II
111th CONGRESS
1st Session
S. 647
IN THE SENATE OF THE UNITED STATES
March 19, 2009
Mr. Grassley (for himself and Mr. Kohl) introduced the following bill; which was read twice and referred to the Committee on Finance
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.
Short title; table of contents
Short title
This Act may be cited
as the Nursing Home Transparency and
Improvement Act of 2009
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I—Improving transparency of information
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. GAO study and report on the relative financial status and performance of special focus facilities.
Sec. 203. National independent monitor pilot program.
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.
Findings
Congress makes the following findings:
The Nursing Home Reform Act of 1987 remains one of the strongest laws in the United States to protect the health, safety, and quality of life of elderly people and individuals with disabilities who live in nursing homes.
The nursing home industry has changed dramatically in the 21 years since the enactment of the Nursing Home Reform Act of 1987, with real estate asset holdings frequently separated from operations in a manner that can frustrate efforts by regulators to hold parent companies accountable for the quality of services that are provided in their facilities.
Although the Centers for Medicare & Medicaid Services reimburses nursing homes for services each year in an amount in excess of $75,000,000,000, the agency does not always know who the owners and operators of the facilities are.
Greater transparency and accountability in the nursing home industry can be achieved by simply requiring publicly and privately owned nursing homes to disclose corporate entities that own individual nursing homes, and other entities with which individual nursing homes have key financial, operational, and management relationships.
Transparency and accountability can be further strengthened by development of an independent monitor pilot program that would allow the Centers for Medicare & Medicaid Services to examine the management of certain nursing home chains that have a record of poor performance and to identify the root causes of quality and safety problems occurring in individual nursing homes.
The
Nursing Home Compare
Medicare website would be significantly
improved by the inclusion of timely, auditable information that is derived from
payroll data about the direct care staffing levels in all nursing homes across
the United States. Inclusion of information about staffing turnover and
retention rates in nursing homes, which are closely linked to the quality and
consistency of services, would also provide consumers with valuable
information.
According to the Alzheimer's Association, an estimated 70 percent of current residents of nursing homes have some degree of cognitive impairment and direct care staff who provide services to such residents would benefit from dementia management and abuse prevention instruction as part of their training.
When nursing
homes elect to close, residents and families generally require help finding
another suitable residence and to minimize transfer trauma
. Good
resident outcomes are achievable when nursing homes provide sufficient written
notice and develop a relocation plan for each resident, and when State
officials take responsibility for assuring that each resident is transferred to
the most appropriate facility or other community setting.
Improving transparency of information
Required disclosure of ownership and additional disclosable parties information
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:
Required disclosure of ownership and additional disclosable parties information
Disclosure
A facility shall have the information described in paragraph (2) available—
during the period beginning on the date of the enactment of this subsection and ending on the date such information is made available to the public under section 101(b) of the Nursing Home Transparency and Improvement Act of 2009, 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
beginning on the effective date of the final regulations promulgated under paragraph (3)(A), for reporting such information in accordance with such final regulations.
Information described
In general
The following information is described in this paragraph:
The information described in subsections (a) and (b), subject to subparagraph (C).
The identity of and information on—
each member of the governing body of the facility, including the name, title, and period of service of each such member;
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
each person or entity who is an additional disclosable party of the facility.
The organizational structure of each additional disclosable party of the facility and a description of the relationship of each such additional disclosable party to the facility and to one another.
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), or (iii) of subparagraph (A), the facility may provide such Form or such information submitted to meet the requirements of paragraph (1).
Special rule
In applying subparagraph (A)(i)—
with respect to subsections (a) and (b),
ownership or control interest
shall include direct or indirect
interests, including such interests in intermediate entities; and
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.
Reporting
In general
Not later than the date that is 2 years after the date of the 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, to the maximum extent practicable (as determined by the facility), accurate and current.
Guidance
The Secretary shall provide guidance and technical assistance to States on how to adopt the standardized format under subparagraph (A).
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 the enactment of this subsection.
Definitions
In this subsection:
Additional disclosable party
The term additional disclosable party means, with respect to a facility, any person or entity who—
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;
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;
lends funds or provides a financial guarantee to the facility in an amount which is equal to or exceeds $50,000; or
provides management or administrative services, management or clinical consulting services, or accounting or financial services to the facility.
Facility
The term facility means a disclosing entity which is—
a skilled nursing facility (as defined in section 1819(a)); or
a nursing facility (as defined in section 1919(a)).
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.
Organizational structure
The term organizational structure means, in the case of—
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;
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);
a general partnership, the partners of the general partnership;
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;
a trust, the trustees of the trust;
an individual, contact information for the individual; and
any other person or entity, such information as the Secretary determines appropriate.
.
Public availability of information
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 accordance with procedures established by the Secretary.
Definitions
In this subsection:
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services.
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)).
Conforming amendments
In general
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).
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).
Effective date
The amendments made by paragraph (1) shall take effect on the date on which the Secretary makes the information described in subsection (b)(1) available to the public under such subsection.
Accountability requirements
Effective compliance and ethics programs
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:
Compliance and ethics programs
Requirement
On or after the date that is 36 months
after the date of the 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).
Development of regulations
In general
Not later than the date that is 2 years after such date of the enactment, the Secretary, working jointly 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.
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 unit nursing home chains.
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 to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
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—
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
includes at least the required components specified in clause (iv).
Required components of program
The required components of a compliance and ethics program of an organization are the following:
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.
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.
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.
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.
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.
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.
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.
The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
.
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:
Compliance and ethics program
Requirement
On
or after the date that is 36 months after the date of the 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).
Development of regulations
In general
Not later than the date that is 2 years after such date of the 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.
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 unit nursing home chains.
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 to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
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—
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
includes at least the required components specified in clause (iv).
Required components of program
The required components of a compliance and ethics program of an organization are the following:
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.
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.
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.
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.
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.
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.
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.
The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
.
Quality assurance and performance improvement program
Skilled nursing facilities
Section 1819(b)(1)(B) of the Social Security Act (42 U.S.C. 1395i–3(b)(1)(B)) is amended—
by striking
Assurance.—A skilled nursing facility
and
inserting “Assurance and
Quality Assurance and Performance Improvement Program.—
In general
A skilled nursing facility
; and
by adding at the end the following new clause:
Quality assurance and performance improvement program
In general
Not later than December 31, 2011, the Secretary shall
establish and implement a quality assurance and performance improvement program
(in this subparagraph referred to as the QAPI program
) for
skilled nursing facilities, including multi unit chains of such facilities.
Under the QAPI program, the Secretary shall establish standards relating to
quality assurance and performance improvement with respect to such facilities
and provide technical assistance to such facilities on the development of best
practices in order to meet such standards. Not later than 1 year after the date
on which the regulations are promulgated under subclause (II), a skilled
nursing facility must submit to the Secretary a plan for the facility to meet
such standards and implement such best practices, including how to coordinate
the implementation of such plan with quality assessment and assurance
activities conducted under clause (i).
Regulations
The Secretary shall promulgate regulations to carry out this clause.
.
Nursing facilities
Section 1919(b)(1)(B) of the Social Security Act (42 U.S.C. 1396r(b)(1)(B)) is amended—
by striking
Assurance.—A nursing facility
and
inserting “Assurance and
Quality Assurance and Performance Improvement Program.—
In general
A nursing facility
; and
by adding at the end the following new clause:
Quality assurance and performance improvement program
In general
Not later than December 31, 2011, the Secretary shall
establish and implement a quality assurance and performance improvement program
(in this subparagraph referred to as the QAPI program
) for
nursing facilities, including multi unit chains of such facilities. Under the
QAPI program, the Secretary shall establish standards relating to quality
assurance and performance improvement with respect to such facilities and
provide technical assistance to such facilities on the development of best
practices in order to meet such standards. Not later than 1 year after the date
on which the regulations are promulgated under subclause (II), a nursing
facility must submit to the Secretary a plan for the facility to meet such
standards and implement such best practices, including how to coordinate the
implementation of such plan with quality assessment and assurance activities
conducted under clause (i).
Regulations
The Secretary shall promulgate regulations to carry out this clause.
.
Nursing home compare Medicare website
Skilled nursing facilities
In general
Section 1819 of the Social Security Act (42 U.S.C. 1395i–3) is amended—
by redesignating subsection (i) as subsection (j); and
by inserting after subsection (h) the following new subsection:
Nursing home compare website
Inclusion of additional information
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:
Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities.
Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and links to the facility plan of correction or other response to such report.
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.
A summary of information on enforcement that includes the number of complaints, including the number of such complaints which the Secretary finds are substantiated, and remedies proposed and imposed by the Secretary or a State with respect to a skilled nursing facility during the preceding 3 years.
A summary of expenditures by skilled nursing facilities for wages and benefits of direct care staff (based on information submitted under section 1888(f)).
Deadline for provision of information
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 the enactment of this subsection.
Exception
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 requirement under subsection (b)(8)(C)(ii) is implemented.
Review and modification of website
In general
The Secretary shall establish a process—
to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
Consultation
In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
State long-term care ombudsman programs;
consumer advocacy groups;
provider stakeholder groups; and
any other representatives of programs or groups the Secretary determines appropriate.
.
Timeliness of submission of survey and certification information
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:
Submission of survey and certification information to the secretary
In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a skilled nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable.
.
Effective date
The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
Nursing facilities
In general
Section 1919 of the Social Security Act (42 U.S.C. 1396r) is amended—
by redesignating subsection (i) as subsection (j); and
by inserting after subsection (h) the following new subsection:
Nursing home compare website
Inclusion of additional information
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:
Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities.
Links to State Internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and links to the facility plan of correction or other response to such report.
The standardized complaint form developed under subsection (f)(10), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
A summary of information on enforcement that includes the number of complaints, including the number of such complaints which the Secretary finds are substantiated, and remedies proposed and imposed by the Secretary or a State with respect to a nursing facility during the preceding 3 years.
Deadline for provision of information
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 the enactment of this subsection.
Exception
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 requirement under subsection (b)(8)(C)(ii) is implemented.
Review and modification of website
In general
The Secretary shall establish a process—
to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
Consultation
In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
State long-term care ombudsman programs;
consumer advocacy groups;
provider stakeholder groups; and
any other representatives of programs or groups the Secretary determines appropriate.
.
Timeliness of submission of survey and certification information
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:
Submission of survey and certification information to the secretary
In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification made respecting a nursing facility (including any enforcement actions taken by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable.
.
Effective date
The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
Availability of reports on surveys, certifications, and complaint investigations
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:
Availability of survey, certification, and complaint investigation reports
A skilled nursing facility must—
have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
.
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:
Availability of survey, certification, and complaint investigation reports
A nursing facility must—
have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
.
Effective date
The amendments made by this subsection shall take effect 1 year after the date of the enactment of this Act.
Guidance to states on form 2567 State inspection reports and complaint investigation reports
Guidance
The Secretary shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility's plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities.
Definitions
In this subsection:
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services.
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)).
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:
Reporting of direct care expenditures
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 the 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).
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.
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 Medicaid and CHIP Payment and Access 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:
Spending on direct care services (including nursing, therapy, and medical services).
Spending on indirect care (including housekeeping and dietary services).
Capital assets (including building and land costs).
Administrative services costs.
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.
.
Standardized complaint form
Skilled nursing facilities
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:
Standardized complaint form
The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a skilled nursing facility.
.
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:
Complaint forms and resolution processes
Complaint forms
The State must make the standardized complaint form developed under subsection (f)(8) available upon request to—
a resident of a skilled nursing facility; and
any person acting on the resident’s behalf.
Complaint resolution process
The State must establish a complaint resolution process in order to ensure that the legal representative of a resident of a skilled nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if they have complained about the quality of care provided by the facility or other issues relating to the facility. Such complaint resolution process shall include—
procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
procedures to determine the likely severity of a complaint and for the investigation of the complaint; and
deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation.
Rule of construction
Nothing in this paragraph shall be construed as preventing a resident of a skilled nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(8) (including submitting a complaint orally).
.
Nursing facilities
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:
Standardized complaint form
The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a nursing facility.
.
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:
Complaint forms and resolution processes
Complaint forms
The State must make the standardized complaint form developed under subsection (f)(10) available upon request to—
a resident of a nursing facility; and
any person acting on the resident’s behalf.
Complaint resolution process
The State must establish a complaint resolution process in order to ensure that the legal representative of a resident of a nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if they have complained about the quality of care provided by the facility or other issues relating to the facility. Such complaint resolution process shall include—
procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
procedures to determine the likely severity of a complaint and for the investigation of the complaint; and
deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation.
Rule of construction
Nothing in this paragraph shall be construed as preventing a resident of a nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(10) (including submitting a complaint orally).
.
Effective date
The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
Ensuring staffing accountability
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:
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 ombudsman 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—
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);
include resident census data and information on resident case mix;
include a regular reporting schedule; and
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.
.
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:
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 ombudsman 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—
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);
include resident census data and information on resident case mix;
include a regular reporting schedule; and
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.
.
Targeting Enforcement
Civil money penalties
Skilled nursing facilities
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—
by striking
Penalties.—The Secretary
and inserting
“Penalties.—
In general
Subject to subclause (II), the Secretary
; and
by adding at the end the following new subclauses:
Reduction of civil money penalties in certain circumstances
Subject to subclause (III), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
Prohibitions on reduction for certain deficiencies
Repeat deficiencies
The Secretary may not reduce the amount of a penalty under subclause (II) if the Secretary had reduced a penalty imposed on the facility in the preceding year under such subclause with respect to a repeat deficiency.
Certain other deficiencies
The Secretary may not reduce the amount of a penalty under subclause (II) if the penalty is imposed on the facility for a deficiency that is found to result in a pattern of harm or widespread harm, immediately jeopardizes the health or safety of a resident or residents of the facility, or results in the death of a resident of the facility.
Collection of civil money penalties
In the case of a civil money penalty imposed under this clause, the Secretary shall issue regulations that—
subject to item (cc), not later than 30 days after the imposition of the penalty, provide for the facility to have the opportunity to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty;
in the case where the penalty is imposed for each day of noncompliance, provide that a penalty may not be imposed for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary 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;
may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of 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), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities implementing quality assurance programs, the appointment of temporary management firms, and other activities approved by the Secretary).
.
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)(IV),
after (i),
.
Nursing facilities
In general
Section 1919(h)(3)(C)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is amended—
by striking
Penalties.—The Secretary
and inserting
“Penalties.—
In general
Subject to subclause (II), the Secretary
; and
by adding at the end the following new subclauses:
Reduction of civil money penalties in certain circumstances
Subject to subclause (III), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
Prohibitions on reduction for certain deficiencies
Repeat deficiencies
The Secretary may not reduce the amount of a penalty under subclause (II) if the Secretary had reduced a penalty imposed on the facility in the preceding year under such subclause with respect to a repeat deficiency.
Certain other deficiencies
The Secretary may not reduce the amount of a penalty under subclause (II) if the penalty is imposed on the facility for a deficiency that is found to result in a pattern of harm or widespread harm, immediately jeopardizes the health or safety of a resident or residents of the facility, or results in the death of a resident of the facility.
Collection of civil money penalties
In the case of a civil money penalty imposed under this clause, the Secretary shall issue regulations that—
subject to item (cc), not later than 30 days after the imposition of the penalty, provide for the facility to have the opportunity to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty;
in the case where the penalty is imposed for each day of noncompliance, provide that a penalty may not be imposed for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary 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;
may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of 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), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities implementing quality assurance programs, the appointment of temporary management firms, and other activities approved by the Secretary).
.
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)(IV),
after
(i),
.
Effective date
The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
GAO study and report on the relative financial status and performance of special focus facilities
Study
In general
The Comptroller General of the United States shall conduct a study on the financial status, resident care, and performance of skilled nursing facilities and nursing facilities in the Special Focus Facility program (or a successor program) established by the Centers for Medicare & Medicaid Services relative to a comparable sample of facilities that are not in such program. Such study shall include an examination of the ownership and control interests, and any affiliated parties, of the facilities studied (as applicable).
Definitions
In this section:
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services.
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)).
Report
Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress and the Secretary a report 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.
National independent monitor pilot program
Establishment
In general
The Secretary shall establish a pilot program to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.
Selection
The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program under this section from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Duration
The Secretary shall conduct the pilot program under this section for a 2-year period.
Implementation
The Secretary shall implement the pilot program under this section not later than 1 year after the date of the enactment of this Act.
Requirements
The Secretary shall evaluate chains selected to participate in the pilot program under this section based on criteria selected by the Secretary, including where evidence suggests that 1 or more facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes 1 or more facilities participating in the “Special Focus Facility” program (or a successor program) or 1 or more facilities with a record of repeated serious safety and quality of care deficiencies.
Responsibilities
An independent monitor that enters into a contract with the Secretary to participate in the conduct of the pilot program under this section shall—
conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities;
undertake sustained oversight of the chain, whether publicly or privately held, to involve the owners of, and any additional disclosable party with respect to a facility of, the chain in facilitating compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;
analyze the management structure, distribution of expenditures, and nurse staffing levels of facilities of the chain in relation to resident census, staff turnover rates, and tenure;
report 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
publish the results of such reviews, analyses, and oversight.
Implementation of recommendations
Receipt of finding by chain
Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the pilot program shall submit to the independent monitor a report—
outlining corrective actions the chain will take to implement the recommendations in such report; or
indicating that the chain will not implement such recommendations, and why it will not do so.
Receipt of report by independent monitor
Not later than 10 days after receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State or States, as appropriate, containing such final recommendations.
Cost of appointment
A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the pilot program under this section. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary).
Waiver authority
The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the pilot program under this section.
Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section.
Definitions
In this section:
Additional disclosable party
The term additional disclosable party has the meaning given such term in section 1124(c)(5)(A) of the Social Security Act, as added by section 101(a).
Facility
The term facility means a skilled nursing facility or a nursing facility.
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
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)).
Evaluation and report
Evaluation
The Inspector General of the Department of Health and Human Services shall evaluate the pilot program conducted under this subsection. Such evaluation shall—
determine whether the independent monitor program should be established on a permanent basis; and
if the Inspector General determines that such program should be established on a permanent basis, recommend appropriate procedures and mechanisms for such establishment.
Report
Not later than 180 days after the completion of the pilot program under this section, the Inspector General shall submit to Congress and the Secretary a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate.
Notification of facility closure
Skilled nursing facilities
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:
Notification of Facility Closure
In general
Any individual who is the administrator of a skilled nursing facility must—
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—
subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
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;
ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
Relocation
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.
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.
.
Conforming amendments
Section 1819(h)(4) of the Social Security Act (42 U.S.C. 1395i–3(h)(4)) is amended—
in the first
sentence, by striking the Secretary shall terminate
and
inserting the Secretary, subject to subsection (c)(7), shall
terminate
; and
in the second
sentence, by striking subsection (c)(2)
and inserting
paragraphs (2) and (7) of subsection (c)
.
Nursing facilities
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:
Notification of Facility Closure
In general
Any individual who is an administrator of a nursing facility must—
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—
subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
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;
ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
Relocation
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.
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.
.
Effective date
The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
National demonstration projects on culture change and use of information technology in nursing homes
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.
Conduct of demonstration projects
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.
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.
Duration and implementation
Duration
The demonstration projects shall each be conducted for a period not to exceed 3 years.
Implementation
The demonstration projects shall each be implemented not later than 1 year after the date of the enactment of this Act.
Definitions
In this section:
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services.
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)).
Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section.
Report
Not later than 9 months after the completion of the demonstration project, the Secretary shall submit to Congress a report on such project, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
Improving staff training
Dementia and abuse prevention training
Skilled nursing facilities
In general
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)
.
Clarification of definition of nurse aide
Section 1819(b)(5)(F) of the Social Security Act (42 U.S.C. 1395i–3(b)(5)(F)) is amended by adding at the end the following flush sentence:
Such term includes an individual who provides such services through an agency or under a contract with the facility.
.
Nursing facilities
In general
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 training
before , (II)
.
Clarification of definition of nurse aide
Section 1919(b)(5)(F) of the Social Security Act (42 U.S.C. 1396r(b)(5)(F)) is amended by adding at the end the following flush sentence:
Such term includes an individual who provides such services through an agency or under a contract with the facility.
.
Effective date
The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
Study and report on training required for certified nurse aides and supervisory staff
Study
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:
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).
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.
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.
Definitions
In this section:
Nurse aide
The term nurse aide has the meaning given such term in sections 1819(b)(5)(F) and 1919(b)(5)(F) of the Social Security Act (42 U.S.C. 1395i–3(b)(5)(F); 1396r(b)(5)(F)), as amended by section 301.
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)).
Secretary
The term Secretary means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
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)).
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.