Text of Senate Amendment 4706

Text of Senate Amendment 4706

Congressional Record, Volume 172 Issue 50 (Thursday, March 19, 2026) [Congressional Record Volume 172, Number 50 (Thursday, March 19, 2026)] [Senate] [Pages S1408-S1410] From the Congressional Record Online through the Government Publishing Office [ www.gpo.gov ] SA 4706. Mr. KIM (for himself, Mr. Wyden, Mr. Lujan, Mr. Van Hollen, Mr. Murphy, and Mr. Blumenthal) submitted an amendment intended to be proposed by him to the bill S. 1383, to establish the Veterans Advisory Committee on Equal Access, and for other purposes; which was ordered to lie on the table; as follows: In lieu of the matter proposed to be inserted, insert the following: SECTION 1. SHORT TITLE. This Act may be cited as the ``Nurses Belong in Nursing Homes Act''. SEC. 2. NURSE STAFFING REQUIREMENTS. (a) Establishing Total Nurse Staffing Hours Per Resident Day; Requiring 24-Hour Use of Registered Professional Nurses in Nursing Homes; Removal of Waiver Authority.-- (1) Medicare.--Section 1819(b)(4) of the Social Security Act (42 U.S.C. 1395i-3(b)(4)) is amended by striking subparagraph (C) and inserting the following: ``(C) Required nursing care.-- ``(i) In general.--A skilled nursing facility must provide-- ``(I) 24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents; ``(II) not later than the date described in clause (iii), a minimum staffing requirement of at least 3.48 hours per resident day (or the number of hours per resident day recommended in the report most recently submitted by the Secretary under section 1128L(b)(2), provided that such number is at least 3.48 hours per resident day) of nursing care provided by a combination of a registered professional nurse, licensed practical nurse (or licensed vocational nurse), or certified nursing assistant that-- ``(aa) provides direct care services to residents in a skilled nursing facility; and ``(bb) reflects an appropriate combination of competencies and skills that is sufficient to ensure the safety of each resident in the facility; and ``(III) the services of a registered professional nurse, such that such services are furnished-- ``(aa) before the date described in clause (iii), at least 8 consecutive hours a day, 7 days a week; and ``(bb) on or after such date, 24 hours a day, 7 days a week. ``(ii) Definition of hours per resident day.--In this subparagraph, the term `hours per resident day' means the total number of hours worked by each type of staff described in clause (i)(II) divided by the total number of residents, as calculated by the Administrator of the Centers for Medicare & Medicaid Services. ``(iii) Date described.--For purposes of subclauses (II) and (III) of clause (i), the date described in this clause is the date that is 180 days after the date of enactment of the Nurses Belong in Nursing Homes Act.''. (2) Medicaid.--Section 1919(b)(4) of the Social Security Act (42 U.S.C. 1396r(b)(4)) is amended by striking subparagraph (C) and inserting the following: ``(C) Required nursing care.-- ``(i) In general.--A nursing facility must provide-- ``(I) 24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents; ``(II) not later than the date described in section 1819(b)(4)(C)(iii), a minimum staffing requirement of at least 3.48 hours per resident day (or the number of hours per resident day recommended in the report most recently submitted by the Secretary under section 1128L(b)(2), provided that such number is at least 3.48 hours per resident day) of nursing care provided by a combination of a registered professional nurse, licensed practical nurse (or licensed vocational nurse), or certified nursing assistant that-- ``(aa) provides direct care services to residents in a nursing facility; and ``(bb) reflects an appropriate combination of competencies and skills that is sufficient to ensure the safety of each resident in the facility; and ``(III) the services of a registered professional nurse, such that such services are furnished-- ``(aa) before the date described in section 1819(b)(4)(C)(iii), at least 8 consecutive hours a day, 7 days a week; and ``(bb) on or after such date, 24 hours a day, 7 days a week. ``(ii) Definition of hours per resident day.--In this subparagraph, the term `hours per resident day' has the meaning given such term in section 1819(b)(4)(C)(ii).''. (b) Study.--Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128K the following new section: ``SEC. 1128L. STUDY AND REPORTS RECOMMENDING MINIMUM STAFFING REQUIREMENTS FOR SKILLED NURSING FACILITIES AND NURSING FACILITIES; PROMULGATION OF REGULATIONS. ``(a) Study.-- ``(1) In general.--Not later than 2 years after the date of enactment of this section, and not less frequently than once every 4 years thereafter, the Secretary shall direct the Assistant Secretary for Planning and Evaluation, the Comptroller General, or the Medicare Payment Advisory Commission, in consultation with the Medicaid and CHIP Payment and Access Commission (in this section referred to as the `designated entity'), to complete a study analyzing nurse staffing requirements at skilled nursing facilities (as defined in section 1819(a)) and nursing facilities (as defined in section 1919(a)) to provide care to individuals seeking their services. ``(2) Contents.--With respect to each study required under paragraph (1), the designated entity shall-- ``(A) consult with-- ``(i) residents, family members of residents, or authorized representatives of residents; ``(ii) registered professional nurses, licensed practical nurses (or licensed vocational nurses), certified nursing assistants, and other categories of direct care professionals (as determined by the Secretary) who work at such skilled nursing facilities or nursing facilities; ``(iii) collective bargaining units or unions that represent direct care workers or direct care professionals who work at such skilled nursing facilities and nursing facilities; ``(iv) operators of nursing facilities and skilled nursing facilities; ``(v) researchers with expertise in the nursing home and long-term care workforce, including the disclosure of funding sources for previously conducted research and conflicts of interest; and ``(vi) long-term care ombudsmen; and ``(B) address the following: ``(i) Whether the minimum staffing requirements established in sections 1819(b)(4)(C)(i)(II) and 1919(b)(4)(C)(i)(II) should be maintained or increased (but in no event decreased below a minimum staffing requirement of at least 3.48 hours per resident day), based on the severity of the health conditions, complexity of health care needs, or other measures of patient acuity of residents at such skilled nursing facilities and nursing facilities, and, if so, how such minimum staffing requirements shall be increased. ``(ii) Whether other minimum hours per resident day minimum staffing requirements should be established for other categories of direct care professionals or direct care workers in addition to the requirements established in sections 1819(b)(4)(C)(i)(II) and 1919(b)(4)(C)(i)(II). [[Page S1409]] ``(iii) A review of staffing, safety, and quality data, as well as staffing requirement exception data, to assess the adequacy of existing staffing practices in such nursing facilities and skilled nursing facilities. ``(b) Reports.-- ``(1) To the secretary.--The designated entity shall submit to the Secretary a report on the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the designated entity determines appropriate. ``(2) To congress.--Not later than 180 days after receiving each report under paragraph (1), the Secretary shall submit to Congress a report on-- ``(A) the findings and recommendations included in such report; and ``(B) any plan to implement such recommendations, including a justification for any recommendations the Secretary determines should not be implemented. ``(c) Regulations.-- ``(1) In general.--Not later than 1 year after the Secretary submits an initial report under subsection (b)(2), the Secretary shall-- ``(A) specify through regulations, consistent with such report, a minimum staffing requirement for nursing staff for skilled nursing facilities (as defined in section 1819(a)) and nursing facilities (as defined in section 1919(a)); and ``(B) require such skilled nursing facilities and such nursing facilities to comply with such staffing requirements, including by providing the minimum staffing sufficient to meet the needs of each resident in any such facility. ``(2) Update.--Not later than 1 year after the Secretary submits each subsequent report under subsection (b)(2), the Secretary shall, consistent with each such report, update the regulations described in paragraph (1)(A) as necessary. ``(d) Funding.--The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 to the Centers for Medicare & Medicaid Services Program Management Account, of $50,000,000 for fiscal year 2027 for purposes of carrying out this section. Amounts transferred pursuant to the previous sentence shall remain available until expended.''. (c) Rule of Construction.--The moratorium imposed under section 71111 of the Act titled ``An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14'' (Public Law 119-21) (relating to implementation of certain staffing standards for long-term care facilities under the Medicare and Medicaid programs) shall not be construed to apply to the amendments made by this section. SEC. 3. PERMANENT FUNDING FOR THE SURVEY AND CERTIFICATION PROGRAM FOR NURSING HOMES AND OTHER HEALTH CARE ENTITIES. Part A of Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after section 1150C the following new section: ``SEC. 1150D. FUNDING FOR THE SURVEY AND CERTIFICATION PROGRAM. ``There is appropriated to th

Referenced legislation: HCONRES14