[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5799 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 5799
To amend titles XVIII and XIX of the Social Security Act to improve the
transparency of information on skilled nursing facilities and nursing
facilities and to clarify and improve the targeting of the enforcement
of requirements with respect to such facilities.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 15, 2008
Ms. Eddie Bernice Johnson of Texas introduced the following bill; which
was referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to improve the
transparency of information on skilled nursing facilities and nursing
facilities and to clarify and improve the targeting of the enforcement
of requirements with respect to such facilities.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Nursing Home
Transparency and Improvement Act of 2008''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING
FACILITIES AND NURSING FACILITIES
Sec. 101. Required disclosure of ownership and affiliated parties
information.
Sec. 102. Accountability requirements.
Sec. 103. Nursing home compare Medicare website.
Sec. 104. Reporting of expenditures.
Sec. 105. Standardized complaint form.
Sec. 106. Ensuring staffing accountability.
TITLE II--TARGETING ENFORCEMENT
Sec. 201. Civil money penalties.
Sec. 202. GAO study and report on the relative financial status and
performance of special focus facilities.
Sec. 203. National independent monitor program.
Sec. 204. GAO studies and reports on temporary management and barriers
to purchasing facilities with a record of
poor care.
Sec. 205. Notification of facility closure.
Sec. 206. National demonstration projects on culture change and use of
information technology in nursing homes.
TITLE III--IMPROVING STAFF TRAINING
Sec. 301. Dementia and abuse prevention training.
Sec. 302. Study and report on training required for certified nurse
aides and supervisory staff.
TITLE I--IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING
FACILITIES AND NURSING FACILITIES
SEC. 101. REQUIRED DISCLOSURE OF OWNERSHIP AND AFFILIATED PARTIES
INFORMATION.
(a) Skilled Nursing Facilities.--Section 1819(d)(1) of the Social
Security Act (42 U.S.C. 1395i-3(d)(1)) is amended by adding at the end
the following new subparagraphs:
``(D) Availability of ownership and affiliated
parties information.--
``(i) In general.--Beginning on the date of
enactment of this subparagraph, a skilled
nursing facility must have the information
described in clause (ii) available for
submission to the Secretary, the Inspector
General of the Department of Health and Human
Services, the State, the State long-term care
ombudsman, a resident of a facility, and the
legal representative of such a resident or
other responsible party in the case where the
Secretary, the Inspector General, the State,
the State long-term care ombudsman, the
resident, or the legal representative or
responsible party requests such information
(and, beginning on the effective date of the
regulations promulgated under subparagraph
(E)(i), for reporting such information in
accordance with such regulations). The facility
shall certify to the Secretary and the
Inspector General of the Department of Health
and Human Services, as a condition of
participation and payment under the program
under this title, that the information
submitted upon such request is accurate and
current.
``(ii) Information described.--The
following information is described in this
clause:
``(I) The identity of individuals
with an ownership or control interest
(as defined in section 1124(a)(3)) in
the facility.
``(II) Information on the members
of the governing body of the skilled
nursing facility, including the names,
titles, and dates of service of such
members.
``(III) Information describing the
organizational structure of any
affiliated or related parties,
including principal officers and
directors of affiliated or related
companies, or members in the case of a
limited liability company.
To the extent that information reported by a
facility to the Internal Revenue Service on
Form 990, information submitted by a facility
to the Securities and Exchange Commission, or
information otherwise submitted to the
Secretary contains the information described in
subclauses (I), (II), and (III), the facility
may provide such Form or such information
submitted to meet the requirements of clause
(i) and subparagraph (E)(i).
``(iii) Definition of affiliated or related
parties.--In this subparagraph, the term
`affiliated or related parties' means companies
or individuals that serve as operators,
landlords, management companies or advisors,
real estate or consulting companies, members of
a limited liability company, administrative
services companies, lenders and companies
providing financial guarantees, captive or
affiliated liability insurance companies, and
such other entities as the Secretary determines
appropriate.
``(E) Reporting.--
``(i) In general.--Not later than 2 years
after the date of enactment of this
subparagraph, the Secretary shall promulgate
regulations requiring skilled nursing
facilities to report the information described
in clause (ii) of subparagraph (D) to the
Secretary in a standardized format, and such
other regulations as are necessary to carry out
such subparagraph. Such regulations shall
ensure that the facility certifies, as a
condition of participation and payment under
the program under this title, that the
information reported is accurate and current.
``(ii) Guidance.--The Secretary shall
provide guidance and technical assistance to
States on how to adopt the standardized format
under clause (i).''.
(b) Nursing Facilities.--Section 1919(d)(1) of the Social Security
Act (42 U.S.C. 1396r(d)(1)) is amended by adding at the end the
following new subparagraph:
``(D) Availability of ownership and affiliated
parties information.--
``(i) In general.--Beginning on the date of
enactment of this subparagraph, a nursing
facility must have the information described in
clause (ii) available for submission to the
Secretary, the Inspector General of the
Department of Health and Human Services, the
State, the State long-term care ombudsman, a
resident of a facility, and the legal
representative of such a resident or other
responsible party in the case where the
Secretary, the Inspector General, the State,
the State long-term care ombudsman, the
resident, or the legal representative or
responsible party requests such information
(and, beginning on the effective date of the
regulations promulgated under subparagraph
(E)(i), for reporting such information in
accordance with such regulations). The facility
shall certify to the Secretary and the
Inspector General of the Department of Health
and Human Services, as a condition of
participation and payment under the program
under this title, that the information
submitted upon such request is accurate and
current.
``(ii) Information described.--The
following information is described in this
clause:
``(I) The identity of individuals
with an ownership or control interest
(as defined in section 1124(a)(3)) in
the facility.
``(II) Information on the members
of the governing body of the nursing
facility, including the names, titles,
and dates of service of such members.
``(III) Information describing the
organizational structure of any
affiliated or related parties,
including principal officers and
directors of affiliated or related
companies, or members in the case of a
limited liability company.
To the extent that information reported by a
facility to the Internal Revenue Service on
Form 990, information submitted by a facility
to the Securities and Exchange Commission, or
information otherwise submitted to the
Secretary contains the information described in
subclauses (I), (II), and (III), the facility
may provide such Form or such information
submitted to meet the requirements of clause
(i) and subparagraph (E)(i).
``(iii) Definition of affiliated or related
parties.--In this subparagraph, the term
`affiliated or related parties' means companies
or individuals that serve as operators,
landlords, management companies or advisors,
real estate or consulting companies, members of
a limited liability company, administrative
services companies, lenders and companies
providing financial guarantees, captive or
affiliated liability insurance companies, and
such other entities as the Secretary determines
appropriate.
``(E) Reporting.--
``(i) In general.--Not later than 2 years
after the date of enactment of this
subparagraph, the Secretary shall promulgate
regulations requiring nursing facilities to
report the information described in clause (ii)
of subparagraph (D) to the Secretary in a
standardized format, and such other regulations
as are necessary to carry out such
subparagraph. Such regulations shall ensure
that the facility certifies, as a condition of
participation and payment under the program
under this title, that the information reported
is accurate and current.
``(ii) Guidance.--The Secretary shall
provide guidance and technical assistance to
States on how to adopt the standardized format
under clause (i).''.
SEC. 102. ACCOUNTABILITY REQUIREMENTS.
(a) Skilled Nursing Facilities.--Section 1819(d)(1) of the Social
Security Act (42 U.S.C. 1395i-3(d)(1)), as amended by section 101, is
amended by adding at the end the following new subparagraph:
``(F) Accountability requirements.--
``(i) In general.--On or after the date
that is 2 years after the date of enactment of
this subparagraph, any skilled nursing facility
or chain of such facilities must meet standards
for being an accountable entity by complying
with the criteria developed under clause (ii).
``(ii) Criteria.--Not later than the date
that is 2 years after such date of enactment,
the Secretary, in consultation with the General
Counsel of the Department of Health and Human
Services and the Inspector General of the
Department of Health and Human Services, shall
develop criteria to define accountability
requirements applicable to facilities and
chains of such facilities. Such criteria
shall--
``(I) include standards for
submission of annual independent audits
for facilities that are part of a group
under common ownership or control,
whether publicly or privately held and
which have annual revenues of
$50,000,000 or more in the aggregate as
a group; and
``(II) require new owners of a
facility to provide proof of financial
ability to operate the facility,
including documentation of projected
revenue and expenses for the first 12
months of operation of the facility.
``(iii) Rule of construction.--The criteria
developed under clause (ii), and any
requirements to submit information under such
criteria, shall be in addition to any
information the Secretary otherwise requires
providers to submit on the ownership and
operation of skilled nursing facilities
(including information required to be submitted
or reported under subparagraph (D) or (E)).''.
(b) Nursing Facilities.--Section 1919(d)(1) of the Social Security
Act (42 U.S.C. 1396r(d)(1)), as amended by section 101, is amended by
adding at the end the following new subparagraph:
``(F) Accountability requirements.--
``(i) In general.--On or after the date
that is 2 years after the date of enactment of
this subparagraph, any nursing facility or
chain of such facilities must meet standards
for being an accountable entity by complying
with the criteria developed under clause (ii).
``(ii) Criteria.--Not later than the date
that is 2 years after such date of enactment,
the Secretary, in consultation with the General
Counsel of the Department of Health and Human
Services and the Inspector General of the
Department of Health and Human Services, shall
develop criteria to define accountability
requirements applicable to facilities and
chains of such facilities. Such criteria
shall--
``(I) include standards for
submission of annual independent audits
for facilities that are part of a group
under common ownership or control,
whether publicly or privately held and
which have annual revenues of
$50,000,000 or more in the aggregate as
a group; and
``(II) require new owners of a
facility to provide proof of financial
ability to operate the facility,
including documentation of projected
revenue and expenses for the first 12
months of operation of the facility.
``(iii) Rule of construction.--The criteria
developed under clause (ii), and any
requirements to submit information under such
criteria, shall be in addition to any
information the Secretary otherwise requires
providers to submit on the ownership and
operation of nursing facilities (including
information required to be submitted or
reported under subparagraph (D) or (E)).''.
SEC. 103. NURSING HOME COMPARE MEDICARE WEBSITE.
(a) Skilled Nursing Facilities.--
(1) In general.--Section 1819 of the Social Security Act
(42 U.S.C. 1395i-3) is amended--
(A) by redesignating subsection (i) as subsection
(j); and
(B) by inserting after subsection (h) the following
new subsection:
``(i) Nursing Home Compare Website.--
``(1) Inclusion of additional information.--
``(A) In general.--The Secretary shall ensure that
the Department of Health and Human Services includes,
as part of the information provided for comparison of
nursing homes on the official Internet website of the
Federal Government for Medicare beneficiaries (commonly
referred to as the `Nursing Home Compare' Medicare
website) (or a successor website), the following
information in a manner that is prominent, easily
accessible, readily understandable to consumers of
long-term care services, and searchable:
``(i) Information that is reported to the
Secretary under subparagraph (E) of subsection
(d)(1) and information submitted with respect
to accountability requirements applicable to
facilities and chains of facilities under
subparagraph (F) of such subsection.
``(ii) Information on the `Special Focus
Facility program' (or a successor program)
established by the Centers for Medicare &
Medicaid Services, according to procedures
established by the Secretary. Such procedures
shall provide for the inclusion of information
with respect to, and the names and locations
of, those facilities that--
``(I) have been enrolled in the
program;
``(II) are enrolled in the program
and have failed to make significant
progress within 18 months after such
enrollment; and
``(III) have closed voluntarily or
whose participation under this title
has been terminated by the Secretary.
``(iii) Staffing data for each facility
(including resident census data and data on the
hours of care provided per resident per day)
based on data submitted under subsection
(b)(8)(C)(ii), including information on
staffing turnover and tenure, in a format that
is clearly understandable to consumers of long-
term care services and allows such consumers to
compare differences in staffing between
facilities.
``(iv) Links to State Internet websites
with information regarding State survey and
certification programs, links to Form 2567
State inspection reports (or a successor form)
on such websites, information to guide
consumers in how to interpret and understand
such reports, and the facility plan of
correction or other response to such report.
``(v) The standardized complaint form
developed under subsection (f)(8), including
explanatory material on what complaint forms
are, how they are used, and how to file a
complaint with the State survey and
certification program and the State long-term
care ombudsman program.
``(vi) A summary of information on
enforcement that includes remedies proposed and
imposed by the Secretary with respect to a
skilled nursing facility during the preceding 3
years.
``(B) Deadline for provision of information.--
``(i) In general.--Except as provided in
clause (ii), the Secretary shall ensure that
the information described in subparagraph (A)
is included on such website (or a successor
website) not later than 1 year after the date
of enactment of this subsection.
``(ii) Exceptions.--
``(I) Ownership and affiliated
parties and accountability requirements
information.--The Secretary shall
ensure that the information described
in subparagraph (A)(i) is included on
such website (or a successor website)
not later than the date on which the
requirements under subparagraphs (E)
and (F), respectively, of subsection
(d)(1) are implemented.
``(II) Staffing data.--The
Secretary shall ensure that the
information described in subparagraph
(A)(iii) is included on such website
(or a successor website) not later than
the date on which the requirement under
subsection (b)(8)(C)(ii) is
implemented.
``(2) Review and modification of website.--
``(A) In general.--The Secretary shall establish a
process--
``(i) to review the accuracy, clarity of
presentation, timeliness, and comprehensiveness
of information reported on such website as of
the day before the date of enactment of this
subsection; and
``(ii) not later than 1 year after the date
of enactment of this subsection, to modify or
revamp such website in accordance with the
review conducted under clause (i).
``(B) Consultation.--In conducting the review under
subparagraph (A)(i), the Secretary shall consult with--
``(i) State long-term care ombudsman
programs;
``(ii) consumer advocacy groups;
``(iii) provider stakeholder groups; and
``(iv) any other representatives of
programs or groups the Secretary determines
appropriate.''.
(2) Timeliness of submission of survey and certification
information.--
(A) In general.--Section 1819(g)(5) of the Social
Security Act (42 U.S.C. 1395i-3(g)(5)) is amended by
adding at the end the following new subparagraph:
``(E) Submission of survey and certification
information to the secretary.--In order to improve the
timeliness of information made available to the public
under subparagraph (A) and provided on the Nursing Home
Compare Medicare website under subsection (i), each
State shall submit information respecting any survey or
certification made respecting a skilled nursing
facility (including any enforcement actions taken by
the State) to the Secretary not later than the date on
which the State sends such information to the facility.
The Secretary shall use the information submitted under
the preceding sentence to update the information
provided on the Nursing Home Compare Medicare website
as expeditiously as practicable.''.
(B) Effective date.--The amendment made by this
paragraph shall take effect 1 year after the date of
enactment of this Act.
(b) Nursing Facilities.--
(1) In general.--Section 1919 of the Social Security Act
(42 U.S.C. 1396r) is amended--
(A) by redesignating subsection (i) as subsection
(j); and
(B) by inserting after subsection (h) the following
new subsection:
``(i) Nursing Home Compare Website.--
``(1) Inclusion of additional information.--
``(A) In general.--The Secretary shall ensure that
the Department of Health and Human Services includes,
as part of the information provided for comparison of
nursing homes on the official Internet website of the
Federal Government for Medicare beneficiaries (commonly
referred to as the `Nursing Home Compare' Medicare
website) (or a successor website), the following
information in a manner that is prominent, easily
accessible, readily understandable to consumers of
long-term care services, and searchable:
``(i) Information that is reported to the
Secretary under subparagraph (E) of subsection
(d)(1) and information submitted with respect
to accountability requirements applicable to
facilities and chains of facilities under
subparagraph (F) of such subsection.
``(ii) Information on the `Special Focus
Facility program' (or a successor program)
established by the Centers for Medicare &
Medicaid Services, according to procedures
established by the Secretary. Such procedures
shall provide for the inclusion of information
with respect to, and the names and locations
of, those facilities that--
``(I) have been enrolled in the
program;
``(II) are enrolled in the program
and have failed to make significant
progress within 18 months after such
enrollment; and
``(III) have closed voluntarily or
whose participation under this title
has been terminated by the Secretary.
``(iii) Staffing data for each facility
(including resident census data and data on the
hours of care provided per resident per day)
based on data submitted under subsection
(b)(8)(C)(ii), including information on
staffing turnover and tenure, in a format that
is clearly understandable to consumers of long-
term care services and allows such consumers to
compare differences in staffing between
facilities.
``(iv) Links to State Internet websites
with information regarding State survey and
certification programs, links to Form 2567
State inspection reports (or a successor form)
on such websites, information to guide
consumers in how to interpret and understand
such reports, and the facility plan of
correction or other response to such report.
``(v) The standardized complaint form
developed under subsection (f)(10), including
explanatory material on what complaint forms
are, how they are used, and how to file a
complaint with the State survey and
certification program and the State long-term
care ombudsman program.
``(vi) A summary of information on
enforcement that includes remedies proposed and
imposed by the Secretary or a State with
respect to a nursing facility during the
preceding 3 years.
``(B) Deadline for provision of information.--
``(i) In general.--Except as provided in
clause (ii), the Secretary shall ensure that
the information described in subparagraph (A)
is included on such website (or a successor
website) not later than 1 year after the date
of enactment of this subsection.
``(ii) Exceptions.--
``(I) Ownership and affiliated
parties and accountability requirements
information.--The Secretary shall
ensure that the information described
in subparagraph (A)(i) is included on
such website (or a successor website)
not later than the date on which the
requirements under subparagraph (E) and
(F), respectively, of subsection (d)(1)
are implemented.
``(II) Staffing data.--The
Secretary shall ensure that the
information described in subparagraph
(A)(iii) is included on such website
(or a successor website) not later than
the date on which the requirement under
subsection (b)(8)(C)(ii) is
implemented.
``(2) Review and modification of website.--
``(A) In general.--The Secretary shall establish a
process--
``(i) to review the accuracy, clarity of
presentation, timeliness, and comprehensiveness
of information reported on such website as of
the day before the date of enactment of this
subsection; and
``(ii) not later than 1 year after the date
of enactment of this subsection, to modify or
revamp such website in accordance with the
review conducted under clause (i).
``(B) Consultation.--In conducting the review under
subparagraph (A)(i), the Secretary shall consult with--
``(i) State long-term care ombudsman
programs;
``(ii) consumer advocacy groups;
``(iii) provider stakeholder groups; and
``(iv) any other representatives of
programs or groups the Secretary determines
appropriate.''.
(2) Timeliness of submission of survey and certification
information.--
(A) In general.--Section 1919(g)(5) of the Social
Security Act (42 U.S.C. 1396r(g)(5)) is amended by
adding at the end the following new subparagraph:
``(E) Submission of survey and certification
information to the secretary.--In order to improve the
timeliness of information made available to the public
under subparagraph (A) and provided on the Nursing Home
Compare Medicare website under subsection (i), each
State shall submit information respecting any survey or
certification made respecting a nursing facility
(including any enforcement actions taken by the State)
to the Secretary not later than the date on which the
State sends such information to the facility. The
Secretary shall use the information submitted under the
preceding sentence to update the information provided
on the Nursing Home Compare Medicare website as
expeditiously as practicable.''.
(B) Effective date.--The amendment made by this
paragraph shall take effect 1 year after the date of
enactment of this Act.
(c) Availability of Reports on Surveys, Certifications, and
Complaint Investigations.--
(1) Skilled nursing facilities.--Section 1819(d)(1) of the
Social Security Act (42 U.S.C. 1395i-3(d)(1)), as amended by
section 102, is amended by adding at the end the following new
subparagraph:
``(G) Availability of survey, certification, and
complaint investigation reports.--A skilled nursing
facility must--
``(i) have reports with respect to any
surveys, certifications, and complaint
investigations made respecting the facility
during the 3 preceding years available for any
individual to review upon request; and
``(ii) post notice of the availability of
such reports in areas of the facility that are
prominent and accessible to the public.''.
(2) Nursing facilities.--Section 1919(d)(1) of the Social
Security Act (42 U.S.C. 1396r(d)(1)), as amended by section
102, is amended by adding at the end the following new
subparagraph:
``(G) Availability of survey, certification, and
complaint investigation reports.--A nursing facility
must--
``(i) have reports with respect to any
surveys, certifications, and complaint
investigations made respecting the facility
during the 3 preceding years available for any
individual to review upon request; and
``(ii) post notice of the availability of
such reports in areas of the facility that are
prominent and accessible to the public.''.
(3) Effective date.--The amendments made by this subsection
shall take effect 1 year after the date of enactment of this
Act.
(d) Guidance to States on Form 2567 State Inspection Reports and
Complaint Investigation Reports.--
(1) Guidance.--The Secretary shall provide guidance to
States on how States can establish electronic links to Form
2567 State inspection reports (or a successor form), complaint
investigation reports, and a facility's plan of correction or
other response to such Form 2567 State inspection reports (or a
successor form) on the Internet website of the State that
provides information on skilled nursing facilities and nursing
facilities.
(2) Definitions.--In this subsection:
(A) Nursing facility.--The term ``nursing
facility'' has the meaning given such term in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).
(B) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(C) Skilled nursing facility.--The term ``skilled
nursing facility'' has the meaning given such term in
section 1819(a) of the Social Security Act (42 U.S.C.
1395i-3(a)).
SEC. 104. REPORTING OF EXPENDITURES.
Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is
amended by adding at the end the following new subsection:
``(f) Reporting of Expenditures.--
``(1) In general.--For cost reports submitted for cost
reporting periods beginning on or after the date that is 1 year
after the date of enactment of this subsection, skilled nursing
facilities shall separately report expenditures for wages and
benefits for nursing staff (by staff level, breaking out (at a
minimum) registered nurses, licensed professional nurses, and
certified nurse assistants).
``(2) Modification of form.--The Secretary, in consultation
with private sector accountants experienced with Medicare and
Medicaid nursing facility home cost reports, shall redesign
such reports to meet the requirement of paragraph (1).
``(3) Categorization.--The Secretary, working in
consultation with the Medicare Payment Advisory Commission, the
Inspector General of the Department of Health and Human
Services, and other expert parties the Secretary determines
appropriate, shall take the expenditures listed on cost reports
submitted by skilled nursing facilities and categorize such
expenditures into the following categories on an annual basis:
``(A) Spending on direct care services (including
nursing, therapy, and non-ancillary therapy services).
``(B) Spending on indirect care (including
housekeeping, dietary, and other related services).
``(C) Capital costs (including building and land
costs).
``(D) Administrative costs.
``(4) Availability of information submitted.--The Secretary
shall establish procedures to make information on expenditures
submitted under this subsection readily available to interested
parties upon request, subject to such requirements as the
Secretary may specify under the procedures established under
this paragraph.''.
SEC. 105. STANDARDIZED COMPLAINT FORM.
(a) Skilled Nursing Facilities.--
(1) Development by the secretary.--Section 1819(f) of the
Social Security Act (42 U.S.C. 1395i-3(f)) is amended by adding
at the end the following new paragraph:
``(8) Standardized complaint form.--The Secretary shall
develop a standardized complaint form for use by a resident (or
a person acting on the resident's behalf) in filing a complaint
with a State survey and certification agency and a State long-
term care ombudsman program with respect to a skilled nursing
facility.''.
(2) State requirements.--Section 1819(e) of the Social
Security Act (42 U.S.C. 1395i-3(e)) is amended by adding at the
end the following new paragraph:
``(6) Complaint forms and resolution processes.--
``(A) Complaint forms.--The State must make the
standardized complaint form developed under subsection
(f)(8) available upon request to--
``(i) a resident of a skilled nursing
facility; and
``(ii) any person acting on the resident's
behalf.
``(B) Complaint resolution process.--The State must
establish a complaint resolution process in order to
ensure that the legal representative of a resident of a
skilled nursing facility or other responsible party is
not denied access to such resident or otherwise
retaliated against if they have complained about the
quality of care provided by the facility or other
issues relating to the facility. Such complaint
resolution process shall include--
``(i) procedures to assure accurate
tracking of complaints received, including
notification to the complainant that a
complaint has been received;
``(ii) procedures to determine the likely
severity of a complaint and for the
investigation of the complaint; and
``(iii) deadlines for responding to a
complaint and for notifying the complainant of
the outcome of the investigation.
``(C) Rule of construction.--Nothing in this
paragraph shall be construed as preventing a resident
of a skilled nursing facility (or a person acting on
the resident's behalf) from submitting a complaint in a
manner or format other than by using the standardized
complaint form developed under subsection (f)(8)
(including submitting a complaint orally).''.
(b) Nursing Facilities.--
(1) Development by the secretary.--Section 1919(f) of the
Social Security Act (42 U.S.C. 1395i-3(f)) is amended by adding
at the end the following new paragraph:
``(10) Standardized complaint form.--The Secretary shall
develop a standardized complaint form for use by a resident (or
a person acting on the resident's behalf) in filing a complaint
with a State survey and certification agency and a State long-
term care ombudsman program with respect to a nursing
facility.''.
(2) State requirements.--Section 1919(e) of the Social
Security Act (42 U.S.C. 1395i-3(e)) is amended by adding at the
end the following new paragraph:
``(8) Complaint forms and resolution processes.--
``(A) Complaint forms.--The State must make the
standardized complaint form developed under subsection
(f)(10) available upon request to--
``(i) a resident of a nursing facility; and
``(ii) any person acting on the resident's
behalf.
``(B) Complaint resolution process.--The State must
establish a complaint resolution process in order to
ensure that the legal representative of a resident of a
nursing facility or other responsible party is not
denied access to such resident or otherwise retaliated
against if they have complained about the quality of
care provided by the facility or other issues relating
to the facility. Such complaint resolution process
shall include--
``(i) procedures to assure accurate
tracking of complaints received, including
notification to the complainant that a
complaint has been received;
``(ii) procedures to determine the likely
severity of a complaint and for the
investigation of the complaint; and
``(iii) deadlines for responding to a
complaint and for notifying the complainant of
the outcome of the investigation.
``(C) Rule of construction.--Nothing in this
paragraph shall be construed as preventing a resident
of a nursing facility (or a person acting on the
resident's behalf) from submitting a complaint in a
manner or format other than by using the standardized
complaint form developed under subsection (f)(10)
(including submitting a complaint orally).''.
(c) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 106. ENSURING STAFFING ACCOUNTABILITY.
(a) Skilled Nursing Facilities.--Section 1819(b)(8) of the Social
Security Act (42 U.S.C. 1395i-3(b)(8)) is amended by adding at the end
the following new subparagraph:
``(C) Submission of staffing information based on
payroll data in a uniform format.--
``(i) Design phase.--
``(I) In general.--The Secretary
shall establish a program for skilled
nursing facilities to report staffing
information (including information with
respect to agency and contract staff)
based on payroll data. Such program
shall be conducted for a 1-year period
beginning on the date of enactment of
this subparagraph.
``(II) Report.--Not later than 6
months after the completion of the
program established under subclause
(I), the Secretary shall submit a
report to Congress containing the
results of the program.
``(ii) Submission of staffing
information.--Beginning not later than 1 year
after the completion of the program established
under clause (i)(I), the Secretary shall
require a skilled nursing facility to
electronically submit to the Secretary nurse
staffing information (including information
with respect to agency and contract staff)
based on payroll data in a uniform format
(according to specifications established by the
Secretary). Such specifications shall require
that the information submitted under the
preceding sentence--
``(I) specify the category of work
a certified employee performs (such as
whether the employee is a registered
nurse, licensed practical nurse,
licensed vocational nurse, or certified
nursing assistant);
``(II) include resident census
data;
``(III) include a regular reporting
schedule; and
``(IV) include information on
employee turnover and tenure and on the
hours of care provided by each category
of certified employees referenced in
subclause (I) per resident per day.''
(b) Nursing Facilities.--Section 1919(b)(8) of the Social Security
Act (42 U.S.C. 1396r(b)(8)) is amended by adding at the end the
following new subparagraph:
``(C) Submission of staffing information based on
payroll data in a uniform format.--
``(i) Design phase.--
``(I) In general.--The Secretary
shall establish a program for nursing
facilities to report staffing
information (including information with
respect to agency and contract staff)
based on payroll data. Such program
shall be conducted for a 1-year period
beginning on the date of enactment of
this subparagraph.
``(II) Report.--Not later than 6
months after the completion of the
program established under subclause
(I), the Secretary shall submit a
report to Congress containing the
results of the program.
``(ii) Submission of staffing
information.--Beginning not later than 1 year
after the completion of the program established
under clause (i)(I), the Secretary shall
require a nursing facility to electronically
submit to the Secretary nurse staffing
information (including information with respect
to agency and contract staff) based on payroll
data in a uniform format (according to
specifications established by the Secretary).
Such specifications shall require that the
information submitted under the preceding
sentence--
``(I) specify the category of work
a certified employee performs (such as
whether the employee is a registered
nurse, licensed practical nurse,
licensed vocational nurse, or certified
nursing assistant);
``(II) include resident census
data;
``(III) include a regular reporting
schedule; and
``(IV) include information on
employee turnover and tenure and on the
hours of care provided by each category
of certified employees referenced in
subclause (I) per resident per day.''
TITLE II--TARGETING ENFORCEMENT
SEC. 201. CIVIL MONEY PENALTIES.
(a) Skilled Nursing Facilities.--
(1) In general.--Section 1819(h)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395i-3(h)(2)(B)(ii)) is amended to
read as follows:
``(ii) Authority with respect to civil
money penalties.--
``(I) Amount.--Subject to subclause
(III), the Secretary may impose a civil
money penalty in the applicable amount
(as defined in subclause (II)) for each
day or each instance of noncompliance
(as determined appropriate by the
Secretary).
``(II) Applicable amount.--In this
clause, the term `applicable amount'
means--
``(aa) in the case where
the deficiency results in the
death of a resident of the
facility, an amount not to
exceed $100,000;
``(bb) in the case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,000 and not
more than $25,000; and
``(cc) in the case of any
other deficiency, an amount not
to exceed $3,000.
``(III) Reduction of civil money
penalties in certain circumstances.--
Subject to subclause (IV), in the case
where a facility self-reports and
promptly corrects a deficiency for
which a penalty was imposed under this
clause not later than 10 calendar days
after the date of such imposition, the
Secretary may reduce the amount of the
penalty imposed by not more than 50
percent.
``(IV) Prohibitions on reduction
for certain deficiencies.--
``(aa) Repeat
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (III)
if the Secretary had reduced a
penalty imposed on the facility
in the preceding year under
such subclause with respect to
a repeat deficiency.
``(bb) Certain other
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (III)
if the penalty is imposed for a
deficiency described in
subclause (II)(bb) and the
actual harm is found to result
in a pattern of harm or
widespread harm that
immediately jeopardizes the
health or safety of a resident
or residents of the facility,
or if the penalty is imposed
for a deficiency described in
subclause (II)(aa).
``(V) Collection of civil money
penalties.--In the case of a civil
money penalty imposed under this clause
for a deficiency described in item (aa)
or (bb) of subclause (II), the
Secretary--
``(aa) subject to item
(bb), shall provide the
opportunity for the facility to
participate in an informal
dispute resolution process
prior to the collection of such
penalty;
``(bb) may provide for the
collection of such civil money
penalty and the placement of
such amounts collected in an
escrow account on the earlier
of the date on which the
informal dispute resolution
process under item (aa) is
completed or the date that is
90 days after the date of the
imposition of the penalty;
``(cc) may provide that
such amounts collected are kept
in such account pending the
resolution of any appeals;
``(dd) in the case where
the facility successfully
appeals the penalty, may
provide for the return of such
amounts collected (plus
interest) to the facility; and
``(ee) in the case where
all such appeals are
unsuccessful, may provide that
some portion of such amounts
collected may be used to
support activities that benefit
residents, including assistance
to support and protect
residents who reside in a
facility that closes
(voluntarily or involuntarily)
or is decertified (including
offsetting costs of relocating
residents to home and
community-based settings or
another facility), and projects
that support resident and
family councils and other
consumer involvement in
assuring quality care in
facilities.
``(VI) Procedure.--The provisions
of section 1128A (other than
subsections (a) and (b) and except to
the extent that such provisions require
a hearing prior to the imposition of a
civil money penalty in the case
described in subclause (V)) shall apply
to a civil money penalty under this
clause in the same manner as such
provisions apply to a penalty or
proceeding under section 1128A(a).''.
(2) Conforming amendment.--The second sentence of section
1819(h)(5) of the Social Security Act (42 U.S.C. 1395i-3(h)(5))
is amended by inserting ``(ii)(V),'' after ``(i),''.
(b) Nursing Facilities.--
(1) Penalties imposed by the state.--
(A) In general.--Section 1919(h)(2) of the Social
Security Act (42 U.S.C. 1396r(h)(2)) is amended--
(i) in subparagraph (A)(ii), by striking
the first sentence and inserting the following:
``A civil money penalty in accordance with
subparagraph (G).''; and
(ii) by adding at the end the following new
subparagraph:
``(G) Civil money penalties.--
``(i) In general.--Subject to clause (iii),
the State may impose a civil money penalty
under subparagraph (A)(ii) in the applicable
amount for each day or each instance of
noncompliance (as determined appropriate by the
State).
``(ii) Definition of applicable amount.--In
this subparagraph, the term `applicable amount'
means--
``(I) in the case where the
deficiency results in the death of a
resident of the facility, an amount not
to exceed $100,000;
``(II) in the case of a deficiency
where the facility is cited for actual
harm or immediate jeopardy, an amount
not less than $3,000 and not more than
$25,000; and
``(III) in the case of any other
deficiency, an amount not to exceed
$3,000.
``(iii) Reduction of civil money penalties
in certain circumstances.--Subject to clause
(iv), in the case where a facility self-reports
and promptly corrects a deficiency for which a
penalty was imposed under subparagraph (A)(ii)
not later than 10 calendar days after the date
of such imposition, the State may reduce the
amount of the penalty imposed by not more than
50 percent.
``(iv) Prohibition on reduction for certain
deficiencies.--
``(I) Repeat deficiencies.--The
State may not reduce the amount of a
penalty under clause (iii) if the State
had reduced a penalty imposed on the
facility in the preceding year under
such clause with respect to a repeat
deficiency.
``(II) Certain other
deficiencies.--The State may not reduce
the amount of a penalty under clause
(iii) if the penalty is imposed for a
deficiency described in clause (ii)(II)
and the actual harm is found to result
in a pattern of harm or widespread harm
that immediately jeopardizes the health
or safety of a resident or residents of
the facility, or if the penalty is
imposed for a deficiency described in
clause (ii)(I).
``(v) Collection of civil money
penalties.--In the case of a civil money
penalty imposed under subparagraph (A)(ii) for
a deficiency described in subclause (I) or (II)
of clause (ii), the State--
``(I) subject to subclause (II),
shall provide the opportunity for the
facility to participate in an informal
dispute resolution process prior to the
collection of such penalty;
``(II) may provide for the
collection of such civil money penalty
and the placement of such amounts
collected in an escrow account on the
earlier of the date on which the
informal dispute resolution process
under subclause (I) is completed or the
date that is 90 days after the date of
the imposition of the penalty;
``(III) may provide that such
amounts collected are kept in such
account pending the resolution of any
appeals;
``(IV) in the case where the
facility successfully appeals the
penalty, may provide for the return of
such amounts collected (plus interest)
to the facility; and
``(V) in the case where all such
appeals are unsuccessful, may provide
that such funds collected shall be used
for the purposes described in the
second sentence of subparagraph
(A)(ii).''.
(B) Conforming amendment.--The second sentence of
section 1919(h)(2)(A)(ii) is amended by inserting ``,
and some portion of such funds may be used to support
activities that benefit residents, including assistance
to support and protect residents who reside in a
facility that closes (voluntarily or involuntarily) or
is decertified (including offsetting costs of
relocating residents to home and community-based
settings or another facility), and projects that
support resident and family councils and other consumer
involvement in assuring quality care in facilities''
before the period at the end.
(2) Penalties imposed by the secretary.--
(A) In general.--Section 1919(h)(3)(C)(ii) of the
Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is
amended to read as follows:
``(ii) Authority with respect to civil
money penalties.--
``(I) Amount.--Subject to subclause
(III), the Secretary may impose a civil
money penalty in the applicable amount
(as defined in subclause (II)) for each
day or each instance of noncompliance
(as determined appropriate by the
Secretary).
``(II) Applicable amount.--In this
clause, the term `applicable amount'
means--
``(aa) in the case where
the deficiency results in the
death of a resident of the
facility, an amount not to
exceed $100,000;
``(bb) in the case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,000 and not
more than $25,000; and
``(cc) in the case of any
other deficiency, an amount not
to exceed $3,000.
``(III) Reduction of civil money
penalties in certain circumstances.--
Subject to subclause (IV), in the case
where a facility self-reports and
promptly corrects a deficiency for
which a penalty was imposed under this
clause not later than 10 calendar days
after the date of such imposition, the
Secretary may reduce the amount of the
penalty imposed by not more than 50
percent.
``(IV) Prohibitions on reduction
for certain deficiencies.--
``(aa) Repeat
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (III)
if the Secretary had reduced a
penalty imposed on the facility
in the preceding year under
such subclause with respect to
a repeat deficiency.
``(bb) Certain other
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (III)
if the penalty is imposed for a
deficiency described in
subclause (II)(bb) and the
actual harm is found to result
in a pattern of harm or
widespread harm that
immediately jeopardizes the
health or safety of a resident
or residents of the facility,
or if the penalty is imposed
for a deficiency described in
subclause (II)(aa).
``(V) Collection of civil money
penalties.--In the case of a civil
money penalty imposed under this clause
for a deficiency described in item (aa)
or (bb) of subclause (II), the
Secretary--
``(aa) subject to item
(bb), shall provide the
opportunity for the facility to
participate in an informal
dispute resolution process
prior to the collection of such
penalty;
``(bb) may provide for the
collection of such civil money
penalty and the placement of
such amounts collected in an
escrow account on the earlier
of the date on which the
informal dispute resolution
process under item (aa) is
completed or the date that is
90 days after the date of the
imposition of the penalty;
``(cc) may provide that
such amounts collected are kept
in such account pending the
resolution of any appeals;
``(dd) in the case where
the facility successfully
appeals the penalty, may
provide for the return of such
amounts collected (plus
interest) to the facility; and
``(ee) in the case where
all such appeals are
unsuccessful, may provide that
some portion of such amounts
collected may be used to
support activities that benefit
residents, including assistance
to support and protect
residents who reside in a
facility that closes
(voluntarily or involuntarily)
or is decertified (including
offsetting costs of relocating
residents to home and
community-based settings or
another facility), and projects
that support resident and
family councils and other
consumer involvement in
assuring quality care in
facilities.
``(VI) Procedure.--The provisions
of section 1128A (other than
subsections (a) and (b) and except to
the extent that such provisions require
a hearing prior to the imposition of a
civil money penalty in the case
described in subclause (V)) shall apply
to a civil money penalty under this
clause in the same manner as such
provisions apply to a penalty or
proceeding under section 1128A(a).''.
(B) Conforming amendment.--Section 1919(h)(5)(8) of
the Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is
amended by inserting ``(ii)(V),'' after ``(i),''.
(c) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 202. GAO STUDY AND REPORT ON THE RELATIVE FINANCIAL STATUS AND
PERFORMANCE OF SPECIAL FOCUS FACILITIES.
(a) Study.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on the financial status, resident
care, and performance of skilled nursing facilities and nursing
facilities in the Special Focus Facility program (or a
successor program) established by the Centers for Medicare &
Medicaid Services relative to a comparable sample of facilities
that are not in such program. Such study shall include an
examination of the ownership and control interests, and any
affiliated parties, of the facilities studied (as applicable).
(2) Definitions.--In this section:
(A) Nursing facility.--The term ``nursing
facility'' has the meaning given such term in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).
(B) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(C) Skilled nursing facility.--The term ``skilled
nursing facility'' has the meaning given such term in
section 1819(a) of the Social Security Act (42 U.S.C.
1395(a)).
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Comptroller General of the United States shall submit a
report to Congress and the Secretary containing the results of the
study conducted under subsection (a), together with recommendations for
such legislation and administrative action as the Comptroller General
determines appropriate.
SEC. 203. NATIONAL INDEPENDENT MONITOR PROGRAM.
(a) Skilled Nursing Facilities.--Section 1819(h) of the Social
Security Act (42 U.S.C. 1395i-3(h)(2) is amended--
(1) by redesignating paragraphs (5) and (6) as paragraphs
(6) and (7), respectively; and
(2) by inserting after paragraph (4) the following new
paragraph:
``(5) National independent monitor program.--
``(A) In general.--Not later than 1 year after the
date of enactment of this paragraph, the Secretary, in
consultation with the Inspector General of the
Department of Health and Human Services, shall develop,
test, and implement a protocol for the establishment of
an independent monitoring program to oversee interstate
and large intrastate chains of skilled nursing
facilities. Such program shall be designed to analyze
such chains in 1 or more of the following instances:
``(i) Where 3 or more facilities of the
chain were enrolled in the `Special Focus
Facility program' (or a successor program)
established by the Centers for Medicare &
Medicaid Services during the preceding 3 years.
``(ii) Where the chain has been
experiencing financial problems that may be
linked to serious quality deficiencies.
``(iii) Where the chain has a record of
chronic poor performance.
``(B) Responsibilities.--The independent monitoring
program established under subparagraph (A) shall
include the following responsibilities:
``(i) Conducting periodic reviews and
preparing root-cause quality and deficiency
analyses of a chain described in such
subparagraph to assess compliance by the chain
with State and Federal laws and regulations.
``(ii) Conducting oversight of efforts by
such a chain, whether publicly or privately
held, to achieve compliance with State and
Federal laws and regulations.
``(iii) Analyzing the management structure,
distribution of expenditures, and nurse
staffing levels of facilities of such a chain
in relation to resident census, staff turnover
rates, and tenure.
``(iv) Reporting findings and
recommendations with respect to such reviews,
analyses, and oversight to the chain and
facilities of the chain, to the Secretary, and
to relevant States.
``(v) Publishing the results of such
reviews, analyses, and oversight.
``(C) Implementation of recommendations.--
``(i) Receipt of finding by chain.--Not
later than 10 days after receipt of a finding
reported under subparagraph (B)(iv), the chain
shall submit a report to the independent
monitor--
``(I) outlining corrective actions
to be taken by the chain to implement
the recommendations in such report; or
``(II) indicating that the chain
will not implement such
recommendations, and why it will not do
so.
``(ii) Receipt of report by independent
monitor.--Not later than 10 days after receipt
of the report submitted by the chain under
clause (i), the independent monitor shall
finalize its recommendations and submit a
report to the chain and facilities of the
chain, the Secretary, and the State or States,
as appropriate, containing such final
recommendations.
``(iii) Civil money penalty.--The Secretary
may impose a civil money penalty under
subsection (h)(2)(B)(ii) on a chain that fails
to respond to or to take corrective actions to
implement the recommendations of the
independent monitor in accordance with this
subparagraph.
``(D) Cost of appointment.--A chain shall be
responsible for all costs associated with the
appointment of independent monitors under the program
under this paragraph. The chain shall pay such costs to
the Secretary (in accordance with procedures
established by the Secretary).
``(E) Evaluation and report.--
``(i) Evaluation.--The Inspector General of
the Department of Health and Human Services
shall evaluate the independent monitoring
program under this paragraph.
``(ii) Report.--Not later than 2 years
after the implementation of such program under
subparagraph (A), the Inspector General shall
submit a report to Congress containing the
results of the evaluation conducted under
clause (i), together with recommendations for
such legislation and administrative action as
the Inspector General determines appropriate.
``(F) Intermediate remedy.--The appointment of an
independent monitor shall be an intermediate remedy
that may be in addition to or in lieu of other remedies
under this subsection.''.
(b) Nursing Facilities.--Section 1919(h) of the Social Security Act
(42 U.S.C. 1396r(h)) is amended--
(1) by redesignating paragraphs (8) and (9) as paragraphs
(9) and (10), respectively; and
(2) by inserting after paragraph (7) the following new
paragraph:
``(8) National independent monitor program.--
``(A) In general.--Not later than 1 year after the
date of enactment of this paragraph, the Secretary, in
consultation with the Inspector General of the
Department of Health and Human Services, shall develop,
test, and implement a protocol for the establishment of
an independent monitoring program to oversee interstate
and large intrastate chains of nursing facilities. Such
program shall be designed to analyze such chains in 1
or more of the following instances:
``(i) Where 3 or more facilities of the
chain were enrolled in the `Special Focus
Facility program' (or a successor program)
established by the Centers for Medicare &
Medicaid Services during the preceding 3 years.
``(ii) Where the chain has been
experiencing financial problems that may be
linked to serious quality deficiencies.
``(iii) Where the chain has a record of
chronic poor performance.
``(B) Responsibilities.--The independent monitoring
program established under subparagraph (A) shall
include the following responsibilities:
``(i) Conducting periodic reviews and
preparing root-cause quality and deficiency
analyses of a chain described in such
subparagraph to assess compliance by the chain
with State and Federal laws and regulations.
``(ii) Conducting oversight of efforts by
such a chain, whether publicly or privately
held, to achieve compliance with State and
Federal laws and regulations.
``(iii) Analyzing the management structure,
distribution of expenditures, and nurse
staffing levels of facilities of such a chain
in relation to resident census, staff turnover
rates, and tenure.
``(iv) Reporting findings and
recommendations with respect to such reviews,
analyses, and oversight to the chain and
facilities of the chain, to the Secretary, and
to relevant States.
``(v) Publishing the results of such
reviews, analyses, and oversight.
``(C) Implementation of recommendations.--
``(i) Receipt of finding by chain.--Not
later than 10 days after receipt of a finding
reported under subparagraph (B)(iv), the chain
shall submit a report to the independent
monitor--
``(I) outlining corrective actions
to be taken by the chain to implement
the recommendations in such report; or
``(II) indicating that the chain
will not implement such
recommendations, and why it will not do
so.
``(ii) Receipt of report by independent
monitor.--Not later than 10 days after receipt
of the report submitted by the chain under
clause (i), the independent monitor shall
finalize its recommendations and submit a
report to the chain and facilities of the
chain, the Secretary, and the State or States,
as appropriate, containing such final
recommendations.
``(iii) Civil money penalty.--A State or
the Secretary may impose a civil money penalty
under subsection (h)(2)(A)(ii), or
(h)(3)(C)(ii), respectively, on a chain that
fails to respond to or to take corrective
actions to implement the recommendations of the
independent monitor in accordance with this
subparagraph.
``(D) Cost of appointment.--A chain shall be
responsible for all costs associated with the
appointment of independent monitors under the program
under this paragraph. The chain shall pay such costs to
the Secretary (in accordance with procedures
established by the Secretary).
``(E) Evaluation and report.--
``(i) Evaluation.--The Inspector General of
the Department of Health and Human Services
shall evaluate the independent monitoring
program under this paragraph.
``(ii) Report.--Not later than 2 years
after the implementation of such program under
subparagraph (A), the Inspector General shall
submit a report to Congress containing the
results of the evaluation conducted under
clause (i), together with recommendations for
such legislation and administrative action as
the Inspector General determines appropriate.
``(F) Intermediate remedy.--The appointment of an
independent monitor shall be an intermediate remedy
that may be in addition to or in lieu of other remedies
under this subsection.''.
SEC. 204. GAO STUDIES AND REPORTS ON TEMPORARY MANAGEMENT AND BARRIERS
TO PURCHASING FACILITIES WITH A RECORD OF POOR CARE.
(a) Study and Report on Temporary Management.--
(1) In general.--The Comptroller General of the United
States (in this section referred to as the ``Comptroller
General'') shall conduct a study on--
(A) best practices for the appointment of temporary
management under sections 1819(h)(2)(B)(iii),
1919(h)(2)(A)(iii), and 1919(h)(3)(C)(iii) of the
Social Security Act (42 U.S.C. 1395i-3(h)(2)(B)(iii);
1396r(h)(2)(A)(iii); 1396r(h)(3)(C)(iii)); and
(B) barriers to the appointment of such temporary
management.
(2) Report.--Not later than 1 year after the date of
enactment of this Act, the Comptroller General shall submit a
report to Congress containing the results of the study
conducted under paragraph (1), together with recommendations
for such legislation and administrative action as the
Comptroller General determines appropriate.
(3) Guidance to states.--The Secretary of Health and Human
Services shall issue guidance to States based on the
recommendations contained in the report submitted under
paragraph (2).
(b) Study and Report on Barriers to Purchasing Facilities With a
Record of Poor Care.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the extent and the nature of any
barriers for new owners who purchase, and potential owners who
wish to purchase, skilled nursing facilities and nursing
facilities with a record of poor care.
(2) Report.--Not later than 1 year after the date of
enactment of this Act, the Comptroller General shall submit a
report to Congress containing the results of the study
conducted under paragraph (1), together with recommendations
for such legislation and administrative action as the
Comptroller General determines appropriate to address any
barriers identified in such study.
(3) Definitions.--In this subsection:
(A) Nursing facility.--The term ``nursing
facility'' has the meaning given such term in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).
(B) Skilled nursing facility.--The term ``skilled
nursing facility'' has the meaning given such term in
section 1819(a) of the Social Security Act (42 U.S.C.
1395(a)).
SEC. 205. NOTIFICATION OF FACILITY CLOSURE.
(a) Skilled Nursing Facilities.--
(1) In general.--Section 1819(c) of the Social Security Act
(42 U.S.C. 1395i-3(c)) is amended by adding at the end the
following new paragraph:
``(7) Notification of facility closure.--
``(A) In general.--Any individual who is the
administrator of a skilled nursing facility must--
``(i) submit to the Secretary, the State
long-term care ombudsman, residents of the
facility, and the legal representatives of such
residents or other responsible parties, written
notification of an impending closure--
``(I) subject to subclause (II),
not later than the date that is 60 days
prior to the date of such closure; and
``(II) in the case of a facility
where the Secretary terminates the
facility's participation under this
title, not later than the date that the
Secretary determines appropriate;
``(ii) ensure that the facility does not
admit any new residents on or after the date on
which such written notification is submitted;
and
``(iii) include in the notice a plan for
the transfer and adequate relocation of the
residents of the facility by a specified date
prior to closure that has been approved by the
State, including assurances that the residents
will be transferred to the most appropriate
facility or other setting in terms of quality,
services, and location, taking into
consideration the needs and best interests of
each resident.
``(B) Relocation.--
``(i) In general.--The State shall ensure
that, before a facility closes, all residents
of the facility have been successfully
relocated to another facility or an alternative
home and community-based setting.
``(ii) Continuation of payments until
residents relocated.--The Secretary may, as the
Secretary determines appropriate, continue to
make payments under this title with respect to
residents of a facility that has submitted a
notification under subparagraph (A) during the
period beginning on the date such notification
is submitted and ending on the date on which
the resident is successfully relocated.''.
(2) Conforming amendments.--Section 1819(h)(4) of the
Social Security Act (42 U.S.C. 1395i-3(h)(4)) is amended--
(A) in the first sentence, by striking ``the
Secretary shall terminate'' and inserting ``the
Secretary, subject to subsection (c)(7), shall
terminate''; and
(B) in the second sentence, by striking
``subsection (c)(2)'' and inserting ``paragraphs (2)
and (7) of subsection (c)''.
(b) Nursing Facilities.--
(1) In general.--Section 1919(c) of the Social Security Act
(42 U.S.C. 1396r(c)) is amended by adding at the end the
following new paragraph:
``(9) Notification of facility closure.--
``(A) In general.--Any individual who is an
administrator of a nursing facility must--
``(i) submit to the Secretary, the State
long-term care ombudsman, residents of the
facility, and the legal representatives of such
residents or other responsible parties, written
notification of an impending closure--
``(I) subject to subclause (II),
not later than the date that is 60 days
prior to the date of such closure; and
``(II) in the case of a facility
where the Secretary terminates the
facility's participation under this
title, not later than the date that the
Secretary determines appropriate;
``(ii) ensure that the facility does not
admit any new residents on or after the date on
which such written notification is submitted;
and
``(iii) include in the notice a plan for
the transfer and adequate relocation of the
residents of the facility by a specified date
prior to closure that has been approved by the
State, including assurances that the residents
will be transferred to the most appropriate
facility or other setting in terms of quality,
services, and location, taking into
consideration the needs and best interests of
each resident.
``(B) Relocation.--
``(i) In general.--The State shall ensure
that, before a facility closes, all residents
of the facility have been successfully
relocated to another facility or an alternative
home and community-based setting.
``(ii) Continuation of payments until
residents relocated.--The Secretary may, as the
Secretary determines appropriate, continue to
make payments under this title with respect to
residents of a facility that has submitted a
notification under subparagraph (A) during the
period beginning on the date such notification
is submitted and ending on the date on which
the resident is successfully relocated.''.
(c) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 206. NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE AND USE OF
INFORMATION TECHNOLOGY IN NURSING HOMES.
(a) In General.--The Secretary shall conduct 2 demonstration
projects, 1 for the development of best practices in skilled nursing
facilities and nursing facilities that are involved in the culture
change movement (including the development of resources for facilities
to find and access funding in order to undertake culture change) and 1
for the development of best practices in skilled nursing facilities and
nursing facilities for the use of information technology to improve
resident care.
(b) Conduct of Demonstration Projects.--
(1) Grant award.--Under each demonstration project
conducted under this section, the Secretary shall award 1 or
more grants to facility-based settings for the development of
best practices described in subsection (a) with respect to the
demonstration project involved. Such award shall be made on a
competitive basis and may be allocated in 1 lump-sum payment.
(2) Consideration of special needs of residents.--Each
demonstration project conducted under this section shall take
into consideration the special needs of residents of skilled
nursing facilities and nursing facilities who have cognitive
impairment, including dementia.
(c) Implementation and Duration.--
(1) Implementation.--The demonstration projects shall each
be implemented not later than 1 year after the date of
enactment of this Act.
(2) In general.--The demonstration projects shall each be
conducted for a period not to exceed 3 years.
(d) Definitions.--In this section:
(1) Nursing facility.--The term ``nursing facility'' has
the meaning given such term in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a)).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(3) Skilled nursing facility.--The term ``skilled nursing
facility'' has the meaning given such term in section 1819(a)
of the Social Security Act (42 U.S.C. 1395(a)).
(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.
(f) Report.--Not later than 9 months after the completion of the
demonstration project, the Secretary shall submit a report to Congress
on such project, together with recommendations for such legislation and
administrative action as the Secretary determines appropriate.
TITLE III--IMPROVING STAFF TRAINING
SEC. 301. DEMENTIA AND ABUSE PREVENTION TRAINING.
(a) Skilled Nursing Facilities.--Section 1819(f)(2)(A)(i)(I) of the
Social Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(I)) is amended by
inserting ``(including, in the case of initial training and, if the
Secretary determines appropriate, in the case of ongoing training,
dementia management training, and patient abuse prevention training''
before ``, (II)''.
(b) Nursing Facilities.--Section 1919(f)(2)(A)(i)(I) of the Social
Security Act (42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by inserting
``(including, in the case of initial training and, if the Secretary
determines appropriate, in the case of ongoing training, dementia
management training, and patient abuse prevention'' before ``, (II)''.
(c) Effective Date.--The amendments made by this section shall take
effect 1 year after the date of enactment of this Act.
SEC. 302. STUDY AND REPORT ON TRAINING REQUIRED FOR CERTIFIED NURSE
AIDES AND SUPERVISORY STAFF.
(a) Study.--
(1) In general.--The Secretary shall conduct a study on the
content of training for certified nurse aides and supervisory
staff of skilled nursing facilities and nursing facilities. The
study shall include an analysis of the following:
(A) Whether the number of initial training hours
for certified nurse aides required under sections
1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the
Social Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(II);
1396r(f)(2)(A)(i)(II)) should be increased from 75 and,
if so, what the required number of initial training
hours should be, including any recommendations for the
content of such training (including training related to
dementia).
(B) Whether requirements for ongoing training under
such sections 1819(f)(2)(A)(i)(II) and
1919(f)(2)(A)(i)(II) should be increased from 12 hours
per year, including any recommendations for the content
of such training.
(2) Consultation.--In conducting the analysis under
paragraph (1)(A), the Secretary shall consult with States that
currently (as of the date of enactment of this Act) require
more than 75 hours of training for certified nurse aides.
(3) Definitions.--In this section:
(A) Nursing facility.--The term ``nursing
facility'' has the meaning given such term in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).
(B) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services, acting through
the Assistant Secretary for Planning and Evaluation.
(C) Skilled nursing facility.--The term ``skilled
nursing facility'' has the meaning given such term in
section 1819(a) of the Social Security Act (42 U.S.C.
1395(a)).
(b) Report.--Not later than 2 years after the date of enactment of
this Act, the Secretary shall submit a report to Congress containing
the results of the study conducted under subsection (a), together with
recommendations for such legislation and administrative action as the
Secretary determines appropriate.
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