b violence means workplace violence directed at a covered employee by customers1 clients1 patients1 students1 inmates1 or any individual for whom a covered facility provides services or for whom the employee performs covered services4 7#aj7 ,type #c violence ,the term type #c violence means workplace violence directed at a covered employee by a present or former employee1 supervisor1 or manager4 7#aa7 ,type #d violence ,the term type #d violence means workplace violence directed at a covered employee by an individual who is not an employee1 but has or is known to have had a personal relationship with such employee1 or with a customer1 client1 patient1 student1 inmate1 or any individual for whom a covered facility provides services or for whom the employee performs covered services4 7#ab7 ,work practice controls 7,a7 ,in general ,the term work practice controls means procedures and rules that are used to effectively reduce workplace violence hazards4 7,b7 ,inclusions ,the term work practice controls includes-- 7i7 assigning and placing sufficient numbers of staff to reduce patient-specific type #b violence hazards2 7ii7 provision of dedicated and available safety personnel such as security guards2 7iii7 employee training on workplace violence prevention methods and techniques to de-escalate and minimize violent behavior2 and 7iv7 employee training on procedures for response in the event of a workplace violence incident and for post-incident response4 7#ac7 ,workplace violence 7,a7 ,in general ,the term workplace violence means any act of violence or threat of violence1 without regard to intent1 that occurs at a covered facility or while a covered employee performs a covered service4 7,b7 ,exclusions ,the term workplace violence does not include lawful acts of self-defense or lawful acts of defense of others4 7,c7 ,inclusions ,the term workplace violence includes-- 7i7 the threat or use of physical force against a covered employee that results in or has a high likelihood of resulting in injury1 psychological trauma1 or stress1 without regard to whether the covered employee sustains an injury1 psychological trauma1 or stress2 and 7ii7 an incident involving the threat or use of a firearm or a dangerous weapon1 including the use of common objects as weapons1 without regard to whether the employee sustains an injury1 psychological trauma1 or stress4 #cbf4 ,application of the ,workplace ,violence ,prevention ,standard to certain facilities receiving ,medicare funds 7a7 ,in general ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,x71 by striking and at the end2 7,b7 in subparagraph 7,y71 by striking the period at the end and inserting 1 and2 and 7,c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of hospitals that are not otherwise subject to the ,occupational ,safety and ,health ,act of #aigj 7or a ,state occupational safety and health plan that is approved under section #ah7;b7 of such ,act7 and skilled nursing facilities that are not otherwise subject to such ,act 7or such a ,state occupational safety and health plan71 to comply with the ,workplace ,violence ,prevention ,standard 7as promulgated under section #cba of the ,long-,term ,care ,workforce ,support ,act74 2 and 7#b7 in subsection 7b77#d7-- 7,a7 in subparagraph 7,a71 by inserting and a hospital or skilled nursing facility that fails to comply with the requirement of subsection 7a77#a77,z7 7relating to the ,workplace ,violence ,prevention ,standard7 after ,bloodborne ,pathogens standard72 and 7,b7 in subparagraph 7,b7-- 7i7 by striking 7a77#a77,u7 and inserting 7a77#a77,v72 and 7ii7 by inserting 7or1 in the case of a failure to comply with the requirement of subsection 7a77#a77,z71 for a violation of the ,workplace ,violence ,prevention standard referred to in such subsection by a hospital or skilled nursing facility1 as applicable1 that is subject to the provisions of such ,act7 before the period at the end4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply beginning on the date that is #a year after the date of issuance of the interim final standard on workplace violence prevention required under section #cba4 ,d ,improving access to job benefits #cca4 ,definitions ,in this subtitle3 7#a7 ,child ,the term child means a biological1 foster1 or adopted child1 a stepchild1 a child of a domestic partner1 a legal ward1 or a child of a person standing in loco parentis4 7#b7 ,commerce2 industry or activity affecting commerce ,the terms commerce and industry or activity affecting commerce mean any activity1 business1 or industry in commerce or in which a labor dispute would hinder or obstruct commerce or the free flow of commerce1 and include commerce and any industry affecting commerce1 as defined in paragraphs 7#a7 and 7#c7 of section #eja of the ,labor ,management ,relations ,act1 #aidg 7#bi ,u4,s4,c4 #adb 7#a7 and 7#c774 7#c7 ,covered direct care professional ,the term covered direct care professional means an employee who is employed as a direct care professional by an employer4 7#d7 ,domestic violence ,the term domestic violence has the meaning given the term in section #djjjb7;a7 of the ,violence ,against ,women ,act of #aiid 7#cd ,u4,s4,c4 #abbia7;a771 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 located4 ,such term also includes dating violence1 as that term is defined in such section4 7#e7 ,employee ,the term employee means an individual who is an employee1 as defined in section #c7;e7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc7;e771 except that a reference in such section to an employer shall be considered to be a reference to an employer described in paragraph 7#f74 7#f7 ,employer 7,a7 ,in general ,the term employer-- 7i7 means a person who is engaged in commerce or in any industry or activity affecting commerce who employs #a or more employees2 7ii7 includes-- 7,i7 any person who acts1 directly or indirectly1 in the interest of an employer to any of the employees of such employer2 and 7,,ii7 any successor in interest of such an employer2 and 7iii7 does not include any public agency4 7,b7 ,definitions ,for purposes of this subparagraph3 7i7 ,employee ,the term employee has the meaning given such term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7ii7 ,person ,the term person has the meaning given such term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7iii7 ,public agency ,the term public agency has the meaning given such term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7,c7 ,predecessors ,any reference in this paragraph to an employer shall include a reference to any predecessor of such employer4 7#g7 ,employment benefits ,the term employment benefits means all benefits provided or made available to employees by an employer1 including group life insurance1 health insurance1 disability insurance1 sick leave1 annual leave1 educational benefits1 and pensions1 regardless of whether such benefits are provided by a practice or written policy of an employer or through an employee benefit plan1 as defined in section #c7c7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7c774 7#h7 ,health care provider ,the term health care provider means a provider who-- 7,a7 7i7 is a doctor of medicine or osteopathy who is authorized to practice medicine or surgery 7as appropriate7 by the ,state in which the doctor practices2 or 7ii7 is any other person determined by the ,secretary to be capable of providing health care services2 and 7,b7 is not employed by an employer for whom the provider issues certification under this subtitle4 7#i7 ,paid sick time ,the term paid sick time means an increment of compensated leave that-- 7,a7 can be-- 7i7 earned by an employee for use during an absence from employment for a reason described in any paragraph of section #ccb7;b72 or 7ii7 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 #ccb7;b72 and 7,b7 is compensated at a rate that is not less than the greatest of-- 7i7 the employee's regular rate of pay2 7ii7 the wage rate described in section #f7;a77#a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf7;a77#a772 or 7iii7 the minimum wage rate provided for in the applicable ,state or local law for the ,state or locality in which the employee is employed4 7#aj7 ,parent ,the term parent means a biological1 foster1 or adoptive parent of an employee1 a stepparent of an employee1 parent-in-law1 parent of a domestic partner1 or a legal guardian or other person who stood in loco parentis to an employee when the employee was a child4 7#aa7 ,public health emergency ,the term public health emergency means a public health emergency declared by the ,secretary of ,health and ,human ,services for a jurisdiction1 or by a ,state public health official with authority to declare such an emergency for the ,state or jurisdiction within the ,state4 7#ab7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7#ac7 ,sexual assault ,the term sexual assault has the meaning given the term in section #djjjb7;a7 of the ,violence ,against ,women ,act of #aiid 7#cd ,u4,s4,c4 #abbia7;a774 7#ad7 ,spouse ,the term spouse1 with respect to an employee1 has the meaning given such term by the marriage laws of the ,state in which the marriage was celebrated4 7#ae7 ,stalking ,the term stalking has the meaning given the term in section #djjjb7;a7 of the ,violence ,against ,women ,act of #aiid 7#cd ,u4,s4,c4 #abbia7;a774 7#af7 ,victim services organization ,the term victim services organization means a nonprofit1 nongovernmental organization that provides assistance to victims of domestic violence1 sexual assault1 or stalking or advocates for such victims1 including a rape crisis center1 an organization carrying out a domestic violence1 sexual assault1 or stalking prevention or treatment program1 an organization operating a shelter or providing counseling services1 or a legal services organization or other organization providing assistance through the legal process4 #ccb4 ,paid sick time 7a7 ,earning of paid sick time 7#a7 ,in general ,subject to subsection 7c71 an employer shall provide each covered direct care professional employed by the employer not less than #a hour of earned paid sick time for every #cj hours worked1 to be used as described in subsection 7b74 ,an employer shall not be required to permit a covered direct care professional to earn1 under this subsection1 more than #ef hours of paid sick time in a year1 unless the employer chooses to set a higher limit4 7#b7 ,exempt covered direct care professionals 7,a7 ,in general ,except as provided in subparagraph 7,b71 for purposes of this subsection1 a covered direct care professional who is exempt from overtime requirements under section #ac7;a77#a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bac7;a77#a77 shall be deemed to work #dj hours in each workweek4 7,b7 ,shorter normal workweek ,if the normal workweek of such a covered direct care professional is less than #dj hours1 the covered direct care professional shall earn paid sick time under this subsection based upon that normal workweek4 7#c7 ,dates for beginning to earn paid sick time and use 7,a7 ,in general ,except as provided in subparagraph 7,b7 and the second sentence of paragraph 7#h71 covered direct care professionals shall begin to earn paid sick time under this section at the commencement of their employment4 ,except as provided in such subparagraph and such sentence1 a covered direct care professional shall be entitled to use the earned paid sick time beginning on the #fjth calendar day following commencement of the covered direct care professional's employment4 ,after that #fjth calendar day1 the covered direct care professional may use the paid sick time as the time is earned4 ,an employer may1 at the discretion of the employer1 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 #fjth day of employment4 7,b7 ,public health emergency ,subparagraph 7,a7 shall not apply with respect to additional paid sick time provided under subsection 7c74 ,in the event of a public health emergency1 a covered direct care professional may immediately use the additional or accrued paid sick time described in subsection 7c71 regardless of how long the covered direct care professional has been employed by an employer4 7#d7 ,carryover 7,a7 ,in general ,except as provided in subparagraph 7,b71 paid sick time earned under this section shall carry over from #a year to the next4 7,b7 ,construction ,except as provided in subsection 7c71 this subtitle shall not be construed to require an employer to permit a covered direct care professional to earn more than #ef hours of earned paid sick time at a given time4 7#e7 ,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 section4 7#f7 ,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 termination1 resignation1 retirement1 or other separation from employment for earned paid sick time that has not been used4 7#g7 ,reinstatement ,if a covered direct care professional is separated from employment with an employer and is rehired1 within #ab months after that separation1 by the same employer1 the employer shall reinstate the covered direct care professional's previously earned paid sick time4 ,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 employer4 7#h7 ,prohibition ,an employer may not require1 as a condition of providing paid sick time under this subtitle1 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 time4 7b7 ,uses ,paid sick time earned under this section may be used by a covered direct care professional for any of the following3 7#a7 ,an absence resulting from a physical or mental illness1 injury1 or medical condition of the covered direct care professional4 7#b7 ,an absence resulting from obtaining professional medical diagnosis or care1 or preventive medical care1 for the covered direct care professional4 7#c7 ,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 jurisdiction1 or at the employer's discretion1 due to a public health emergency4 7#d7 ,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 emergency1 regardless of whether the covered direct care professional has actually contracted the communicable disease4 7#e7 ,an absence for the purpose of caring for a child1 a parent1 a spouse1 a domestic partner1 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-- 7,a7 who is a child1 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 emergency1 including if a school or entity operating the place of care is physically closed but is providing education or care to the child remotely2 or 7,b7 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 emergency1 regardless of whether the person has actually contracted the communicable disease4 7#f7 ,an absence for the purpose of caring for a child1 a parent1 a spouse1 a domestic partner1 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-- 7,a7 who has any of the conditions or needs for diagnosis or care described in paragraph 7#a7 or 7#b72 7,b7 who is a child1 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 disability2 or 7,c7 who is otherwise in need of care4 7#g7 ,an absence resulting from domestic violence1 sexual assault1 or stalking1 if the time is to-- 7,a7 seek medical attention for the covered direct care professional or the covered direct care professional's child1 parent1 spouse1 domestic partner1 or an individual related to the covered direct care professional as described in paragraph 7#f71 to recover from physical or psychological injury or disability caused by domestic violence1 sexual assault1 or stalking2 7,b7 obtain or assist a related person described in paragraph 7#f7 in obtaining services from a victim services organization2 7,c7 obtain or assist a related person described in paragraph 7#f7 in obtaining psychological or other counseling2 7,d7 seek relocation2 or 7,e7 take legal action1 including preparing for or participating in any civil or criminal legal proceeding related to or resulting from domestic violence1 sexual assault1 or stalking4 7c7 ,additional paid sick time for public health emergency 7#a7 ,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 #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d7 or a major disaster or emergency declared by the ,president under section #dja or #eja1 respectively1 of the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eagj1 #eaia71 an employer in the jurisdiction involved shall provide each covered direct care professional of the employer in that jurisdiction with additional paid sick time1 in addition to any amount of paid sick time accrued by the covered direct care professional under subsection 7a7 7including paid leave referred to in subsection 7a77#d774 7#b7 ,amount of paid sick time ,in receiving additional paid sick time under paragraph 7#a71 the covered direct care professional shall receive-- 7,a7 for a full-time salaried covered direct care professional1 a specified amount of paid sick time that is sufficient to provide the covered direct care professional with #ad continuous days away from work without a reduction in pay2 and 7,b7 for a part-time or hourly covered direct care professional1 a specified amount of paid sick time equal to the number of hours that the covered direct care professional was scheduled to work or1 if not so scheduled1 regularly works in a #ad-;day period4 7#c7 ,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 7b7 beginning on the date a public health emergency is declared1 regardless of how long the covered direct care professional has been employed by an employer4 7#d7 ,sequencing ,during the public health emergency1 a covered direct care professional may first use the additional sick time for those purposes4 ,the covered direct care professional may then use the accrued sick time during the public health emergency1 or retain the accrued sick time for use after the public health emergency4 ,an employer may not require a covered direct care professional to use the accrued sick time1 or any other paid leave provided by the employer to the covered direct care professional1 before using the additional sick time4 7#e7 ,periods ,a covered direct care professional may take the additional sick time on the schedule that meets the covered direct care professional's needs1 consistent with subsection 7b71 including taking the additional sick time intermittently or on a reduced leave schedule1 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 employer4 7d7 ,scheduling ,a covered direct care professional shall make a reasonable effort to schedule a period of paid sick time under subsection 7a7 in a manner that does not unduly disrupt the operations of the employer4 7e7 ,procedures 7#a7 ,in general ,paid sick time shall be provided upon the oral or written request of a covered direct care professional4 ,such request shall-- 7,a7 include the expected duration of the period of such time2 and 7,b7 7i7 in a case in which the need for such period of time is foreseeable at least #g days in advance of such period1 be provided at least #g days in advance of such period2 and 7ii7 otherwise1 be provided as soon as practicable after the covered direct care professional is aware of the need for such period4 7#b7 ,certification in general 7,a7 ,provision 7i7 ,in general ,subject to subparagraphs 7,c7 and 7,d71 an employer may require that a request for paid sick time under this section for a purpose described in paragraph 7#a71 7#b71 or 7#f7 of subsection 7b7 be supported by a certification issued by the health care provider of the covered direct care professional or of an individual described in subsection 7b77#f71 as appropriate1 if the period of such time covers more than #c consecutive workdays4 7ii7 ,timeliness ,the covered direct care professional shall provide a copy of such certification to the employer in a timely manner1 not later than #cj days after the first day of the period of time4 ,the employer shall not delay the commencement of the period of time on the basis that the employer has not yet received the certification4 7,b7 ,sufficient certification 7i7 ,in general ,a certification provided under subparagraph 7,a7 shall be sufficient if it states-- 7,i7 the date on which the period of time will be needed2 7,,ii7 the probable duration of the period of time2 7,,iii7 the appropriate medical facts within the knowledge of the health care provider regarding the condition involved1 subject to clause 7ii72 and 7,,iv7 7aa7 for purposes of paid sick time under subsection 7b77#a71 a statement that absence from work is medically necessary2 7bb7 for purposes of such time under subsection 7b77#b71 the dates on which testing for a medical diagnosis or care is expected to be given and the duration of such testing or care2 and 7cc7 for purposes of such time under subsection 7b77#f71 in the case of time to care for someone who is not a child1 a statement that care is needed for an individual described in such subsection1 and an estimate of the amount of time that such care is needed for such individual4 7ii7 ,limitation ,in issuing a certification under subparagraph 7,a71 a health care provider shall make reasonable efforts to limit the medical facts described in clause 7i77,,iii7 that are disclosed in the certification to the minimum necessary to establish a need for the covered direct care professional to use paid sick time4 7,c7 ,public health emergencies ,no certification or other documentation may be required under this subtitle by an employer during any public health emergency4 7,d7 ,regulations ,regulations prescribed under section #cci 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 paragraph4 7,e7 ,confidentiality and nondisclosure 7i7 ,protected health information ,nothing in this subtitle shall be construed to require a health care provider to disclose information in violation of section #aagg of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#f7 or the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note74 7ii7 ,health information records ,if an employer possesses health information about a covered direct care professional1 a covered direct care professional's child1 parent1 spouse1 domestic partner1 or an individual related to the covered direct care professional as described in subsection 7b77#f71 such information shall-- 7,i7 be maintained on a separate form and in a separate file from other personnel information2 7,,ii7 be treated as a confidential medical record2 and 7,,iii7 not be disclosed except to the affected covered direct care professional or with the permission of the affected covered direct care professional4 7#c7 ,certification in the case of domestic violence1 sexual assault1 or stalking 7,a7 ,in general ,an employer may require that a request for paid sick time under this section for a purpose described in subsection 7b77#g7 be supported by any one of the following3 7i7 ,a police report indicating that the covered direct care professional1 or a member of the covered direct care professional's family described in subsection 7b77#g71 was a victim of domestic violence1 sexual assault1 or stalking4 7ii7 ,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 7b77#g7 from the perpetrator of an act of domestic violence1 sexual assault1 or stalking1 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 7b77#g7 has appeared in court or is scheduled to appear in court in a proceeding related to domestic violence1 sexual assault1 or stalking4 7iii7 ,other documentation signed by a covered direct care professional or volunteer working for a victim services organization1 an attorney1 a police officer1 a medical professional1 a social worker1 an antiviolence counselor1 or a member of the clergy1 affirming that the covered direct care professional or a member of the covered direct care professional's family described in subsection 7b77#g7 is a victim of domestic violence1 sexual assault1 or stalking4 7,b7 ,requirements ,the requirements of paragraph 7#b7 shall apply to certifications under this paragraph1 except that-- 7i7 subclauses 7,,iii7 and 7,,iv7 of subparagraph 7,b77i7 and subparagraph 7,b77ii7 of such paragraph shall not apply2 7ii7 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 work1 and the covered direct care professional shall not be required to explain the details of the domestic violence1 sexual assault1 or stalking involved2 and 7iii7 with respect to confidentiality under subparagraph 7,e7 of such paragraph1 any information provided to the employer under this paragraph shall be confidential1 except to the extent that any disclosure of such information is-- 7,i7 requested or consented to in writing by the covered direct care professional2 or 7,,ii7 otherwise required by applicable ,federal or ,state law4 7,c7 ,specification of documentation ,an employer may not specify which of the forms of documentation described in clause 7i71 7ii71 or 7iii7 of subparagraph 7,a7 is required to be provided in order to satisfy the requirement under such subparagraph4 #ccc4 ,notice requirement 7a7 ,in general ,each employer shall notify each covered direct care professional employed by the employer and include in any employee handbook the information-- 7#a7 describing paid sick time available to covered direct care professionals under this subtitle2 7#b7 pertaining to the filing of an action under this subtitle2 7#c7 on the details of the notice requirement for a foreseeable period of time under section #ccb7;e77#a77;,b77i72 and 7#d7 that describes-- 7,a7 the protections that a covered direct care professional has in exercising rights under this subtitle2 and 7,b7 how the covered direct care professional can contact the ,secretary if any of the rights are violated4 7b7 ,posting of notice ,each employer shall post and keep posted a notice1 to be prepared or approved in accordance with procedures specified in regulations prescribed under section #cci1 setting forth excerpts from1 or summaries of1 the pertinent provisions of this subtitle including the information described in paragraphs 7#a7 through 7#d7 of subsection 7a74 7c7 ,location ,the notice described under subsection 7b7 shall be posted-- 7#a7 in conspicuous places on the premises of the employer1 where notices to employees 7including applicants7 are customarily posted2 or 7#b7 in employee handbooks4 7d7 ,violation2 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 #ajj for each separate offense4 #ccd4 ,prohibited acts 7a7 ,interference with rights 7#a7 ,exercise of rights ,it shall be unlawful for any employer to interfere with1 restrain1 or deny the exercise of1 or the attempt to exercise1 any right provided under this subtitle1 including-- 7,a7 discharging or discriminating against 7including retaliating against7 any individual1 including a job applicant1 for exercising1 or attempting to exercise1 any right provided under this subtitle2 7,b7 using the taking of paid sick time under this subtitle as a negative factor in an employment action1 such as hiring1 promotion1 reducing hours or number of shifts1 or a disciplinary action2 or 7,c7 counting the paid sick time under a no-fault attendance policy or any other absence-control policy4 7#b7 ,discrimination ,it shall be unlawful for any employer to discharge or in any other manner discriminate against 7including retaliating against7 any individual1 including a job applicant1 for opposing any practice made unlawful by this subtitle4 7b7 ,interference with proceedings or inquiries ,it shall be unlawful for any person to discharge or in any other manner discriminate against 7including retaliating against7 any individual1 including a job applicant1 because such individual-- 7#a7 has filed an action1 or has instituted or caused to be instituted any proceeding1 under or related to this subtitle2 7#b7 has given1 or is about to give1 any information in connection with any inquiry or proceeding relating to any right provided under this subtitle2 or 7#c7 has testified1 or is about to testify1 in any inquiry or proceeding relating to any right provided under this subtitle4 7c7 ,construction ,nothing in this section shall be construed to state or imply that the scope of the activities prohibited by section #aje of the ,family and ,medical ,leave ,act of #aiic 7#bi ,u4,s4,c4 #bfae7 is less than the scope of the activities prohibited by this section4 #cce4 ,enforcement authority 7a7 ,investigative authority 7#a7 ,in general ,to ensure compliance with the provisions of this subtitle1 or any regulation or order issued under this subtitle1 the ,secretary shall have1 subject to paragraph 7#c71 the investigative authority provided under section #aa7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;a771 with respect to employers1 covered direct care professionals1 and other individuals affected by an employer4 7#b7 ,obligation to keep and preserve records ,an employer shall make1 keep1 and preserve records pertaining to compliance with this subtitle in accordance with section #aa7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;c77 and in accordance with regulations prescribed by the ,secretary4 7#c7 ,required submissions generally limited to an annual basis ,the ,secretary shall not require1 under the authority of this subsection1 an employer to submit to the ,secretary any books or records more than once during any #ab-month period1 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 subtitle1 or is investigating a charge pursuant to subsection 7c74 7#d7 ,subpoena authority ,for the purposes of any investigation provided for in this subsection1 the ,secretary shall have the subpoena authority provided for under section #i of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bji74 7b7 ,civil action by covered direct care professionals or individuals 7#a7 ,right of action ,an action to recover the damages or equitable relief prescribed in paragraph 7#a7 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-- 7,a7 the covered direct care professional or individual2 or 7,b7 the covered direct care professional or individual and others similarly situated4 7#b7 ,liability ,any employer who violates section #ccd 7including a violation relating to rights provided under section #ccb7 shall be liable to any covered direct care professional or individual affected-- 7,a7 for damages equal to-- 7i7 the amount of-- 7,i7 any wages1 salary1 employment benefits1 or other compensation denied or lost by reason of the violation2 or 7,,ii7 in a case in which wages1 salary1 employment benefits1 or other compensation have not been denied or lost1 any actual monetary losses sustained as a direct result of the violation up to a sum equal to #ef hours of wages or salary for the covered direct care professional or individual1 or the specified period described in section #ccb7;c77#c71 or a combination of those hours and that period1 as the case may be2 7ii7 the interest on the amount described in clause 7i7 calculated at the prevailing rate2 and 7iii7 an additional amount as liquidated damages2 and 7,b7 for such equitable relief as may be appropriate1 including employment1 reinstatement1 and promotion4 7#c7 ,fees and costs ,the court in an action under this subsection shall1 in addition to any judgment awarded to the plaintiff1 allow a reasonable attorney's fee1 reasonable expert witness fees1 and other costs of the action to be paid by the defendant4 7c7 ,action by the ,secretary 7#a7 ,administrative action ,the ,secretary shall receive1 investigate1 and attempt to resolve complaints of violations of section #ccd 7including a violation relating to rights provided under section #ccb7 in the same manner that the ,secretary receives1 investigates1 and attempts to resolve complaints of violations of sections #f and #g of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf and #bjg74 7#b7 ,civil action ,the ,secretary may bring an action in any court of competent jurisdiction to recover the damages described in subsection 7b77#b77;,a74 7#c7 ,sums recovered ,any sums recovered by the ,secretary pursuant to paragraph 7#b7 shall be held in a special deposit account and shall be paid1 on order of the ,secretary1 directly to each covered direct care professional or individual affected4 ,any such sums not paid to a covered direct care professional or individual affected because of inability to do so within a period of #c years shall be deposited into the ,treasury of the ,united ,states as miscellaneous receipts4 7d7 ,limitation 7#a7 ,in general ,except as provided in paragraph 7#b71 an action may be brought under subsection 7b71 7c71 or 7e7 not later than #b years after the date of the last event constituting the alleged violation for which the action is brought4 7#b7 ,willful violation ,in the case of an action brought for a willful violation of section #ccd 7including a willful violation relating to rights provided under section #ccb71 such action may be brought not later than #c years after the last event constituting the alleged violation for which such action is brought4 7#c7 ,commencement ,in determining when an action is commenced under subsection 7b71 7c71 or 7e7 for the purposes of this subsection1 it shall be considered to be commenced on the date when the complaint is filed4 7e7 ,action for injunction by ,secretary ,the district courts of the ,united ,states shall have jurisdiction1 for cause shown1 in an action brought by the ,secretary-- 7#a7 to restrain violations of section #ccd 7including a violation relating to rights provided under section #ccb71 including the restraint of any withholding of payment of wages1 salary1 employment benefits1 or other compensation1 plus interest1 found by the court to be due to covered direct care professionals or individuals eligible under this subtitle2 or 7#b7 to award such other equitable relief as may be appropriate1 including employment1 reinstatement1 and promotion4 7f7 ,solicitor of labor ,the ,solicitor of ,labor may appear for and represent the ,secretary on any litigation brought under subsection 7c7 or 7e74 #ccf4 ,education and outreach 7a7 ,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 subtitle4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary #bj1jjj1jjj to carry out such campaign4 #ccg4 ,effect on existing employment benefits 7a7 ,more protective ,nothing in this subtitle shall be construed to diminish the obligation of an employer to comply with any contract1 collective bargaining agreement1 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 subtitle4 7b7 ,less protective ,the rights established for covered direct care professionals under this subtitle shall not be diminished by any contract1 collective bargaining agreement1 or any employment benefit program or plan4 #cch4 ,encouragement of more generous leave policies ,nothing in this subtitle shall be construed-- 7#a7 to discourage employers from adopting or retaining leave policies more generous than policies that comply with the requirements of this subtitle2 or 7#b7 to discourage or prevent an employer from adopting a contract1 collective bargaining agreement1 or employment benefit program or plan that provides greater right or benefits to covered direct care professionals than the rights established under this subtitle4 #cci4 ,regulations 7a7 ,in general ,subject to subsection 7b71 not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall prescribe such regulations as are necessary to carry out this subtitle4 7b7 ,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 immediately1 without regard whether regulations have been prescribed under this section4 #cci;,a4 ,effective date ,if a public health emergency was declared before and remains in effect on the date of enactment of this ,act1 for purposes of this subtitle1 including section #ccb7;c71 the public health emergency shall be considered to have been declared on the date of enactment of this ,act4 #cci;,b4 ,collection of data and further study 7a7 ,compilation of information ,the ,commissioner of the ,bureau of ,labor ,statistics shall-- 7#a7 collect data on-- 7,a7 the amount of paid and unpaid sick time available to covered direct care professionals by occupation and type of employment establishment2 and 7,b7 an estimate of the average sick time used by covered direct care professionals according to occupation and the type of covered direct care professional2 and 7#b7 annually report that data to the ,comptroller ,general of the ,united ,states4 7b7 ,,gao study ,the ,comptroller ,general of the ,united ,states shall-- 7#a7 conduct a study to evaluate the implementation of this subtitle-- 7,a7 that includes an estimation of the access of covered direct care professionals to paid sick time1 the awareness of covered direct care professionals of rights under this ,act1 and the experiences of employers in complying with this subtitle2 and 7,b7 that takes into account access1 awareness1 and experiences of covered direct care professionals by race1 ethnicity1 gender1 disability1 occupation1 and any other characteristic determined by the ,secretary2 and 7#b7 not later than #e years after the date of enactment of this ,act1 submit the report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,special ,committee on ,aging of the ,senate and the ,committee on ,education and ,workforce of the ,house of ,representatives4 ,,iv ,national ,direct ,care ,professional ,compensation ,strategy #dja4 ,definitions ,in this title3 7#a7 ,advisory ,council ,the term ,advisory ,council means the ,national ,direct ,care ,professional ,compensation ,advisory ,council convened under section #djc4 7#b7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#c7 ,strategy ,the term ,strategy means the ,national ,direct ,care ,professional ,compensation ,strategy set forth under section #djb4 #djb4 ,national ,direct ,care ,professional ,compensation ,strategy 7a7 ,in general ,the ,secretary1 in consultation with the heads of other appropriate ,federal agencies1 shall develop jointly with the ,advisory ,council and submit to the appropriate committees of ,congress1 and the ,state agencies responsible for carrying out direct care professional programs1 and make publicly available on the internet website of the ,department of ,health and ,human ,services1 a ,national ,direct ,care ,professional ,compensation ,strategy4 7b7 ,contents 7#a7 ,in general ,the ,strategy shall identify recommended actions that the ,federal ,government 7under existing ,federal programs71 ,state and local governments1 communities1 health care providers1 including direct care professionals and others1 are taking1 or may take1 to provide direct care professionals a livable wage1 including recommendations on-- 7,a7 how to calculate the fair cost of labor provided by direct care professionals2 7,b7 how ,state ,medicaid agencies1 managed care organizations1 and other public payers should establish policies and procedures to ensure the direct care professional workforce is compensated at the full cost of their labor2 7,c7 how to set clear expectations for employers of direct care professionals with respect to compensation for such professionals2 and 7,d7 how to ensure additional training and certification is tied to increased compensation for such professionals4 7#b7 ,considerations ,the recommendations under paragraph 7#a7 shall take into account-- 7,a7 the particular challenges of the direct care professional workforce1 including-- 7i7 the largely part-time nature of the work2 7ii7 the mobile or transient nature of positions in the direct care professional workforce2 7iii7 precarity due to race1 ethnicity1 sexual orientation1 gender identity1 and immigration status2 and 7iv7 any decrease in public benefits that direct care professionals may experience following an increase in wages2 and 7,b7 strategies for wage enhancement for direct care professionals4 7c7 ,duties of the ,secretary ,the ,secretary1 in carrying out subsection 7a71 shall oversee the following3 7#a7 ,collecting and making publicly available information submitted by the ,advisory ,council under section #djc7;e7 to the appropriate committees of ,congress1 and the ,state agencies responsible for carrying out direct care professional programs1 including evidence-based or promising practices and innovative models 7both domestic and foreign7 regarding compensation for direct care professionals4 7#b7 ,coordinating and assessing existing ,federal ,government programs and activities to compensate direct care professionals while ensuring maximum effectiveness and avoiding unnecessary duplication4 7#c7 ,providing technical assistance1 as appropriate1 such as disseminating identified best practices and information sharing based on reports provided under section #djc7;e71 to ,state or local efforts to compensate direct care professionals4 7d7 ,initial strategy2 updates ,the ,secretary shall-- 7#a7 not later than #ah months after the date of enactment of this ,act1 develop1 publish1 and submit to the appropriate committees of ,congress1 and the ,state agencies responsible for carrying out direct care professional programs1 an initial ,strategy incorporating the items addressed in the ,advisory ,council's initial report under section #djc7;e7 and other relevant information1 including best practices1 for compensating direct care professionals2 and 7#b7 biennially update1 republish1 and submit to the appropriate committees of ,congress and the ,state agencies responsible for carrying out direct care professional programs the ,strategy1 taking into account the most recent annual report submitted under section #djc7;e77#a7-- 7,a7 to reflect new developments1 challenges1 opportunities1 and solutions2 and 7,b7 to review progress based on recommendations for compensating direct care professionals in the ,strategy and1 based on the results of such review1 recommend priority actions for improving the implementation of such recommendations1 as appropriate4 7e7 ,process for public input ,the ,secretary shall establish a process for public input to inform the development of1 and updates to1 the ,strategy1 including a process for the public to submit recommendations to the ,advisory ,council and an opportunity for public comment on the proposed ,strategy4 7f7 ,no preemption ,nothing in this title preempts any authority of a ,state or local government to compensate direct care professionals4 7g7 ,rule of construction ,nothing in this title shall be construed to permit the ,secretary 7through regulation1 guidance1 grant criteria1 or otherwise7 to-- 7#a7 mandate1 direct1 or control the allocation of ,state or local resources2 7#b7 mandate the use of any of the best practices identified in the reports required under this title2 or 7#c7 otherwise expand the authority of the ,secretary beyond that expressly provided to the ,secretary in this title4 7h7 ,authorization of appropriations ,there is authorized to be appropriated for the advisory committee #ajj1jjj for each of years #bjbf through #bjcj4 #djc4 ,national ,direct ,care ,professional ,compensation ,advisory ,council 7a7 ,convening ,the ,secretary shall convene a ,national ,direct ,care ,professional ,compensation ,advisory ,council to advise and provide recommendations1 including identified best practices1 to the ,secretary on compensating direct care professionals4 7b7 ,membership 7#a7 ,in general ,the members of the ,advisory ,council shall consist of-- 7,a7 the appointed members under paragraph 7#b72 and 7,b7 the ,federal members under paragraph 7#c74 7#b7 ,appointed members ,in addition to the ,federal members under paragraph 7#c71 the ,secretary shall appoint not more than #ae voting members of the ,advisory ,council who are not representatives of ,federal departments or agencies and who shall include at least #a representative of each of the following3 7,a7 ,direct care professionals4 7,b7 ,older individuals eligible for long-term care services under a ,state ,medicaid program4 7,c7 ,people with disabilities4 7,d7 ,health care and social service providers4 7,e7 ,employers of direct care professionals4 7,f7 ,state and local officials responsible for direct care professional policies in their jurisdictions4 7,g7 ,accreditation bodies responsible for accrediting direct care professionals4 7,h7 ,veterans who are older individuals or people with disabilities4 7,i7 ,organizations representing workers1 including labor organizations4 7,j7 ,as appropriate1 other experts in direct care and advocacy organizations for the direct care professional workforce4 7#c7 ,federal members ,the ,federal members of the ,advisory ,council1 who shall be nonvoting members1 shall consist of the following3 7,a7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7or the ,administrator's designee74 7,b7 ,the ,administrator of the ,administration for ,community ,living 7or the ,administrator's designee who has experience in both aging and disability74 7,c7 ,the ,secretary of ,veterans ,affairs 7or the ,secretary's designee74 7,d7 ,the ,secretary of ,labor 7or the ,secretary's designee74 7,e7 ,the ,administrator of the ,health ,resources and ,services ,administration 7or the ,administrator's designee74 7,f7 ,the heads of other ,federal departments or agencies 7or their designees71 including relevant departments or agencies that oversee labor and workforce1 economic1 government financial policies1 community service1 and other impacted populations1 as appointed by the ,secretary or the ,chair of the ,advisory ,council4 7#d7 ,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 program4 7c7 ,meetings ,the ,advisory ,council shall meet quarterly during the #a-year period beginning on the date of enactment of this ,act and at least #c times during each year thereafter4 ,meetings of the ,advisory ,council shall be open to the public4 7d7 ,non-,federal member compensation 7#a7 ,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 #ecae of title #e1 ,united ,states ,code1 for each day 7including travel time7 during which the member is engaged in the performance of the duties of the ,commission4 7#b7 ,travel expenses ,a member of the ,advisory ,council who is not an officer or employee of the ,federal ,government shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for employees of agencies under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from their homes or regular places of business in the performance of services for the ,commission4 7#c7 ,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 ,council4 7#d7 ,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 ,council4 7e7 ,advisory ,council annual reports 7#a7 ,in general ,not later than #ab months after the date of enactment of this ,act1 and annually thereafter1 the ,advisory ,council shall submit to the ,secretary1 the appropriate committees of ,congress1 and the ,state agencies responsible for carrying out direct care professional programs1 and make publicly available on the internet website of the ,department of ,health and ,human ,services1 a report concerning the development1 maintenance1 and updating of the ,strategy1 including a description of the outcomes of the recommendations and any priorities included in the initial report pursuant to paragraph 7#b71 as appropriate4 7#b7 ,initial report ,the ,advisory ,council's initial report under paragraph 7#a7 shall include-- 7,a7 an inventory and assessment of all federally funded efforts to compensate direct care professionals and the outcomes of such efforts1 including analyses of the extent to which federally funded efforts are reaching direct care professionals and gaps in such efforts2 7,b7 recommendations-- 7i7 to improve and better coordinate ,federal programs and activities to compensate direct care professionals1 as well as opportunities to improve the coordination of such ,federal programs and activities with ,state programs2 and 7ii7 to effectively deliver services based on the performance1 mission1 and purpose of a program while eliminating redundancies1 avoiding unnecessary duplication and overlap1 and ensuring the needs of direct care professionals are met2 7,c7 the identification of challenges faced by direct care professionals1 including financial1 health1 and other challenges1 and existing approaches to address such challenges2 and 7,d7 an evaluation of how the status of the direct care professional workforce affects the ,medicare program1 the ,medicaid program1 and other ,federal programs4 7f7 ,nonapplicability of ,federal ,advisory ,committee ,act ,chapter #aj of title #e1 ,united ,states ,code1 shall not apply to the ,advisory ,council4 #djd4 ,sunset provision ,the authority and obligations established by this title shall terminate on the date that is #aj years after the date of enactment of this ,act4 ,v ,improving oversight and accountability #eja4 ,evaluation of implementation and outcomes 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 in conjunction with the ,secretary of ,labor1 shall evaluate the implementation and outcomes of this ,act in the aggregate through a contract with an external evaluator who has experience in evaluating-- 7#a7 home and community-based services2 7#b7 disability programs2 7#c7 programs for older individuals2 7#d7 nursing homes and intermediate care facilities2 and 7#e7 health care workforce programs1 including direct care professional workforce programs4 7b7 ,evaluation criteria ,the external evaluator shall document and evaluate the implementation and outcomes of this ,act1 and the amendments made by this ,act1 including outcomes based on-- 7#a7 the impact on workforce creation1 training1 education1 recruitment1 retention1 professional development1 and advancement of the direct care professional workforce1 including direct care professionals from low-income families2 7#b7 the economic effects1 including the impact on compensation and benefits1 on the direct care professional workforce2 7#c7 the impact on working conditions1 including scheduling flexibility and stability1 for direct care professionals2 7#d7 the impact of workforce investment activities1 including supportive services1 on recruitment1 wages1 benefits1 and advancement of direct care professionals2 7#e7 the impact on burnout1 attrition1 and stability of the direct care professional workforce2 7#f7 the impact on vacancy rates and crude separation rates of the direct care professional workforce2 7#g7 the economic effects on-- 7,a7 individuals enrolled for medical assistance under a ,state ,medicaid program2 7,b7 people with disabilities and older individuals receiving long-term care services1 including home and community-based services2 and 7,c7 the families of any such individuals or persons described in subparagraph 7,a7 or 7,b72 7#h7 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 programs2 7#i7 the capacity of the direct care professional workforce to provide services for individuals needing long-term care services or changes in access1 availability1 and quality of long-term care services2 7#aj7 the impact on ,state waiting lists for home and community-based services2 7#aa7 the impact on mental health outcomes1 including substance use disorders and suicidality1 among direct care professionals2 7#ab7 promising practices identified by activities authorized or conducted pursuant to this ,act1 or the amendments made by this ,act2 and 7#ac7 any other factor as determined appropriate by the ,secretary of ,health and ,human ,services4 7c7 ,fiscal analysis ,the ,secretary of ,health and ,human ,services1 in conjunction with the ,secretary of ,labor1 shall contract with an independent external evaluator to track spending by ,states and providers of funding provided to ,states under sections #aja and #ajb 7including the amendments made by such sections74 ,the evaluator shall-- 7#a7 collect spending data from each ,state receiving funds under such sections2 7#b7 analyze the data to determine what percentage of funding under such sections was expended to improve wages and benefits of direct care professionals1 disaggregated by subcategories of direct care professionals described in section #c7aa72 7#c7 beginning #b years after the date of enactment of this ,act1 and every year thereafter through fiscal year #bjdj-- 7,a7 publish an annual report of ,state spending and the analyses conducted under paragraph 7#b72 and 7,b7 provide all such reports to the appropriate committees of ,congress2 and 7#d7 share the data described in paragraph 7#a7 with researchers to encourage further analysis4 7d7 ,dissemination of evaluation findings ,the ,secretary of ,health and ,human ,services shall-- 7#a7 disseminate the findings from the evaluations conducted under this section1 and from any other evaluation conducted under this ,act or an amendment made by this ,act1 to-- 7,a7 all ,state ,medicaid agencies2 and 7,b7 the appropriate committees of ,congress2 and 7#b7 make all such findings publicly available in an accessible electronic format and any other accessible format determined appropriate by the ,secretary4