[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7128 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 7128
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
September 26, 2008
Mr. Stark (for himself and Ms. Schakowsky) 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 Quality of Care 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 additional disclosable
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. National independent monitoring requirements.
Sec. 203. GAO studies and reports on temporary management.
Sec. 204. Notification of facility closure.
Sec. 205. 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 ADDITIONAL DISCLOSABLE
PARTIES INFORMATION.
(a) In General.--Section 1124 of the Social Security Act (42 U.S.C.
1320a-3) is amended by adding at the end the following new subsection:
``(c) Required Disclosure of Ownership and Additional Disclosable
Parties Information.--
``(1) Disclosure.--
``(A) In general.--A facility shall have the
information described in paragraph (2) available--
``(i) during the period beginning on the
date of enactment of this subsection and ending
on the date such information is made available
through the Online Survey, Certification and
Reporting (OSCAR) data network (or any
successor system) maintained by the Secretary,
for submission to the Secretary, the Inspector
General of the Department of Health and Human
Services, the State in which the facility is
located, and the State long-term care ombudsman
in the case where the Secretary, the Inspector
General, the State, or the State long-term care
ombudsman requests such information; and
``(ii) beginning on the effective date of
the final regulations promulgated under
paragraph (3)(A), for reporting such
information in accordance with such final
regulations.
Nothing in clause (i) shall be construed as authorizing
a facility to dispose of or delete information
described in such clause after the effective date of
the final regulations promulgated under paragraph
(3)(A).
``(B) Public availability of information.--During
the period described in subparagraph (A)(i), a facility
shall--
``(i) make the information described in
paragraph (2) available to the public upon
request; and
``(ii) post a notice of the availability of
such information in the lobby of the facility
in a prominent manner.
``(2) Information described.--
``(A) In general.--The following information is
described in this paragraph:
``(i) The information described in
subsections (a) and (b), subject to
subparagraph (C).
``(ii) The identity of and information on--
``(I) each member of the governing
body of the facility, including the
name, title, and period of service of
each such member;
``(II) each person or entity who is
an officer, director, member, partner,
trustee, or managing employee of the
facility, including the name, title,
and period of service of each such
person or entity; and
``(III) each person or entity who
is an additional disclosable party of
the facility.
``(iii) The organizational structure of
each person and entity described in clauses
(ii) and (iii) and a description of the
relationship of each such person or entity to
the facility and to one another.
``(B) Special rule where information is already
reported or submitted.--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 or any other
Federal agency contains the information described in
clauses (i), (ii), (iii), or (iv) of subparagraph (A),
the facility may provide such Form or such information
submitted to meet the requirements of paragraph (1).
``(C) Special rule.--In applying subparagraph
(A)(i)--
``(i) with respect to subsections (a) and
(b), `ownership or control interest' shall
include direct or indirect interests through
any number of intermediate entities; and
``(ii) subsection (a)(3)(A)(ii) shall
include the owner of a whole or part interest
in any mortgage, deed of trust, note, or other
obligation secured, in whole or in part, by the
entity or any of the property or assets
thereof, if the interest is equal to or exceeds
5 percent of the total property or assets of
the entirety.
``(3) Reporting.--
``(A) In general.--Not later than the date that is
2 years after the date of enactment of this subsection,
the Secretary shall promulgate final regulations
requiring, effective on the date that is 90 days after
the date on which such final regulations are published
in the Federal Register, a facility to report the
information described in paragraph (2) to the Secretary
in a standardized format, and such other regulations as
are necessary to carry out this subsection. Such final
regulations shall ensure that the facility certifies,
as a condition of participation and payment under the
program under title XVIII or XIX, that the information
reported by the facility in accordance with such final
regulations is accurate and current.
``(B) Guidance.--The Secretary shall provide
guidance and technical assistance to States on how to
adopt the standardized format under subparagraph (A).
``(4) No effect on existing reporting requirements.--
Nothing in this subsection shall reduce, diminish, or alter any
reporting requirement for a facility that is in effect as of
the date of enactment of this subsection.
``(5) Definitions.--In this subsection:
``(A) Additional disclosable party.--The term
`additional disclosable party' means, with respect to a
facility, any person or entity who--
``(i) exercises operational, financial, or
managerial control over the facility or a part
thereof, or provides policies or procedures for
any of the operations of the facility, or
provides financial or cash management services
to the facility;
``(ii) leases or subleases real property to
the facility, or owns a whole or part interest
equal to or exceeding 5 percent of the total
value of such real property;
``(iii) lends funds or provides a financial
guarantee to the facility in an amount which is
equal to or exceeds $50,000;
``(iv) provides management or
administrative services, management or clinical
consulting services, or accounting or financial
services to the facility;
``(v) provides therapy, pharmacy, or
hospice services to residents of the facility;
or
``(vi) leases employees to or employs staff
on behalf of the facility.
``(B) Facility.--The term `facility' means a
disclosing entity which is--
``(i) a skilled nursing facility (as
defined in section 1819(a)); or
``(ii) a nursing facility (as defined in
section 1919(a)).
``(C) Managing employee.--The term `managing
employee' means, with respect to a facility, an
individual (including a general manager, business
manager, administrator, director, or consultant) who
directly or indirectly manages, advises, or supervises
any element of the practices, finances, or operations
of the facility.
``(D) Organizational structure.--The term
`organizational structure' means, in the case of--
``(i) a corporation, the officers,
directors, and shareholders of the corporation
who have an ownership interest in the
corporation which is equal to or exceeds 5
percent;
``(ii) a limited liability company, the
members and managers of the limited liability
company (including, as applicable, what
percentage each member and manager has of the
ownership interest in the limited liability
company);
``(iii) a general partnership, the partners
of the general partnership;
``(iv) a limited partnership, the general
partners and any limited partners of the
limited partnership who have an ownership
interest in the limited partnership which is
equal to or exceeds 10 percent;
``(v) a trust, the trustees of the trust;
``(vi) an individual, contact information
for the individual; and
``(vii) any other person or entity, such
information as the Secretary determines
appropriate.''.
(b) Public Availability of Information.--
(1) In general.--Not later than the date that is 1 year
after the date on which the final regulations promulgated under
section 1124(c)(3)(A) of the Social Security Act, as added by
subsection (a), are published in the Federal Register, the
Secretary shall make the information reported in accordance
with such final regulations available to the public in a
similar manner as information with respect to skilled nursing
facilities and nursing facilities is made available to the
public through the Online Survey, Certification and Reporting
(OSCAR) data network (or any successor system) maintained by
the Secretary.
(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)).
(c) Conforming Amendments.--
(1) Skilled nursing facilities.--Section 1819(d)(1) of the
Social Security Act (42 U.S.C. 1395i-3(d)(1)) is amended by
striking subparagraph (B) and redesignating subparagraph (C) as
subparagraph (B).
(2) Nursing facilities.--Section 1919(d)(1) of the Social
Security Act (42 U.S.C. 1396r(d)(1)) is amended by striking
subparagraph (B) and redesignating subparagraph (C) as
subparagraph (B).
SEC. 102. ACCOUNTABILITY REQUIREMENTS.
(a) Effective Compliance and Ethics Programs.--
(1) 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 subparagraph:
``(D) Compliance and ethics programs.--
``(i) Requirement.--On or after the date
that is 36 months after the date of enactment
of this subparagraph, a skilled nursing
facility shall, with respect to the entity that
operates the facility (in this subparagraph
referred to as the `operating organization' or
`organization'), have in operation a compliance
and ethics program that is effective in
preventing and detecting criminal, civil, and
administrative violations under this Act and in
promoting quality of care consistent with
regulations developed under clause (ii).
``(ii) Development of regulations.--
``(I) In general.--Not later than
the date that is 2 years after such
date of enactment, the Secretary, in
consultation with the Inspector General
of the Department of Health and Human
Services, shall promulgate regulations
for an effective compliance and ethics
program for operating organizations,
which may include a model compliance
program.
``(II) Design of regulations.--
Such regulations with respect to
specific elements or formality of a
program may vary with the size of the
organization, such that larger
organizations should have a more formal
program and include established written
policies defining the standards and
procedures to be followed by its
employees. Such requirements may
specifically apply to the corporate
level management of multi-nursing home
chains.
``(III) Evaluation.--Not later than
3 years after the date of promulgation
of regulations under this clause, the
Secretary shall complete an evaluation
of the compliance and ethics programs
required to be established under this
subparagraph. Such evaluation shall
determine if such programs led to
changes in deficiency citations,
changes in quality performance, or
changes in other metrics of patient
quality of care. The Secretary shall
submit a report to Congress on such
evaluation and shall include in such
report such recommendations regarding
changes in the requirements for such
programs as the Secretary determines
appropriate.
``(iii) Requirements for compliance and
ethics programs.--In this subparagraph, the
term `compliance and ethics program' means,
with respect to a skilled nursing facility, a
program of the operating organization that--
``(I) has been reasonably designed,
implemented, and enforced so that it
generally will be effective in
preventing and detecting criminal,
civil, and administrative violations
under this Act and in promoting quality
of care; and
``(II) includes at least the
required components specified in clause
(iv).
``(iv) Required components of program.--The
required components of a compliance and ethics
program of an organization are the following:
``(I) The organization must have
established compliance standards and
procedures to be followed by its
employees and other agents that are
reasonably capable of reducing the
prospect of criminal, civil, and
administrative violations under this
Act.
``(II) Specific individuals within
high-level personnel of the
organization must have been assigned
overall responsibility to oversee
compliance with such standards and
procedures and has sufficient resources
and authority to assure such
compliance.
``(III) The organization must have
used due care not to delegate
substantial discretionary authority to
individuals whom the organization knew,
or should have known through the
exercise of due diligence, had a
propensity to engage in criminal,
civil, and administrative violations
under this Act.
``(IV) The organization must have
taken steps to communicate effectively
its standards and procedures to all
employees and other agents, such as by
requiring participation in training
programs or by disseminating
publications that explain in a
practical manner what is required.
``(V) The organization must have
taken reasonable steps to achieve
compliance with its standards, such as
by utilizing monitoring and auditing
systems reasonably designed to detect
criminal, civil, and administrative
violations under this Act by its
employees and other agents and by
having in place and publicizing a
reporting system whereby employees and
other agents could report violations by
others within the organization without
fear of retribution.
``(VI) The standards must have been
consistently enforced through
appropriate disciplinary mechanisms,
including, as appropriate, discipline
of individuals responsible for the
failure to detect an offense.
``(VII) After an offense has been
detected, the organization must have
taken all reasonable steps to respond
appropriately to the offense and to
prevent further similar offenses,
including any necessary modification to
its program to prevent and detect
criminal, civil, and administrative
violations under this Act.
``(VIII) The organization must
periodically undertake reassessment of
its compliance program to identify
changes necessary to reflect changes
within the organization and its
facilities.''.
(2) 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) Compliance and ethics program.--
``(i) Requirement.--On or after the date
that is 36 months after the date of enactment
of this subparagraph, a nursing facility shall,
with respect to the entity that operates the
facility (in this subparagraph referred to as
the `operating organization' or
`organization'), have in operation a compliance
and ethics program that is effective in
preventing and detecting criminal, civil, and
administrative violations under this Act and in
promoting quality of care consistent with
regulations developed under clause (ii).
``(ii) Development of regulations.--
``(I) In general.--Not later than
the date that is 2 years after such
date of enactment, the Secretary, in
consultation with the Inspector General
of the Department of Health and Human
Services, shall develop regulations for
an effective compliance and ethics
program for operating organizations,
which may include a model compliance
program.
``(II) Design of regulations.--
Such regulations with respect to
specific elements or formality of a
program may vary with the size of the
organization, such that larger
organizations should have a more formal
program and include established written
policies defining the standards and
procedures to be followed by its
employees. Such requirements may
specifically apply to the corporate
level management of multi-nursing home
chains.
``(III) Evaluation.--Not later than
3 years after the date of promulgation
of regulations under this clause the
Secretary shall complete an evaluation
of the compliance and ethics programs
required to be established under this
subparagraph. Such evaluation shall
determine if such programs led to
changes in deficiency citations,
changes in quality performance, or
changes in other metrics of patient
quality of care. The Secretary shall
submit a report to Congress on such
evaluation and shall include in such
report such recommendations regarding
changes in the requirements for such
programs as the Secretary determines
appropriate.
``(iii) Requirements for compliance and
ethics programs.--In this subparagraph, the
term `compliance and ethics program' means,
with respect to a nursing facility, a program
of the operating organization that--
``(I) has been reasonably designed,
implemented, and enforced so that it
generally will be effective in
preventing and detecting criminal,
civil, and administrative violations
under this Act and in promoting quality
of care; and
``(II) includes at least the
required components specified in clause
(iv).
``(iv) Required components of program.--The
required components of a compliance and ethics
program of an organization are the following:
``(I) The organization must have
established compliance standards and
procedures to be followed by its
employees and other agents that are
reasonably capable of reducing the
prospect of criminal, civil, and
administrative violations under this
Act.
``(II) Specific individuals within
high-level personnel of the
organization must have been assigned
overall responsibility to oversee
compliance with such standards and
procedures and has sufficient resources
and authority to assure such
compliance.
``(III) The organization must have
used due care not to delegate
substantial discretionary authority to
individuals whom the organization knew,
or should have known through the
exercise of due diligence, had a
propensity to engage in criminal,
civil, and administrative violations
under this Act.
``(IV) The organization must have
taken steps to communicate effectively
its standards and procedures to all
employees and other agents, such as by
requiring participation in training
programs or by disseminating
publications that explain in a
practical manner what is required.
``(V) The organization must have
taken reasonable steps to achieve
compliance with its standards, such as
by utilizing monitoring and auditing
systems reasonably designed to detect
criminal, civil, and administrative
violations under this Act by its
employees and other agents and by
having in place and publicizing a
reporting system whereby employees and
other agents could report violations by
others within the organization without
fear of retribution.
``(VI) The standards must have been
consistently enforced through
appropriate disciplinary mechanisms,
including, as appropriate, discipline
of individuals responsible for the
failure to detect an offense.
``(VII) After an offense has been
detected, the organization must have
taken all reasonable steps to respond
appropriately to the offense and to
prevent further similar offenses,
including any necessary modification to
its program to prevent and detect
criminal, civil, and administrative
violations under this Act.
``(VIII) The organization must
periodically undertake reassessment of
its compliance program to identify
changes necessary to reflect changes
within the organization and its
facilities.''.
(b) Quality Assurance and Performance Improvement (QAPI)
Demonstration Program.--
(1) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
establish a demonstration program (in this subsection referred
to as the ``program'') to be conducted over a 3-year period to
test and evaluate models for quality assurance and performance
improvement (QAPI) programs with respect to nursing facilities,
including skilled nursing facilities.
(2) Facilities to be included.--The program shall include
at least 15, but not more than 30, nursing facilities,
including a mix of facilities, such as special focus facilities
and high and middle performing facilities, but shall have a
focus on lower performing facilities. The nursing facilities
included in the program shall reflect large and medium chains
and stand alone homes.
(3) Activities.--The program shall provide funding for
quality assurance and performance improvement activities at
nursing facilities, such as data analysis, root-cause analysis,
and systemic improvements. The results of such analysis shall
be reported to, and used by the governing body at such
facilities to make systemic improvements in quality of care.
(4) Evaluation.--
(A) In general.--The Secretary, in consultation
with the Inspector General of the Department of Health
and Human Services, shall conduct an evaluation of the
program to determine if quality assurance and
performance improvement activities led to changes in
deficiency citations, changes in quality performance,
or changes in other metrics of patient quality of care.
Not later than 1 year after completion of the program,
the Secretary shall submit to Congress a report on such
evaluation and shall include in such report
recommendations on statutory changes needed to modify
and strengthen quality assurance and performance
improvement programs in skilled nursing facilities and
nursing facilities.
(B) Best practices manual.--The Secretary, in
consultation with the Inspector General of the
Department of Health and Human Services, shall use the
results of such evaluation to create a resource manual
for nursing facilities on best practices in quality
assurance and performance improvement.
(C) Proposal to revise quality assurance and
performance improvement programs.--The Secretary,
taking into account the results of such evaluation,
shall include in the proposed rule published under
section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e)(5)(A)) for the subsequent fiscal year to the
extent otherwise authorized under section 1819(b)(1)(B)
or 1819(d)(1)(D) of the Social Security Act or other
regulatory authority, one or more proposals for skilled
nursing facilities to modify and strengthen quality
assurance and performance improvement programs in such
facilities. At the time of publication of such proposed
rule and to the extent otherwise authorized under
section 1919(b)(1)(B) or 1919(d)(1)(D) of such Act or
other regulatory authority, the Secretary shall
promulgate as a proposed rule one or more proposals for
nursing facilities to modify and strengthen quality
assurance and performance improvement programs in such
facilities.
(5) Authorization of appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
this subsection.
(c) GAO Study on Nursing Facility Undercapitalization.--
(1) In general.--The Comptroller General of the United
States shall conduct a study that examines the following:
(A) The extent to which corporations that own or
operate large numbers of nursing facilities, taking
into account ownership type (including private equity
and control interests), are undercapitalizing such
facilities.
(B) The effects of such undercapitalization on
quality of care, including staffing and food costs, at
such facilities.
(C) Options to address such undercapitalization,
such as requirements relating to surety bonds,
liability insurance, or minimum capitalization.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under paragraph (1).
(3) Nursing facility.--In this subsection, the term
``nursing facility'' includes a skilled nursing facility.
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 section 1124(c)(3).
``(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, since the previous
quarter--
``(I) were newly enrolled in the
program;
``(II) are enrolled in the program
and have failed to significantly
improve;
``(III) are enrolled in the program
and have significantly improved;
``(IV) have graduated from the
program; and
``(V) have closed voluntarily or no
longer participate under this title.
``(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), 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 and State and national averages for
the facilities. Such format shall include--
``(I) concise explanations of how
to interpret the data (such as a plain
English explanation of data reflecting
``nursing home staff hours per resident
day'');
``(II) differences in types of
staff (such as training associated with
different categories of staff);
``(III) the relationship between
nurse staffing levels and quality of
care; and
``(IV) an explanation that
appropriate staffing levels vary based
on patient case mix.
``(iv) Links to State internet websites
where information about State survey and
certification programs, Form 2567 inspection
reports (or a successor form), and facility
plans of corrections may be found, along with
information to guide consumers in interpreting
and understanding such reports.
``(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) The number of adjudicated instances
of criminal violations by a nursing facility or
crimes committed by an employee of a nursing
facility--
``(I) that were committed inside of
the facility; and
``(II) with respect to such
instances of violations or crimes
committed outside of the facility, that
were the violations or crimes of elder
abuse, neglect, and exploitation,
criminal sexual abuse of an elder, or
other violations or crimes that
resulted in the serious bodily injury
of an elder.
``(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 section 1124(c)(3)
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) 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;
``(iv) skilled nursing facility employees
and their representatives; and
``(v) 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.
Any necessary subsequent corrections to prior
information submitted by the State shall be submitted
to the Secretary in a timely fashion. 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, but not less frequently than
quarterly.''.
(B) Effective date.--The amendment made by this
paragraph shall take effect 1 year after the date of
enactment of this Act.
(3) Special focus facility program.--Section 1819(f) of
such Act is amended by adding at the end the following new
paragraph:
``(8) Special focus facility program.--
``(A) In general.--The Secretary shall conduct a
special focus facility program for enforcement of
requirements for skilled nursing facilities that the
Secretary has identified as having substantially failed
to meet applicable requirements of this Act.
``(B) Periodic surveys.--Under such program the
Secretary shall conduct surveys of each facility in the
program not less often than once very 6 months.''.
(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 section 1124(c)(3).
``(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, since the previous
quarter--
``(I) were newly enrolled in the
program;
``(II) are enrolled in the program
and have failed to significantly
improve;
``(III) are enrolled in the program
and have significantly improved;
``(IV) have graduated from the
program; and
``(V) have closed voluntarily or or
no longer participate under this title.
``(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), 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 and State and national averages for
the facilities. Such format shall include--
``(I) concise explanations of how
to interpret the data (such as a plain
English explanation of data reflecting
``nursing home staff hours per resident
day'');
``(II) differences in types of
staff (such as training associated with
different categories of staff);
``(III) the relationship between
nurse staffing levels and quality of
care; and
``(IV) an explanation that
appropriate staffing levels vary based
on patient case mix.
``(iv) Links to State internet websites
where information about State survey and
certification programs, Form 2567 inspection
reports (or a successor form), and facility
plans of corrections may be found, along with
information to guide consumers in interpreting
and understanding such reports.
``(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) The number of adjudicated instances
of criminal violations by a nursing facility or
crimes committed by an employee of a nursing
facility--
``(I) that were committed inside of
the facility; and
``(II) with respect to such
instances of violations or crimes
committed outside of the facility, that
were the violations or crimes of elder
abuse, neglect, and exploitation,
criminal sexual abuse of an elder, or
other violations or crimes that
resulted in the serious bodily injury
of an elder.
``(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 section 1124(c)(3)
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) 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;
``(iv) skilled nursing facility employees
and their representatives; and
``(v) 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. Any
necessary subsequent corrections to prior information
submitted by the State shall be submitted to the
Secretary in a timely fashion. 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, but not less frequently than quarterly.''.
(B) Effective date.--The amendment made by this
paragraph shall take effect 1 year after the date of
enactment of this Act.
(3) Special focus facility program.--Section 1919(f) of
such Act is amended by adding at the end the following new
paragraph:
``(8) Special focus facility program.--
``(A) In general.--The Secretary shall conduct a
special focus facility program for enforcement of
requirements for nursing facilities that the Secretary
has identified as having substantially failed to meet
applicable requirements of this Act.
``(B) Periodic surveys.--Under such program the
Secretary shall conduct surveys of each facility in the
program not less often than once very 6 months.''.
(c) Availability of Reports on Surveys, Certifications, and
Substantiated 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
substantiated complaint investigation reports.--A
skilled nursing facility must--
``(i) have reports with respect to any
surveys, certifications, and substantiated
complaint investigations made respecting the
facility during the 3 preceding years available
for any individual to review upon request,
along with the plan of corrective action; and
``(ii) post notice of the availability of
such reports in areas of the facility that are
prominent and accessible to the public.
The facility shall not make available under clause (i)
identifying information about complainants or
residents.''.
(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
substantiated complaint investigation reports.--A
nursing facility must--
``(i) have reports with respect to any
surveys, certifications, and substantiated
complaint investigations made respecting the
facility during the 3 preceding years available
for any individual to review upon request,
along with the plan of corrective action; and
``(ii) post notice of the availability of
such reports in areas of the facility that are
prominent and accessible to the public.
The facility shall not make available under clause (i)
identifying information about complainants or
residents.''.
(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
Substantiated 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),
substantiated 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 in a manner that does
not disclose identifying information about complainants or
residents.
(2) Requirement.--As a condition of a contract with a State
under section 1864(d) of the Social Security Act, effective not
later than 2 years after the date of the enactment of this Act,
the Secretary of Health and Human Services shall require that a
State have, on the State's Internet website referred to in
paragraph (1), the electronic links referred to in such
paragraph.
(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) 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 Direct Care Expenditures.--
``(1) In general.--For cost reports submitted under this
title for cost reporting periods beginning on or after the date
that is 2 years after the date of enactment of this subsection,
skilled nursing facilities shall separately report expenditures
for wages and benefits for direct care staff (breaking out (at
a minimum) registered nurses, licensed professional nurses,
certified nurse assistants, and other medical and therapy
staff).
``(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) not later
than 1 year after the date of the enactment of this subsection.
``(3) Categorization by functional accounts.--Not later
than 30 months after the date of the enactment of this
subsection, 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, as modified under
paragraph (1), submitted by skilled nursing facilities and
categorize such expenditures, regardless of any source of
payment for such expenditures, for each skilled nursing
facility into the following functional accounts on an annual
basis:
``(A) Spending on direct care services (including
nursing, therapy, and medical services).
``(B) Spending on indirect care (including
housekeeping and dietary services).
``(C) Capital assets (including building and land
costs).
``(D) Administrative services 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 in filing, in
good faith, 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 process and whistleblower protection.--
``(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;
``(ii) any person acting on the resident's
behalf; and
``(iii) any person who works at a skilled
nursing facility or is a representative of such
a worker.
``(B) Complaint resolution process.--The State must
establish a complaint resolution process in order to
ensure that a resident is not retaliated against if the
resident has complained, in good faith, about the
quality of care or other issues relating to the skilled
nursing facility, 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 such representative
or party has complained, in good faith, about the
quality of care provided by the facility or other
issues relating to the facility, and that a person who
works at a skilled nursing facility is not retaliated
against if the worker has complained, in good faith,
about quality of care or services or an issue relating
to the quality of care or services provided at the
facility, whether the resident, legal representative,
other responsible party, or worker used the form
developed under subsection (f)(8) or some other method
for submitting the complaint. 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;
``(iii) deadlines for responding to a
compliant and procedures in order to enable the
complainant to track the status of the
complaint and investigation; and
``(iv) procedures to ensure that the
identity of the complainant will be kept
confidential.
``(C) Whistleblower protection.--
``(i) Prohibition against retaliation.--No
person who works at a skilled nursing facility
may be penalized, discriminated, or retaliated,
against with respect to any aspect of
employment, including discharge, promotion,
compensation, terms, conditions, or privileges
of employment, or have a contract for services
terminated, because the person (or anyone
acting at the person's request) complained, in
good faith, about the quality of care or
services provided by a nursing facility or
about other issues relating to quality of care
or services, whether using the form developed
under subsection (f)(8) or some other method
for submitting the complaint.
``(ii) Retaliatory reporting.--A skilled
nursing facility may not file a complaint or a
report against a person who works (or has
worked) at the facility with the appropriate
State professional disciplinary agency because
the person (or anyone acting at the person's
request) filed, in good faith, a complaint
described in clause (i).
``(iii) Commencement of action.--Any person
who believes the person has been penalized,
discriminated, or retaliated against, or had a
contract for services terminated in violation
of clause (i) or against whom a complaint has
been filed in violation of clause (ii) may
bring an action at law or equity in the
appropriate district court of the United
States, which shall have jurisdiction over such
action without regard to the amount in
controversy or the citizenship of the parties,
and which shall have jurisdiction to grant
complete relief, including, but not limited to,
injunctive relief (such as reinstatement),
compensatory damages (which may include
reimbursement of lost wages, compensation, and
benefits), costs of litigation (including
reasonable attorney and expert witness fees),
exemplary damages where appropriate, and such
other relief as the court deems just and
proper.
``(iv) Rights not waivable.--The rights
protected by this paragraph may not be
diminished by contract or other agreement, and
nothing in this paragraph shall be construed to
diminish any greater or additional protection
provided by Federal or State law or by contract
or other agreement.
``(v) Rule of construction.--Nothing in
this section shall be construed as preventing a
resident of a skilled nursing facility, a
person acting on the resident's behalf, or a
person who works at a skilled nursing facility
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).
``(vi) Requirement to post notice of
employee rights.--Each skilled nursing facility
shall post conspicuously in an appropriate
location a sign (in a form specified by the
Secretary) specifying the rights of persons
under this paragraph and including a statement
that an employee may file a complaint with the
Secretary against the a skilled nursing
facility that violates the provisions of this
paragraph and information with respect to the
manner of filing such a complaint.
``(D) Good faith defined.--For purposes of this
paragraph, an individual shall be deemed to be acting
in good faith with respect to the filing of a complaint
if the individual reasonably believes--
``(i) the information reported or disclosed
in the complaint is true; and
``(ii) a violation of this title has
occurred or may occur in relation to such
information.''.
(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 in filing, in
good faith, 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 process and whistleblower protection.--
``(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;
``(ii) any person acting on the resident's
behalf; and
``(iii) any person who works at a nursing
facility or a representative of such a worker.
``(B) Complaint resolution process.--The State must
establish a complaint resolution process in order to
ensure that a resident is not retaliated against if the
resident has complained, in good faith, about the
quality of care or other issues relating to the nursing
facility, 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 such representative or party has complained,
in good faith, about the quality of care provided by
the facility or other issues relating to the facility,
and that a person who works at a nursing facility is
not retaliated against if the worker has complained, in
good faith, about quality of care or services or an
issue relating to the quality of care or services
provided at the facility, whether the resident, legal
representative, other responsible party, or worker used
the form developed under subsection (f)(10) or some
other method for submitting the complaint. 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;
``(iii) deadlines for responding to a
compliant and procedures in order to enable the
complainant to track the status of the
complaint and investigation; and
``(iv) procedures to ensure that the
identity of the complainant will be kept
confidential.
``(C) Whistleblower protection.--
``(i) Prohibition against retaliation.--No
person who works at a skilled nursing facility
may be penalized, discriminated, or retaliated,
against with respect to any aspect of
employment, including discharge, promotion,
compensation, terms, conditions, or privileges
of employment, or have a contract for services
terminated, because the person (or anyone
acting at the person's request) complained, in
good faith, about the quality of care or
services provided by a nursing facility or
about other issues relating to quality of care
or services, whether using the form developed
under subsection (f)(10) or some other method
for submitting the complaint.
``(ii) Retaliatory reporting.--A nursing
facility may not file a complaint or a report
against a person who works (or has worked) at
the facility with the appropriate State
professional disciplinary agency because the
person (or anyone acting at the person's
request) filed, in good faith, a complaint
described in clause (i).
``(iii) Commencement of action.--Any person
has been penalized, discriminated, or
retaliated against, or had a contract for
services terminated in violation of clause (i)
or against whom a complaint has been filed in
violation of clause (ii) may bring an action at
law or equity in the appropriate district court
of the United States, which shall have
jurisdiction over such action without regard to
the amount in controversy or the citizenship of
the parties, and which shall have jurisdiction
to grant complete relief, including, but not
limited to, injunctive relief (such as
reinstatement), compensatory damages (which may
include reimbursement of lost wages,
compensation, and benefits), costs of
litigation (including reasonable attorney and
expert witness fees), exemplary damages where
appropriate, and such other relief as the court
deems just and proper.
``(iv) Rights not waivable.--The rights
protected by this paragraph may not be
diminished by contract or other agreement, and
nothing in this paragraph shall be construed to
diminish any greater or additional protection
provided by Federal or State law or by contract
or other agreement.
``(v) Rule of construction.--Nothing in
this section shall be construed as preventing a
resident of a nursing facility, a person acting
on the resident's behalf, or a person who works
at a nursing facility 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).
``(vi) Requirement to post notice of
employee rights.--Each nursing facility shall
post conspicuously in an appropriate location a
sign (in a form specified by the Secretary)
specifying the rights of persons under this
paragraph and including a statement that an
employee may file a complaint with the
Secretary against the a skilled nursing
facility that violates the provisions of this
paragraph and information with respect to the
manner of filing such a complaint.
``(D) Good faith defined.--For purposes of this
paragraph, an individual shall be deemed to be acting
in good faith with respect to the filing of a complaint
if the individual reasonably believes--
``(i) the information reported or disclosed
in the complaint is true; and
``(ii) a violation of this title has
occurred or may occur in relation to such
information.''.
(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.--Beginning not later
than 2 years after the date of the enactment of this
subparagraph, and after consulting with State long-term
care omubdsman programs, consumer advocacy groups,
provider stakeholder groups, employees and their
representatives, and other parties the Secretary deems
appropriate, the Secretary shall require a skilled
nursing facility to electronically submit to the
Secretary direct care staffing information (including
information with respect to agency and contract staff)
based on payroll and other verifiable and auditable
data in a uniform format (according to specifications
established by the Secretary in consultation with such
programs, groups, and parties). 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,
certified nursing assistant, therapist, or
other medical personnel);
``(ii) include resident census data and
information on resident case mix;
``(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 clause (i) per resident
per day.
Nothing in this subparagraph shall be construed as
preventing the Secretary from requiring submission of
such information with respect to specific categories,
such as nursing staff, before other categories of
certified employees. Information under this
subparagraph with respect to agency and contract staff
shall be kept separate from information on employee
staffing.''
(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.--Beginning not later
than 2 years after the date of the enactment of this
subparagraph, and after consulting with State long-term
care omubdsman programs, consumer advocacy groups,
provider stakeholder groups, employees and their
representatives, and other parties the Secretary deems
appropriate, the Secretary shall require a nursing
facility to electronically submit to the Secretary
direct care staffing information (including information
with respect to agency and contract staff) based on
payroll and other verifiable and auditable data in a
uniform format (according to specifications established
by the Secretary in consultation with such programs,
groups, and parties). 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,
certified nursing assistant, therapist, or
other medical personnel);
``(ii) include resident census data and
information on resident case mix;
``(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 clause (i) per resident
per day.
Nothing in this subparagraph shall be construed as
preventing the Secretary from requiring submission of
such information with respect to specific categories,
such as nursing staff, before other categories of
certified employees. Information under this
subparagraph with respect to agency and contract staff
shall be kept separate from information on employee
staffing.''
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
(IV), the Secretary may impose a civil
money penalty in the applicable per
instance or per day amount (as defined
in subclause (II) and (III)) for each
day or each instance, respectively, of
noncompliance (as determined
appropriate by the Secretary).
``(II) Applicable per instance
amount.--In this clause, the term
`applicable per instance amount'
means--
``(aa) in the case where
the deficiency is found to be a
direct proximate cause of death
of a resident of the facility,
an amount not to exceed
$100,000;
``(bb) in each case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,050 and not
more than $25,000; and
``(cc) in each case of any
other deficiency, an amount not
less than $250 and not to
exceed $3,050.
``(III) Applicable per day
amount.--In this clause, the term
`applicable per day amount' means--
``(aa) in each case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,050 and not
more than $25,000; and
``(bb) in each case of any
other deficiency, an amount not
less than $250 and not to
exceed $3,050.
``(IV) Reduction of civil money
penalties in certain circumstances.--
Subject to subclauses (V) and (VI), 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.
``(V) Prohibitions on reduction for
certain deficiencies.--
``(aa) Repeat
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (IV) 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 (IV) if
the penalty is imposed for a
deficiency described in
subclause (II)(bb) or (III)(aa)
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).
``(VI) Limitation on aggregate
reductions.--The aggregate reduction in
a penalty under subclause (IV) may not
exceed 35 percent on the basis of self-
reporting, on the basis of a waiver of
an appeal (as provided for under
regulations under section 488.436 of
title 42, Code of Federal Regulations),
or on the basis of both.
``(VII) 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) or subclause
(III)(aa), 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, shall
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 of the State
long term care ombudsman or
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.
``(VIII) 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 (VII)) 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).
``(IX) Indexing amounts.--For years
beginning after 2010, each of the
amounts specified in subclauses (II)
and (III) shall be subject to periodic
increase in accordance with the
provisions of section 5 of the Federal
Civil Penalties Inflation Adjustment
Act of 1990 (Public Law 101-410; 28
U.S.C. 2461 note).''.
(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
per instance or per day amount (as defined in
clause (ii) and (iii)) for each day or each
instance, respectively, of noncompliance (as
determined appropriate by the State).
``(ii) Applicable per instance amount.--In
this subparagraph, the term `applicable per
instance amount' means--
``(I) in the case where the
deficiency is found to be a direct
proximate cause of death of a resident
of the facility, an amount not to
exceed $100,000;
``(II) in each case of a deficiency
where the facility is cited for actual
harm or immediate jeopardy, an amount
not less than $3,050 and not more than
$25,000; and
``(III) in each case of any other
deficiency, an amount not less than
$250 and not to exceed $3,050.
``(iii) Applicable per day amount.--In this
subparagraph, the term `applicable per day
amount' means--
``(I) in each case of a deficiency
where the facility is cited for actual
harm or immediate jeopardy, an amount
not less than $3,050 and not more than
$25,000; and
``(II) in each case of any other
deficiency, an amount not less than
$250 and not to exceed $3,050.
``(iv) Reduction of civil money penalties
in certain circumstances.--Subject to clauses
(v) and (vi), 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.
``(v) Prohibition on reduction for certain
deficiencies.--
``(I) Repeat deficiencies.--The
State may not reduce the amount of a
penalty under clause (iv) 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
(iv) if the penalty is imposed for a
deficiency described in clause (ii)(II)
or (iii)(I) 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).
``(vi) Limitation on aggregate
reductions.--The aggregate reduction in a
penalty under clause (iv) may not exceed 35
percent on the basis of self-reporting, on the
basis of a waiver of an appeal (as provided for
under regulations under section 488.436 of
title 42, Code of Federal Regulations), or on
the basis of both.
``(vii) 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) or clause (iii)(I), 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, shall 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).
``(viii) Indexing amounts.--For years
beginning after 2010, each of the amounts
specified in clauses (ii) and (iii) shall be
subject to periodic increase in accordance with
the provisions of section 5 of the Federal
Civil Penalties Inflation Adjustment Act of
1990 (Public Law 101-410; 28 U.S.C. 2461
note).''.
(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 of the State long-term care ombudsman 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) In general.--Subject to
subclause (III), the Secretary may
impose a civil money penalty in the
applicable per instance or per day
amount (as defined in subclause (II)
and (III)) for each day or each
instance, respectively, of
noncompliance (as determined
appropriate by the Secretary).
``(II) Applicable per instance
amount.--In this clause, the term
`applicable per instance amount'
means--
``(aa) in the case where
the deficiency is found to be a
direct proximate cause of death
of a resident of the facility,
an amount not to exceed
$100,000;
``(bb) in each case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,050 and not
more than $25,000; and
``(cc) in each case of any
other deficiency, an amount not
less than $250 and not to
exceed $3,050.
``(III) Applicable per day
amount.--In this subparagraph, the term
`applicable per day amount' means--
``(aa) in each case of a
deficiency where the facility
is cited for actual harm or
immediate jeopardy, an amount
not less than $3,050 and not
more than $25,000; and
``(bb) in each case of any
other deficiency, an amount not
less than $250 and not to
exceed $3,050.
``(IV) Reduction of civil money
penalties in certain circumstances.--
Subject to subclauses (V) and (VI), 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
State may reduce the amount of the
penalty imposed.
``(V) Prohibition on reduction for
certain deficiencies.--
``(aa) Repeat
deficiencies.--The Secretary
may not reduce the amount of a
penalty under subclause (IV) 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 (IV) if
the penalty is imposed for a
deficiency described in
subclause (II)(aa) or (III)(a)
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)(a).
``(VI) Limitation on aggregate
reductions.--The aggregate reduction in
a penalty under subclause (IV) may not
exceed 35 percent on the basis of self-
reporting, on the basis of a waiver of
an appeal (as provided for under
regulations under section 488.436 of
title 42, Code of Federal Regulations),
or on the basis of both.
``(VII) 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) or clause (iii)(I), the
State--
``(aa) 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;
``(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 subclause (I) 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, shall
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
such funds collected shall be
used for the purposes described
in the second sentence of
paragraph (2)(A)(ii).
``(VIII) Indexing amounts.--For
years beginning after 2010, each of the
amounts specified in subclauses (II)
and (III) shall be subject to periodic
increase in accordance with the
provisions of section 5 of the Federal
Civil Penalties Inflation Adjustment
Act of 1990 (Public Law 101-410; 28
U.S.C. 2461 note).
``(IX) 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 (VII)) 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. NATIONAL INDEPENDENT MONITORING REQUIREMENTS.
(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 monitoring requirements.--
``(A) In general.--Not later than 1 year after the
date of enactment of this paragraph, the Secretary
shall, in consultation with the Inspector General of
the Department of Health and Human Services, evaluate
the potential benefit and feasibility of applying
independent monitoring requirements to interstate and
large intrastate chains of skilled nursing facilities.
``(B) Considerations.--The feasibility evaluation
under subparagraph (A) shall consider the following:
``(i) The need for independent monitoring
requirements to address and remedy patterns of
chronic poor performance, based on quality
deficiencies, high staff turnover rates, or
poor performance on other metrics of quality of
care.
``(ii) Criteria for selecting interstate
and large intrastate chains subject to
independent monitoring requirements,
including--
``(I) chains that have had a number
of the facilities of such chain
enrolled in the `Special Focus Facility
program' (or a successor program)
established by the Centers for Medicare
& Medicaid Services during the
preceding 3 years that exceeds a
threshold number specified by the
Secretary;
``(II) chains experiencing
financial problems that may be linked
to serious quality deficiencies;
``(III) chains experiencing low
staffing levels in relation to the
number and case mix of patients or
turnover rates linked to serious
quality deficiencies; and
``(IV) chains that have a record of
chronic poor performance;
and including other appropriate criteria.
``(iii) Responsibilities of independent
monitors, including--
``(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 direct care 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;
and
``(V) other responsibilities of
independent monitors;
``(iv) Other implementation issues,
including timelines, processes, and enforcement
mechanisms for implementation of independent
monitor recommendations and corrective action
plans.''.
(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:
``(7) National independent monitoring requirements.--
``(A) In general.--Not later than 1 year after the
date of enactment of this paragraph, the Secretary
shall, in consultation with the Inspector General of
the Department of Health and Human Services, evaluate
the potential benefit and feasibility of applying
independent monitoring requirements to interstate and
large intrastate chains of nursing facilities.
``(B) Considerations.--The feasibility evaluation
under subparagraph (A) shall consider the following:
``(i) The need for independent monitoring
requirements to address and remedy patterns of
chronic poor performance, based on quality
deficiencies, high staff turnover rates, or
poor performance on other metrics of quality of
care.
``(ii) Criteria for selecting interstate
and large intrastate chains subject to
independent monitoring requirements,
including--
``(I) chains that have had a number
of the facilities of such chain
enrolled in the `Special Focus Facility
program' (or a successor program)
established by the Centers for Medicare
& Medicaid Services during the
preceding 3 years that exceeds a
threshold number specified by the
Secretary;
``(II) chains experiencing
financial problems that may be linked
to serious quality deficiencies;
``(III) chains experiencing low
staffing levels in relation to the
number and case mix of patients or
turnover rates linked to serious
quality deficiencies; and
``(IV) chains that have a record of
chronic poor performance;
and including other appropriate criteria.
``(iii) Responsibilities of independent
monitors, including--
``(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 direct care 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;
and
``(V) other responsibilities of
independent monitors;
``(iv) Other implementation issues,
including timelines, processes, and enforcement
mechanisms for implementation of independent
monitor recommendations and corrective action
plans.''.
SEC. 203. GAO STUDIES AND REPORTS ON TEMPORARY MANAGEMENT.
(a) In General.--The Comptroller General of the United States (in
this section referred to as the ``Comptroller General'') shall conduct
a study on--
(1) 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
(2) barriers to the appointment of such temporary
management.
(b) 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 subsection (a),
together with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
(c) 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 subsection (b).
SEC. 204. 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
license holder 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, best interests, and
preferences 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 the
license holder 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, best interests, and
preferences 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. 205. 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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