This bill significantly enhances nurse staffing requirements in skilled nursing facilities and nursing facilities participating in Medicare and Medicaid. It mandates a minimum of 3.48 hours of nursing care per resident day , provided by a combination of registered professional nurses, licensed practical nurses, or certified nursing assistants. This minimum can be increased based on future recommendations but cannot fall below the 3.48-hour threshold. A key provision requires nursing homes to provide 24-hour, 7-day-a-week services of a registered professional nurse , effective 180 days after the bill's enactment. The legislation also establishes a process for ongoing evaluation, requiring the Secretary to conduct studies every four years to analyze nurse staffing needs and recommend adjustments. Based on these studies, the Secretary must issue and update regulations to specify minimum staffing requirements. To support the nursing home workforce, the bill directs that at least half of the civil money penalties (CMPs) collected from facilities be used by states for workforce development initiatives. These funds can support various projects aimed at recruiting, educating, and training individuals for the skilled nursing facility workforce. This includes funding new career pathway programs and offering student loan repayment or tuition assistance for qualified providers. Qualified providers eligible for loan repayment or tuition assistance include physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, and certified nursing assistants who commit to serving in a nursing facility for at least three years within a ten-year period. However, these funds are explicitly prohibited from being given to entities with "related party" relationships to nursing facilities or used to reimburse costs for nurse aide training programs. States are required to report annually on the allocation and impact of these funds. Furthermore, the bill provides permanent annual funding of $800,000,000 for the Survey and Certification Program, starting in fiscal year 2027, to ensure robust oversight of nursing homes and other healthcare entities. This dedicated funding aims to strengthen the program's ability to monitor compliance and quality of care. Finally, it codifies specific federal regulations related to long-term services and supports and payment transparency reporting, giving them the force and effect of law.