,,ii  #aai? ,,congress  #b;d ,session   
,s4 #chhf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #ab1 #bjbf,mr4
 ,wyd5 7= himself1 ,mr4 ,kim1 ,mr4      
,book]1 ,ms4 ,w>r51 ,mr4 ,lujn1 ,mr4    
,murphy1 & ,mr4 ,blum5?al7 introduc$ !  
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to e/abli% total nurse /aff+ h\rs p]   
resid5t day1 to require #bd-;h\r use (  
regi/]$ pr(essional nurses 9 nurs+      
homes1 & = o!r purposes4  #a4 ,%ort     
title ,?is ,act may be cit$ z ! ,nurses 
,belong 9 ,nurs+ ,homes ,act4  #b4      
,nurse /aff+ requirem5ts  7a7 ,e/abli%+ 
total nurse /aff+ h\rs p] resid5t day2  
requir+ #bd-;,h\r use ( regi/]$         
pr(essional nurses 9 nurs+ homes2       
removal ( waiv] au?ority  7#a7 ,m$ic>e  
,section #ahai7;b77#d7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;b77#d77 is am5d$ by /rik+   
subp>agraph 7,c7 & ins]t+ ! foll[+3     
7,c7  ,requir$ nurs+ c>e  7i7  ,9 g5]al 
,a skill$ nurs+ facility mu/ provide--  

7,i7 #bd-;h\r lic5s$ nurs+ s]vices :i*  
are suffici5t to meet ! nurs+ ne$s ( its
 resid5ts2  7,,ii7 n lat] ?an ! date    
describ$ 9 clause 7iii71 a m9imum /aff+ 
requirem5t ( at lea/ #c4dh h\rs p]      
resid5t day 7or ! numb] ( h\rs p]       
resid5t day recomm5d$ 9 ! report mo/    
rec5tly submitt$ by ! ,secret>y "u      
section #aabh,l7b77#b71 provid$ t su*   
numb] is at lea/ #c4dh h\rs p] resid5t  
day7 ( nurs+ c>e provid$ by a comb9ation
 ( a regi/]$ pr(essional nurse1 lic5s$  
practical nurse 7or lic5s$ vocational   
nurse71 or c]tifi$ nurs+ assi/ant t--   
7aa7 provides direct c>e s]vices to     
resid5ts 9 a skill$ nurs+ facility2 &   
7bb7 reflects an appropriate comb9ation 
( compet5cies & skills t is suffici5t to
 ensure ! safety ( ea* resid5t 9 !      
facility2 &  7,,iii7 ! s]vices ( a      
regi/]$ pr(essional nurse1 su* t su*    
s]vices are furni%$--  7aa7 be=e ! date 
describ$ 9 clause 7iii71 at lea/ #h     
consecutive h\rs a day1 #g days a week2 
&  7bb7 on or aft] su* date1 #bd h\rs a 

day1 #g days a week4  7ii7  ,def9ition (
 h\rs p] resid5t day  ,9 ?is            
subp>agraph1 ! t]m h\rs p] resid5t day  
means ! total numb] ( h\rs work$ by ea* 
type ( /aff describ$ 9 clause 7i77,,ii7 
divid$ by ! total numb] ( resid5ts1 z   
calculat$ by ! ,adm9i/rator ( ! ,c5t]s =
 ,m$ic>e  ,m$icaid ,s]vices4  7iii7     
,date describ$  ,= purposes ( subclauses
 7,,ii7 & 7,,iii7 ( clause 7i71 ! date  
describ$ 9 ?is clause is ! date t is    
#ahj days aft] ! date ( enactm5t ( !    
,nurses ,belong 9 ,nurs+ ,homes ,act4  4
  7#b7  ,m$icaid  ,section #aiai7;b77#d7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acifr7b77#d77 is am5d$ by    
/rik+ subp>agraph 7,c7 & ins]t+ !       
foll[+3  7,c7  ,requir$ nurs+ c>e  7i7  
,9 g5]al  ,a nurs+ facility mu/         
provide-- 7,i7 #bd-;h\r lic5s$ nurs+    
s]vices :i* are suffici5t to meet !     
nurs+ ne$s ( its resid5ts2  7,,ii7 n    
lat] ?an ! date describ$ 9 section      
#ahai7;b77#d77;,c77iii71 a m9imum /aff+ 
requirem5t ( at lea/ #c4dh h\rs p]      

resid5t day 7or ! numb] ( h\rs p]       
resid5t day recomm5d$ 9 ! report mo/    
rec5tly submitt$ by ! ,secret>y "u      
section #aabh,l7b77#b71 provid$ t su*   
numb] is at lea/ #c4dh h\rs p] resid5t  
day7 ( nurs+ c>e provid$ by a comb9ation
 ( a regi/]$ pr(essional nurse1 lic5s$  
practical nurse 7or lic5s$ vocational   
nurse71 or c]tifi$ nurs+ assi/ant t--   
7aa7 provides direct c>e s]vices to     
resid5ts 9 a nurs+ facility2 &  7bb7    
reflects an appropriate comb9ation (    
compet5cies & skills t is suffici5t to  
ensure ! safety ( ea* resid5t 9 !       
facility2 &  7,,iii7 ! s]vices ( a      
regi/]$ pr(essional nurse1 su* t su*    
s]vices are furni%$--  7aa7 be=e ! date 
describ$ 9 section                      
#ahai7;b77#d77;,c77iii71 at lea/ #h     
consecutive h\rs a day1 #g days a week2 
&  7bb7 on or aft] su* date1 #bd h\rs a 
day1 #g days a week4  7ii7  ,def9ition (
 h\rs p] resid5t day  ,9 ?is            
subp>agraph1 ! t]m h\rs p] resid5t day  
has ! mean+ giv5 su* t]m 9 section      

#ahai7;b77#d77;,c77ii74  4  7b7 ,/udy   
,title ,,xi ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acja et seq47 is am5d$  
by ins]t+ aft] section #aabh,k ! foll[+ 
new section3  #aabh,l4 ,/udy & reports  
recomm5d+ m9imum /aff+ requirem5ts =    
skill$ nurs+ facilities & nurs+         
facilities2 promulgation ( regulations  
7a7 ,/udy  7#a7 ,9 g5]al ,n lat] ?an #b 
ye>s aft] ! date ( enactm5t ( ?is       
section1 & n less frequ5tly ?an once e  
#d ye>s !reaft]1 ! ,secret>y %all direct
 ! ,assi/ant ,secret>y = ,plann+ &      
,evaluation1 ! ,comptroll] ,g5]al1 or ! 
,m$ic>e ,paym5t ,advisory ,commission1 9
 consultation ) ! ,m$icaid & ,,*ip      
,paym5t & ,access ,commission 79 ?is    
section ref]r$ to z ! designat$ entity71
 to complete a /udy analyz+ nurse /aff+ 
requirem5ts at skill$ nurs+ facilities  
7z def9$ 9 section #ahai7;a77 & nurs+   
facilities 7z def9$ 9 section #aiai7;a77
 to provide c>e to individuals seek+ _! 
s]vices4  7#b7 ,cont5ts ,) respect to   
ea* /udy requir$ "u p>agraph 7#a71 !    

designat$ entity %all-- 7,a7 consult )--
 7i7 resid5ts1 family memb]s ( resid5ts1
 or au?oriz$ repres5tatives ( resid5ts2 
7ii7 regi/]$ pr(essional nurses1 lic5s$ 
practical nurses 7or lic5s$ vocational  
nurses71 c]tifi$ nurs+ assi/ants1 & o!r 
categories ( direct c>e pr(essionals 7z 
det]m9$ by ! ,secret>y7 :o "w at su*    
skill$ nurs+ facilities or nurs+        
facilities2  7iii7 collective b>ga9+    
units or unions t repres5t direct c>e   
work]s or direct c>e pr(essionals :o "w 
at su* skill$ nurs+ facilities & nurs+  
facilities2  7iv7 op]ators ( nurs+      
facilities & skill$ nurs+ facilities2   
7v7 rese>*]s ) exp]tise 9 ! nurs+ home &
 long-t]m c>e work=ce1 includ+ !        
disclosure ( fund+ s\rces = previ\sly   
conduct$ rese>* & conflicts ( int]e/2 & 
7vi7 long-t]m c>e ombudsm52 &  7,b7     
address ! foll[+3 7i7 ,:e!r ! m9imum    
/aff+ requirem5ts e/abli%$ 9 sections   
#ahai7;b77#d77;,c77i77,,ii7 &           
#aiai7;b77#d77;,c77i77,,ii7 %\ld be     
ma9ta9$ or increas$ 7b 9 no ev5t        

decreas$ bel[ a m9imum /aff+ requirem5t 
( at lea/ #c4dh h\rs p] resid5t day71   
bas$ on ! sev]ity ( ! heal? conditions1 
complexity ( heal? c>e ne$s1 or o!r     
measures ( pati5t acuity ( resid5ts at  
su* skill$ nurs+ facilities & nurs+     
facilities1 &1 if s1 h[ su* m9imum /aff+
 requirem5ts %all be increas$4  7ii7    
,:e!r o!r m9imum h\rs p] resid5t day    
m9imum /aff+ requirem5ts %\ld be        
e/abli%$ = o!r categories ( direct c>e  
pr(essionals or direct c>e work]s 9     
addition to ! requirem5ts e/abli%$ 9    
sections #ahai7;b77#d77;,c77i77,,ii7 &  
#aiai7;b77#d77;,c77i77,,ii74  7iii7 ,a  
review ( /aff+1 safety1 & quality data1 
z well z /aff+ requirem5t exception     
data1 to assess ! adequacy ( exi/+ /aff+
 practices 9 su* nurs+ facilities &     
skill$ nurs+ facilities4  7b7 ,reports  
7#a7 ,to ! ,secret>y ,! designat$ entity
 %all submit to ! ,secret>y a report on 
! results ( ! /udy conduct$ "u          
subsection 7a71 toge!r ) recomm5dations 
= su* legislation & adm9i/rative action 

z ! designat$ entity det]m9es           
appropriate4  7#b7 ,to ,congress ,n lat]
 ?an #ahj days aft] receiv+ ea* report  
"u p>agraph 7#a71 ! ,secret>y %all      
submit to ,congress a report on-- 7,a7 !
 f9d+s & recomm5dations includ$ 9 su*   
report2 &  7,b7 any plan to implem5t su*
 recomm5dations1 includ+ a ju/ification 
= any recomm5dations ! ,secret>y        
det]m9es %\ld n be implem5t$4  7c7      
,regulations  7#a7 ,9 g5]al ,n lat] ?an 
#a ye> aft] ! ,secret>y submits an      
initial report "u subsection 7b77#b71 ! 
,secret>y %all-- 7,a7 specify ?r\gh     
regulations1 consi/5t ) su* report1 a   
m9imum /aff+ requirem5t = nurs+ /aff =  
skill$ nurs+ facilities 7z def9$ 9      
section #ahai7;a77 & nurs+ facilities 7z
 def9$ 9 section #aiai7;a772 &  7,b7    
require su* skill$ nurs+ facilities &   
su* nurs+ facilities to comply ) su*    
/aff+ requirem5ts1 includ+ by provid+ ! 
m9imum /aff+ suffici5t to meet ! ne$s ( 
ea* resid5t 9 any su* facility4  7#b7   
,update ,n lat] ?an #a ye> aft] !       

,secret>y submits ea* subsequ5t report  
"u subsection 7b77#b71 ! ,secret>y %all1
 consi/5t ) ea* su* report1 update !    
regulations describ$ 9 p>agraph         
7#a77;,a7 z necess>y4  7d7 ,fund+ ,!    
,secret>y %all provide = ! transf]1 f ! 
,f$]al ,hospital ,insurance ,tru/ ,fund 
"u section #ahag to ! ,c5t]s = ,m$ic>e  
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 ( #ej1jjj1jjj = fiscal ye>     
#bjbg = purposes ( c>ry+ out ?is        
section4 ,am\nts transf]r$ pursuant to !
 previ\s s5t5ce %all rema9 available    
until exp5d$4  4  7c7 ,rule (           
con/ruction ,! moratorium impos$ "u     
section #gaaaa ( ! ,act titl$ ,an ,act  
to provide = reconciliation pursuant to 
title ,,ii ( ,h4 ,con4 ,res4 #ad        
7,public ,law #aai-ba7 7relat+ to       
implem5tation ( c]ta9 /aff+ /&>ds =     
long-t]m c>e facilities "u ! ,m$ic>e &  
,m$icaid programs7 %all n be con/ru$ to 
apply to ! am5dm5ts made by ?is section4
  #c4 ,p]man5t fund+ = ! ,survey &      
,c]tification ,program = nurs+ homes &  

o!r heal? c>e entities ,"p ,a ( ,title  
,,xi ( ! ,social ,security ,act 7#db    
,u4,s4,c4 #acja et seq47 is am5d$ by    
ins]t+ aft] section #aaej;,c ! foll[+   
new section3  #aaej;,d4 ,fund+ = !      
,survey & ,c]tification ,program ,!re is
 appropriat$ to ! ,secret>y1 out ( !    
,f$]al ,hospital ,insurance ,tru/ ,fund 
"u section #ahag & ! ,f$]al ,supplem5t>y
 ,m$ical ,insurance ,tru/ ,fund "u      
section #ahda 79 su* proportions z !    
,secret>y det]m9es to be appropriate71  
#hjj1jjj1jjj = fiscal ye> #bjbg & ea*   
subsequ5t fiscal ye> = ! purpose (      
conduct+ ! ,secret>y's ,survey &        
,c]tification ,program1 includ+ "u      
section #ahfd4 ,am\nts appropriat$ "u ! 
prec$+ s5t5ce %all rema9 available until
 exp5d$4  4  #d4 ,inve/+ 9 ! nurs+ home 
work=ce  7a7 ,m$ic>e ,section #ahai7;h7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#c7;h77 is am5d$--    
7#a7 9 p>agraph 7#b77;,b77ii77,,iv77ff71
 by ins]t+ 1 provid$ t n less ?an half (
 su* am\nts are provid$ to ! ,/ate 9 :i*

 ! facility is locat$ = ! purposes      
describ$ 9 p>agraph 7#g71 aft] collect$ 
may2 &  7#b7 by add+ at ! end ! foll[+  
new p>agraph3  7#g7 ,use ( civil money  
p5alty am\nts to support ! skill$ nurs+ 
facility work=ce  7,a7 ,9 g5]al ,subject
 to subp>agraph 7,b71 a ,/ate %all use !
 am\nts provid$ to su* ,/ate pursuant to
 p>agraph 7#b77;,b77ii77,,iv77ff7 = !   
fiscal ye> 9 :i* su* am\nts are provid$ 
= ! foll[+ purposes3 7i7 ,provid+ grants
 to entities su* z educational          
in/itutions1 advocacy organizations =   
skill$ nurs+ facility resid5ts1 s5ior   
citiz5s1 or individuals ) disabilities1 
& unions t repres5t ! skill$ nurs+      
facility work=ce to support projects t  
use community-driv5 approa*es to        
recruit1 educate1 & tra9 individuals to 
exp& ! skill$ nurs+ facility work=ce4   
7ii7 ,! fund+ ( projects t develop new  
c>e] pa?way programs = ! skill$ nurs+   
facility work=ce4  7iii7 ,! repaym5t (  
/ud5t loans = qualifi$ skill$ nurs+     
facility provid]s 7z def9$ 9 subp>agraph

 7,c77 or ! paym5t ( tuition = su*      
provid]s :o commit to s]v+ 9 a skill$   
nurs+ facility or a nurs+ facility 7z   
def9$ 9 section #aiai7;a77 = n less ?an 
#c ye>s )9 a #aj-ye> p]iod4  7,b7       
,prohibitions on use ( funds  7i7       
,prohibition on provid+ funds to        
entities relat$ to facilities ,a ,/ate  
may n provide any am\nts provid$ to su* 
,/ate pursuant to p>agraph              
7#b77;,b77ii77,,iv77ff7 to an entity t  
has a relat$ p>ty relation%ip ) a nurs+ 
facility or skill$ nurs+ facility 9 su* 
,/ate4  7ii7 ,prohibition on us+ funds =
 reimbursem5t ( co/s incurr$ 9 complet+ 
nurse aide tra9+ & compet5cy evaluation 
programs & nurse aide compet5cy         
evaluation programs ,a ,/ate may n use  
any am\nts provid$ to su* ,/ate pursuant
 to p>agraph 7#b77;,b77ii77,,iv77ff7    
to-- 7,i7 reimburse co/s incurr$ 9      
complet+ a nurse aide tra9+ & compet5cy 
evaluation program or a nurse aide      
compet5cy evaluation program "u         
subsection 7f77#b77;,a72 or  7,,ii7     

supplant ! paym5t ( su* co/s "u su*     
subsection4  7,c7 ,def9itions ,9 ?is    
p>agraph3 7i7 ,qualifi$ skill$ nurs+    
facility provid] ,! t]m qualifi$ skill$ 
nurs+ facility provid] means-- 7,i7 a   
g]iatrician or o!r physician1 nurse     
practition]1 physician assi/ant1 or o!r 
practition] :o provides s]vices 9 a     
skill$ nurs+ facility or nurs+ facility2
 or  7,,ii7 a regi/]$ pr(essional nurse1
 a lic5s$ practical nurse 7or a lic5s$  
vocational nurse71 or a c]tifi$ nurs+   
assi/ant :o provides direct c>e s]vices 
to resid5ts 9 a skill$ nurs+ facility or
 nurs+ facility1 z det]m9$ by !         
,secret>y4  7ii7 ,relat$ p>ty ,! t]m    
relat$ p>ty means an entity t1 to a     
significant ext5t is associat$ or       
affiliat$ )1 or has control (1 or is    
controll$ by1 a nurs+ facility or skill$
 nurs+ facility4  7,d7 ,annual report+  
7i7 ,report f ,/ates ,n lat] ?an #a ye> 
aft] ! date ( enactm5t ( ?is p>agraph1 &
 annually !reaft]1 ea* ,/ate t receives 
am\nts pursuant to p>agraph             

7#b77;,b77ii77,,iv77ff7 %all submit to !
 ,secret>y a report describ+-- 7,i7 h[  
am\nts receiv$ 9 ! previ\s fiscal ye> 7 
allocat$2  7,,ii7 ! me*anisms to ensure 
su* am\nts b5efit ! developm5t ( !      
skill$ nurs+ facility work=ce2  7,,iii7 
h[ su* am\nts w impact measurable       
outcomes = resid5ts ( skill$ nurs+      
facilities & nurs+ facilities1 su* z    
/aff vacancy rates1 turnov] rates1 m$ian
 h\rly wages1 /aff+ h\rs p] resid5t1 &  
resid5t quality outcomes2 &  7,,iv7 h[  
su* ,/ate is ensur+ compliance )        
subp>agraph 7,b74  7ii7 ,report to      
,congress ,n lat] ?an #ahj days aft] !  
,secret>y receives ! annual reports f   
,/ates "u clause 7i71 ! ,secret>y %all  
submit to ,congress a report describ+ ! 
in=mation conta9$ 9 su* reports4  4  7b7
 ,m$icaid ,section #aiai7;h7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acifr7h77 is am5d$-- 7#a7 9 p>agraph   
7#b77;,a77ii7-- 7,a7 9 ! second s5t5ce1 
by /rik+ ,funds collect$ & ins]t+       
,subject to ! la/ s5t5ce ( ?is clause1  

funds collect$2 &  7,b7 by ins]t+ !     
foll[+ s5t5ce at ! end3 ,n less ?an half
 ( ! funds collect$ pursuant to ?is     
clause %all be us$ = ! purposes describ$
 9 p>agraph 7#aj742  7#b7 9 p>agraph    
7#c77;,c77ii77,,iv77ff71 by ins]t+ 1    
provid$ t n less ?an half ( su* am\nts  
are provid$ to ! ,/ate 9 :i* ! facility 
is locat$ = ! purposes describ$ 9       
p>agraph 7#aj712 &  7#c7 by add+ at !   
end ! foll[+ new p>agraph3  7#aj7 ,use (
 civil money p5alty am\nts to support ! 
nurs+ facility work=ce  7,a7 ,9 g5]al   
,subject to subp>agraph 7,b71 a ,/ate   
%all use n less ?an half ( ! funds      
collect$ "u p>agraph 7#b77;,a77ii7 & !  
am\nts provid$ to su* ,/ate pursuant to 
p>agraph 7#c77;,c77ii77,,iv77ff7        
7collectively ref]r$ to 9 ?is p>agraph z
 civil money p5alty am\nts7 = ! fiscal  
ye> 9 :i* su* am\nts are collect$ or    
provid$ = ! foll[+ activities3 7i7      
,provid+ grants to entities su* z       
educational in/itutions1 advocacy       
organizations = nurs+ facility resid5ts1

 s5ior citiz5s1 or individuals )        
disabilities1 & unions t repres5t !     
nurs+ facility work=ce to support       
projects t use community-driv5 approa*es
 to recruit1 educate1 & tra9 individuals
 to exp& ! nurs+ facility work=ce4  7ii7
 ,! fund+ ( projects t develop new c>e] 
pa?way programs = ! nurs+ facility      
work=ce4  7iii7 ,! repaym5t ( /ud5t     
loans = qualifi$ nurs+ facility provid]s
 7z def9$ 9 subp>agraph 7,c77 or !      
paym5t ( tuition = su* provid]s :o      
commit to s]v+ 9 a skill$ nurs+ facility
 7z def9$ 9 section #ahai7;a77 or a     
nurs+ facility = n less ?an #c ye>s )9 a
 #aj-ye> p]iod4  7,b7 ,prohibition on   
use ( funds  7i7 ,prohibition on provid+
 funds to entities relat$ to facilities 
,a ,/ate may n provide any civil money  
p5alty am\nts to an entity t has a      
relat$ p>ty relation%ip ) a nurs+       
facility or skill$ nurs+ facility 9 su* 
,/ate4  7ii7 ,prohibition on us+ funds =
 reimbursem5t ( co/s incurr$ 9 complet+ 
nurse aide tra9+ & compet5cy programs & 

nurse aide compet5cy evaluation programs
 ,a ,/ate may n use any civil money     
p5alty am\nts to-- 7,i7 reimburse co/s  
incurr$ 9 complet+ a nurse aid tra9+ &  
compet5cy evaluation program or a nurse 
aide compet5cy evaluation program "u    
subsection 7f77#b77;,a72 or  7,,ii7     
supplant ! paym5t ( su* co/s "u su*     
subsection4  7,c7 ,def9itions ,9 ?is    
p>agraph3 7i7 ,qualifi$ nurs+ facility  
provid] ,! t]m qualifi$ nurs+ facility  
provid] means-- 7,i7 a g]iatrician or   
o!r physician1 nurse practition]1       
physician assi/ant1 or o!r practition]  
:o provides s]vices 9 a skill$ nurs+    
facility or nurs+ facility2 or  7,,ii7 a
 regi/]$ pr(essional nurse1 lic5s$      
practical nurse 7or a lic5s$ vocational 
nurse71 or c]tifi$ nurs+ assi/ant :o    
provides direct c>e s]vices to resid5ts 
9 a skill$ nurs+ facility or nurs+      
facility1 z det]m9$ by ! ,secret>y4     
7ii7 ,relat$ p>ty ,! t]m relat$ p>ty    
means an entity t1 to a significant     
ext5t is associat$ or affiliat$ )1 or   

has control (1 or is controll$ by1 a    
nurs+ facility or skill$ nurs+ facility4
  7,d7 ,annual report+  7i7 ,report f   
,/ates ,n lat] ?an #a ye> aft] ! date ( 
enactm5t ( ?is p>agraph1 & annually     
!reaft]1 ea* ,/ate t receives any civil 
money p5alty am\nts %all submit to !    
,secret>y a report describ+-- 7,i7 h[   
am\nts receiv$ 9 ! previ\s fiscal ye> 7 
allocat$2  7,,ii7 ! me*anisms to ensure 
su* am\nts b5efit ! developm5t ( ! nurs+
 facility work=ce2  7,,iii7 h[ su*      
am\nts w impact measurable outcomes =   
resid5ts ( skill$ nurs+ facilities &    
nurs+ facilities1 su* z /aff vacancy    
rates1 turnov] rates1 m$ian h\rly wages1
 /aff+ h\rs p] resid5t1 & resid5t       
quality outcomes2 &  7,,iv7 h[ su* ,/ate
 is ensur+ compliance ) subp>agraph     
7,b74  7ii7 ,report to ,congress ,n lat]
 ?an #ahj days aft] ! ,secret>y receives
 ! annual reports f ,/ates "u clause    
7i71 ! ,secret>y %all submit to         
,congress a report describ+ ! in=mation 
conta9$ 9 su* report4  4  #e4           

,codification ( regulations reg>d+      
requirem5ts = long-t]m s]vices &        
supports & paym5t transp>5cy report+    
,sections #dch4gb & #ddb4dc ( title #db1
 ,code ( ,f$]al ,regulations 7z 9 effect
 on ,may #aj1 #bjbd71 %all h ! =ce &    
effect ( law4