[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3886 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
2d Session
S. 3886
To establish total nurse staffing hours per resident day, to require
24-hour use of registered professional nurses in nursing homes, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 12, 2026
Mr. Wyden (for himself, Mr. Kim, Mr. Booker, Ms. Warren, Mr. Lujan, Mr.
Murphy, and Mr. Blumenthal) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish total nurse staffing hours per resident day, to require
24-hour use of registered professional nurses in nursing homes, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
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).
``(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 the Secretary, out of the Federal
Hospital Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841 (in such
proportions as the Secretary determines to be appropriate),
$800,000,000 for fiscal year 2027 and each subsequent fiscal year for
the purpose of conducting the Secretary's Survey and Certification
Program, including under section 1864. Amounts appropriated under the
preceding sentence shall remain available until expended.''.
SEC. 4. INVESTING IN THE NURSING HOME WORKFORCE.
(a) Medicare.--Section 1819(h) of the Social Security Act (42
U.S.C. 1395i-3(h)) is amended--
(1) in paragraph (2)(B)(ii)(IV)(ff), by inserting ``,
provided that not less than half of such amounts are provided
to the State in which the facility is located for the purposes
described in paragraph (7),'' after ``collected may''; and
(2) by adding at the end the following new paragraph:
``(7) Use of civil money penalty amounts to support the
skilled nursing facility workforce.--
``(A) In general.--Subject to subparagraph (B), a
State shall use the amounts provided to such State
pursuant to paragraph (2)(B)(ii)(IV)(ff) for the fiscal
year in which such amounts are provided for the
following purposes:
``(i) Providing grants to entities such as
educational institutions, advocacy
organizations for skilled nursing facility
residents, senior citizens, or individuals with
disabilities, and unions that represent the
skilled nursing facility workforce to support
projects that use community-driven approaches
to recruit, educate, and train individuals to
expand the skilled nursing facility workforce.
``(ii) The funding of projects that develop
new career pathway programs for the skilled
nursing facility workforce.
``(iii) The repayment of student loans for
qualified skilled nursing facility providers
(as defined in subparagraph (C)) or the payment
of tuition for such providers who commit to
serving in a skilled nursing facility or a
nursing facility (as defined in section
1919(a)) for not less than 3 years within a 10-
year period.
``(B) Prohibitions on use of funds.--
``(i) Prohibition on providing funds to
entities related to facilities.--A State may
not provide any amounts provided to such State
pursuant to paragraph (2)(B)(ii)(IV)(ff) to an
entity that has a related party relationship
with a nursing facility or skilled nursing
facility in such State.
``(ii) Prohibition on using funds for
reimbursement of costs incurred in completing
nurse aide training and competency evaluation
programs and nurse aide competency evaluation
programs.--A State may not use any amounts
provided to such State pursuant to paragraph
(2)(B)(ii)(IV)(ff) to--
``(I) reimburse costs incurred in
completing a nurse aide training and
competency evaluation program or a
nurse aide competency evaluation
program under subsection (f)(2)(A); or
``(II) supplant the payment of such
costs under such subsection.
``(C) Definitions.--In this paragraph:
``(i) Qualified skilled nursing facility
provider.--The term `qualified skilled nursing
facility provider' means--
``(I) a geriatrician or other
physician, nurse practitioner,
physician assistant, or other
practitioner who provides services in a
skilled nursing facility or nursing
facility; or
``(II) a registered professional
nurse, a licensed practical nurse (or a
licensed vocational nurse), or a
certified nursing assistant who
provides direct care services to
residents in a skilled nursing facility
or nursing facility, as determined by
the Secretary.
``(ii) Related party.--The term `related
party' means an entity that, to a significant
extent is associated or affiliated with, or has
control of, or is controlled by, a nursing
facility or skilled nursing facility.
``(D) Annual reporting.--
``(i) Report from states.--Not later than 1
year after the date of enactment of this
paragraph, and annually thereafter, each State
that receives amounts pursuant to paragraph
(2)(B)(ii)(IV)(ff) shall submit to the
Secretary a report describing--
``(I) how amounts received in the
previous fiscal year were allocated;
``(II) the mechanisms to ensure
such amounts benefit the development of
the skilled nursing facility workforce;
``(III) how such amounts will
impact measurable outcomes for
residents of skilled nursing facilities
and nursing facilities, such as staff
vacancy rates, turnover rates, median
hourly wages, staffing hours per
resident, and resident quality
outcomes; and
``(IV) how such State is ensuring
compliance with subparagraph (B).
``(ii) Report to congress.--Not later than
180 days after the Secretary receives the
annual reports from States under clause (i),
the Secretary shall submit to Congress a report
describing the information contained in such
reports.''.
(b) Medicaid.--Section 1919(h) of the Social Security Act (42
U.S.C. 1396r(h)) is amended--
(1) in paragraph (2)(A)(ii)--
(A) in the second sentence, by striking ``Funds
collected'' and inserting ``Subject to the last
sentence of this clause, funds collected''; and
(B) by inserting the following sentence at the end:
``Not less than half of the funds collected pursuant to
this clause shall be used for the purposes described in
paragraph (10).'';
(2) in paragraph (3)(C)(ii)(IV)(ff), by inserting ``,
provided that not less than half of such amounts are provided
to the State in which the facility is located for the purposes
described in paragraph (10),''; and
(3) by adding at the end the following new paragraph:
``(10) Use of civil money penalty amounts to support the
nursing facility workforce.--
``(A) In general.--Subject to subparagraph (B), a
State shall use not less than half of the funds
collected under paragraph (2)(A)(ii) and the amounts
provided to such State pursuant to paragraph
(3)(C)(ii)(IV)(ff) (collectively referred to in this
paragraph as `civil money penalty amounts') for the
fiscal year in which such amounts are collected or
provided for the following activities:
``(i) Providing grants to entities such as
educational institutions, advocacy
organizations for nursing facility residents,
senior citizens, or individuals with
disabilities, and unions that represent the
nursing facility workforce to support projects
that use community-driven approaches to
recruit, educate, and train individuals to
expand the nursing facility workforce.
``(ii) The funding of projects that develop
new career pathway programs for the nursing
facility workforce.
``(iii) The repayment of student loans for
qualified nursing facility providers (as
defined in subparagraph (C)) or the payment of
tuition for such providers who commit to
serving in a skilled nursing facility (as
defined in section 1819(a)) or a nursing
facility for not less than 3 years within a 10-
year period.
``(B) Prohibition on use of funds.--
``(i) Prohibition on providing funds to
entities related to facilities.--A State may
not provide any civil money penalty amounts to
an entity that has a related party relationship
with a nursing facility or skilled nursing
facility in such State.
``(ii) Prohibition on using funds for
reimbursement of costs incurred in completing
nurse aide training and competency programs and
nurse aide competency evaluation programs.--A
State may not use any civil money penalty
amounts to--
``(I) reimburse costs incurred in
completing a nurse aid training and
competency evaluation program or a
nurse aide competency evaluation
program under subsection (f)(2)(A); or
``(II) supplant the payment of such
costs under such subsection.
``(C) Definitions.--In this paragraph:
``(i) Qualified nursing facility
provider.--The term `qualified nursing facility
provider' means--
``(I) a geriatrician or other
physician, nurse practitioner,
physician assistant, or other
practitioner who provides services in a
skilled nursing facility or nursing
facility; or
``(II) a registered professional
nurse, licensed practical nurse (or a
licensed vocational nurse), or
certified nursing assistant who
provides direct care services to
residents in a skilled nursing facility
or nursing facility, as determined by
the Secretary.
``(ii) Related party.--The term `related
party' means an entity that, to a significant
extent is associated or affiliated with, or has
control of, or is controlled by, a nursing
facility or skilled nursing facility.
``(D) Annual reporting.--
``(i) Report from states.--Not later than 1
year after the date of enactment of this
paragraph, and annually thereafter, each State
that receives any civil money penalty amounts
shall submit to the Secretary a report
describing--
``(I) how amounts received in the
previous fiscal year were allocated;
``(II) the mechanisms to ensure
such amounts benefit the development of
the nursing facility workforce;
``(III) how such amounts will
impact measurable outcomes for
residents of skilled nursing facilities
and nursing facilities, such as staff
vacancy rates, turnover rates, median
hourly wages, staffing hours per
resident, and resident quality
outcomes; and
``(IV) how such State is ensuring
compliance with subparagraph (B).
``(ii) Report to congress.--Not later than
180 days after the Secretary receives the
annual reports from States under clause (i),
the Secretary shall submit to Congress a report
describing the information contained in such
report.''.
SEC. 5. CODIFICATION OF REGULATIONS REGARDING REQUIREMENTS FOR LONG-
TERM SERVICES AND SUPPORTS AND PAYMENT TRANSPARENCY
REPORTING.
Sections 438.72 and 442.43 of title 42, Code of Federal Regulations
(as in effect on May 10, 2024), shall have the force and effect of law.
<all>
Nurses Belong in Nursing Homes Act
#3886 | S Congress #119
Policy Area: Health
Subjects:
Last Action: Read twice and referred to the Committee on Finance. (2/12/2026)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text