; (iii) in subclause (I), by striking clause (ii) and inserting clause (iii) ; and (iv) in subclause (II), by striking clause (ii) and inserting clause (iii) ; (B) by redesignating clauses (ii) and (iii) as clauses (iii) and (iv), respectively; and (C) by inserting after clause (i) the following new clause: (ii) General requirements after 2019 (I) In general With respect to nursing facility services provided on or after January 1, 2020, a nursing facility must— (aa) provide nursing services that are sufficient to meet the nursing needs of its residents on a 24-hour basis, to be divided into day shifts, evening shifts, and night shifts; (bb) provide for minimum nurse staffing levels with respect to each such shift, in accordance with this clause; and (cc) ensure that, in carrying out items (aa) and (bb), a total minimum of 4.1 hours of care is provided per resident per day, with 0.75 hours of care of such total minimum provided by a registered professional nurse, 0.54 hours of care of such total minimum provided by a licensed practical nurse, and 2.81 hours of care of such total minimum provided by a nurse aide (as defined in paragraph (5)(F)). (II) Day shifts With respect to a day shift, the nursing facility must have— (aa) at least 1 registered professional nurse for every 28 residents, with a minimum of 0.29 hours of care provided per resident during each such shift; (bb) at least 1 licensed practical nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during each such shift; and (cc) at least 1 nurse aide (as defined in paragraph (5)(F)) for every 7 residents, with a minimum of 1.14 hours of care provided per resident during each such shift. (III) Evening shifts With respect to an evening shift, the nursing facility must have— (aa) at least 1 registered professional nurse for every 30 residents, with a minimum of 0.26 hours of care provided per resident during each such shift