,,ii #aaith ,,congress #b;d ,session ,s4 #dhhi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bd1 #bjbf,mr4 ,kaine 7for himself1 ,ms4 ,duckworth1 ,mr4 ,lujn1 ,ms4 ,smith1 ,mrs4 ,gillibrand1 ,mr4 ,wyden1 ,ms4 ,hassan1 and ,mr4 ,reed7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to award grants for the creation1 recruitment1 training and education1 retention1 and advancement of the direct care workforce and to award grants to support family caregivers4 #a4 ,short title ,this ,act may be cited as the ,supporting ,our ,direct ,care ,workforce and ,family ,caregivers ,act4 #b4 ,definitions ,in this ,act3 7#a7 ,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#b7 ,community college ,the term community 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#c7 ,direct care professional ,the term direct care professional-- 7,a7 means an individual who1 in exchange for compensation1 provides services to a person with a disability or an older individual that promotes the independence of such person or individual1 including-- 7i7 services that enhance the independence and community inclusion for such person or individual1 including traveling with such person or individual or attending and assisting such person or individual while visiting friends and family1 shopping1 or socializing2 7ii7 services such as coaching and supporting such person or individual in communicating needs1 achieving self-expression1 pursuing personal goals1 living independently1 and participating actively in employment or voluntary roles in the community2 7iii7 services such as providing assistance with activities of daily living 7such as feeding1 bathing1 toileting1 and ambulation7 and with tasks such as meal preparation1 shopping1 light housekeeping1 and laundry2 7iv7 services that support such person or individual at home1 work1 school1 or in any other community setting2 or 7v7 services that promote health and wellness1 including scheduling and taking such person or individual to health care appointments1 communicating with health and allied health professionals1 administering medications1 implementing health and behavioral health interventions and treatment plans1 and monitoring and recording health status and progress2 and 7,b7 may include-- 7i7 a direct support professional supporting people with intellectual and developmental disabilities2 7ii7 a home and community-based services manager or direct support professional manager2 7iii7 a self-directed care worker2 7iv7 a personal care service worker2 7v7 a direct care worker1 as defined in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep72 or 7vi7 any other position or job related to the home care or direct care workforce1 such as positions or jobs in respite care or palliative care1 as determined by the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services and the ,secretary of ,labor4 7#d7 ,direct care workforce ,the term direct care workforce means the broad workforce of direct care professionals4 7#e7 ,family caregiver ,the term family caregiver has the meaning given such term in section #b of the ,,raise ,family ,caregivers ,act 7#db ,u4,s4,c4 #cjcjs note2 ,public ,law #aae-aai7 and includes paid and unpaid family caregivers4 7#f7 ,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 training of1 or educating direct care professionals or family caregivers2 7iv7 an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization2 7v7 a community college or other institution of higher education2 or 7vi7 a consortium of entities listed in any of clauses 7i7 through 7v72 7,b7 that agrees to include1 as applicable with respect to the type of grant the entity is seeking under this ,act and the activities supported through such grant1 older individuals1 people with disabilities1 direct care professionals1 and family caregivers1 as advisors and trainers in such activities2 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#g7 ,employ2 employer ,the terms employ and employer have the meanings given the terms in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc et seq474 7#h7 ,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#i7 ,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#aj7 ,older individual ,the term older individual means an individual who is #fj years of age or older4 7#aa7 ,person with a disability ,the term person with disability means an individual with a disability1 as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#ab7 ,project participant ,the term project participant means an individual participating in a project or activity assisted with a grant under this ,act1 including 7as applicable for the category of the grant7 a direct care professional1 or an individual training to be such a professional1 or a family caregiver4 7#ac7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,administrator for ,community ,living4 7#ad7 ,self-directed care professional ,the term self-directed care professional 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 services4 7#ae7 ,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 ,act1 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 7#af7 ,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#ag7 ,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#ah7 ,work-based learning ,the term work-based learning has the meaning given the term in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf 7#bj ,u4,s4,c4 #bcjb74 #c4 ,authority to establish a technical assistance center for building the direct care workforce 7a7 ,program authorized ,the ,secretary shall establish a national technical assistance center 7referred to in this section as the ,center7 for1 in consultation with the ,secretary of ,labor1 the ,secretary of ,education1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the heads of other entities as necessary-- 7#a7 supporting direct care workforce creation1 training and education1 recruitment1 retention1 and advancement2 and 7#b7 supporting family caregivers and activities of family caregivers as a critical part of the support team for older individuals or people with disabilities4 7b7 ,advisory council ,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 and entities described in paragraphs 7#c77;,b71 and 7#ab71 of section #e7;b7 7without regard to a specific project described in such paragraphs7 for service on the advisory council4 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 colleges2 7#b7 develop learning and dissemination strategies to-- 7,a7 engage ,states and other entities in activities supported under this ,act and best practices2 and 7,b7 distribute findings from activities supported by grants under this ,act2 7#c7 develop recommendations for training and education curricula and other strategies for supporting family caregivers2 7#d7 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 support professionals as a healthcare support occupation2 7#e7 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 ladders or pathways1 specializations or certifications1 or other activities2 and 7#f7 develop strategies for assisting with reporting and evaluation of grant activities under section #g4 #d4 ,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 professional 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,b7 or 7,c71 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 professionals who are managers or supervisory staff that have coaching1 training1 managerial1 supervisory1 or other oversight responsibilities1 including through education or training programs for such professionals or individuals seeking to become such professionals4 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 ,family caregiver grants ,grants to eligible entities to create and carry out projects for providing support to paid or unpaid family caregivers through educational1 training1 or other resources1 including resources for caregiver self-care or educational or training resources for individuals newly in a caregiving role or seeking additional support in the role of a family caregiver4 7#c7 ,projects for advancement opportunities ,not less than #cj percent of projects assisted with grants under this ,act 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 ,act 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 ,act4 #e4 ,project plans 7a7 ,in general ,an eligible entity seeking a grant under this ,act 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 #d7;b77 with the grant 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 ,state or relevant geographic area1 including a description of the populations likely to need long-term care services1 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 workforce vacancy rates1 crude separation rates1 and the number of direct care professionals1 including such professionals who are managers or supervisors1 in the region4 7#c7 ,an advisory committee to advise the eligible entity on activities to be carried out through the grant4 ,such advisory committee-- 7,a7 may be comprised of entities listed in paragraph 7#ab72 and 7,b7 shall include-- 7i7 older individuals or persons with a disability2 7ii7 organizations representing the rights and interests of people receiving services by the direct care professionals or family caregivers targeted by the project2 7iii7 individuals who are direct care professionals or family caregivers targeted by the project and organizations representing the rights and interests of direct care professionals or family caregivers2 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 and 7vi7 representatives reflecting diverse racial1 cultural1 ethnic1 geographic1 socioeconomic1 and gender identity and sexual orientation perspectives4 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 home and community based 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 and 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 wage required by other applicable ,federal or ,state law1 or a collective bargaining agreement4 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 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 evidenced-supported practices for adult learners and universal design for learning and ensure recipients of services provided by the direct care professionals or family caregivers 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 7vi7 incorporate evidence-supported practices for family caregiver engagement2 and 7vii7 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 health1 including co-occurring behavioral health conditions and intellectual or developmental disabilities2 7iii7 ,alzheimer's and dementia care2 7iv7 chronic disease management2 and 7v7 the use of supportive or assistive technology4 7#ab7 ,how the eligible entity will consult on the implementation of the project1 or coordinate the project with1 each of the following entities1 to the extent that each such entity is not the eligible entity3 7,a7 ,the ,state ,medicaid agency1 ,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,b7 ,the local board and ,state board for each region1 or ,state1 to be served by the project4 7,c7 ,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,d7 ,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,e7 ,area agencies on aging1 as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7,f7 ,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,g7 ,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,h7 ,aging and ,disability ,resource ,centers 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb774 7,i7 ,a nonprofit ,state provider association that represents providers who employ the direct care professionals targeted by the project1 where such associations exist4 7,j7 ,an entity that employs the direct care professionals targeted by the project4 7,k7 ,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,l7 ,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,m7 ,direct care professionals or direct care workforce organizations representing underserved communities1 including communities of color4 7#ac7 ,how the eligible entity will consult throughout the project with-- 7,a7 individuals employed or working as the direct care professionals or family caregivers targeted by the project2 7,b7 representatives of such professionals or caregivers2 7,c7 individuals assisted by such professionals or caregivers2 7,d7 the families of such professionals or caregivers2 and 7,e7 individuals receiving education or training to become such professionals or caregivers4 7#ad7 ,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 barriers to employment4 7c7 ,considerations ,in selecting eligible entities to receive a grant under this ,act1 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 #f4 ,uses of funds2 supplement1 not supplant 7a7 ,uses of funds 7#a7 ,in general ,each eligible entity receiving a grant under this ,act shall use the funds of such grant to carry out at least #a project described in section #d7;a77#b74 7#b7 ,administrative costs ,each eligible entity receiving a grant under this ,act shall not use more than #e percent of the funds of such grant for costs associated with the administration of activities under this ,act4 7#c7 ,direct support ,each eligible entity receiving a grant under this ,act 7except for a grant described in section #d7;a77#b77;,d77 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 ,act 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 professionals or provide support for family caregivers1 in the ,state or region served by the eligible entity4 7c7 ,prohibition ,no amounts made available under this ,act 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 #g4 ,evaluations and reports2 technical assistance 7a7 ,reporting requirements by grant recipients 7#a7 ,in general ,an eligible entity receiving a grant under this ,act shall cooperate with the ,secretary and annually provide a report to the ,secretary that includes any relevant data requested by the ,secretary in a manner specified by the ,secretary4 7#b7 ,contents ,the data requested by the ,secretary for an annual report may include any of the following 7as determined relevant by the ,secretary with respect to the category of the grant and each project supported through the grant73 7,a7 ,the number of individuals and the demographics of these individuals served by each project supported by the grant1 including-- 7i7 the number of individuals recruited through each such project to be employed as a direct care professional2 7ii7 the number of individuals who through each such project attained employment as a direct care professional2 and 7iii7 the number of individuals who enrolled in each such project and withdrew or were terminated from each such project without completing training or attaining employment as a direct care professional4 7,b7 ,the number of family caregivers participating in an education or training program through each project supported by the grant4 7,c7 ,the number of project participants who through each such project participated in and completed-- 7i7 work-based learning2 7ii7 on-the-job training2 7iii7 an apprenticeship program2 or 7iv7 a professional development or mentoring program4 7,d7 7i7 ,other services1 benefits1 or supports 7other than the services1 benefits1 or supports described in subparagraph 7,c77 provided through each such project to assist in the recruitment1 retention1 or advancement of direct care professionals 7including through education or training for such professionals or individuals seeking to become such professionals72 7ii7 the number of individuals who accessed such services1 benefits1 or supports2 and 7iii7 the impact of such services1 benefits1 or supports4 7,e7 ,the crude separation and vacancy rates of direct care professionals1 and such rates for those professionals who are managers or supervisors1 in the geographic region for a number of years before the grant was awarded1 as determined by the ,secretary1 and annually thereafter for the duration of the grant period4 7,f7 ,how each project supported by the grant assessed satisfaction with respect to-- 7i7 project participants assisted by the project2 7ii7 individuals receiving services delivered by project participants1 including-- 7,i7 any impact on the health or health outcomes of such individuals2 and 7,,ii7 any impact on the ability of individuals to transition to or remain in the community in an environment that meets the criteria established in the section #dda4cja7;c77#d7 of title #db1 ,code of ,federal ,regulations 7or successor regulations72 and 7iii7 employers of such project participants4 7,g7 ,the performance of the eligible entity with respect to unsubsidized employment1 median earnings1 credential attainment1 measurable skill gains1 and employer satisfaction4 7,h7 ,any other information with respect to outcomes of the project as determined by the ,secretary4 7b7 ,annual report to ,congress by ,secretary ,not later than #b years after the date of enactment of this ,act1 and each year thereafter until all projects supported through a grant under this ,act are completed1 the ,secretary shall prepare and submit to ,congress an annual report on the progress of each project supported through a grant under this ,act and the activities of the technical assistance center established under section #c4 7c7 ,,gao report ,not later than #a year after the date on which all projects supported through a grant under this ,act are completed1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report including-- 7#a7 an assessment of how the technical assistance center established under section #c and the projects supported through a grant under this ,act assisted in the creation1 recruitment1 training and education1 retention1 and advancement of the direct care workforce or in providing support for family caregivers2 and 7#b7 recommendations for such legislative or administrative actions needed for improving the assistance described in paragraph 7#a71 as the ,comptroller ,general determines appropriate4 7d7 ,independent evaluations ,not later than #f months after the date of enactment of this ,act1 the ,secretary shall enter into a contract with an independent entity to provide independent evaluations of activities supported by grants under this ,act and activities of the technical assistance center established under section #c4 #h4 ,authorization of appropriations 7a7 ,in general ,there are authorized to be appropriated-- 7#a7 for the establishment and activities of the technical assistance center under section #c1 #b1jjj1jjj for each of fiscal years #bjbg through #bjca2 and 7#b7 for grants under section #d1 #a1jjj1jjj1jjj for fiscal year #bjbg4 7b7 ,availability ,amounts made available under this ,act shall remain available until ,september #cj1 #bjcf4