[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4614 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4614

  To amend title XVIII of the Social Security Act to require skilled 
  nursing facilities furnishing services to Medicare beneficiaries to 
submit data to the Secretary of Health and Human Services with respect 
to nursing staff levels of the facility, to require posting of staffing 
information by facilities and the Secretary, to assess the adequacy of 
training requirements for certified nurse aides, and provide for grants 
    to improve the quality of care furnished in nursing facilities.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 2000

Mr. Stark (for himself, Ms. Eshoo, Mr. George Miller of California, Ms. 
Woolsey, Ms. Pelosi, Ms. Lee, and Mr. Lantos) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
addition to the Committee on 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 title XVIII of the Social Security Act to require skilled 
  nursing facilities furnishing services to Medicare beneficiaries to 
submit data to the Secretary of Health and Human Services with respect 
to nursing staff levels of the facility, to require posting of staffing 
information by facilities and the Secretary, to assess the adequacy of 
training requirements for certified nurse aides, and provide for grants 
    to improve the quality of care furnished in nursing 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 Staff 
Accountability and Training Improvement Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title.
      TITLE I--INFORMATION ON NURSING STAFF IN NURSING FACILITIES

Sec. 101. Submission of nursing staff level data to the secretary.
Sec. 102. Information on nursing facility staffing.
Sec. 103. Direct spending for administrative expenses of State agencies 
                            determining compliance by providers of 
                            services with conditions of participation.
Sec. 104. Comprehensive report on certified nurse aide training.
Sec. 105. Effective date.
 TITLE II--GRANTS TO IMPROVE QUALITY OF NURSING HOME AND LONG-TERM CARE

Sec. 201. Improvement of training of long-term care professionals and 
                            workers.
Sec. 202. Upward mobility of long-term care workers.
Sec. 203. Retention of long-term care professionals and workers in 
                            medically underserved areas.
Sec. 204. Improvement in worker safety.
Sec. 205. Demonstration program to implement quality improvement models 
                            in nursing facility settings.

      TITLE I--INFORMATION ON NURSING STAFF IN NURSING FACILITIES

SEC. 101. SUBMISSION OF NURSING STAFF LEVEL DATA TO THE SECRETARY.

    (a) Medicare.--
            (1) In general.--Section 1819(b) of the Social Security Act 
        (42 U.S.C. 1395i-3(b)) is amended by adding at the end the 
        following new paragraph:
            ``(8) Submission of data on staffing levels.--
                    ``(A) In general.--A skilled nursing facility shall 
                submit to the Secretary, in a form and manner 
                determined by the Secretary, such data for a covered 
                period (as defined in subparagraph (C)) with respect to 
                nursing staff as is necessary for the Secretary to 
                determine whether a resident of the skilled nursing 
                facility receives the level of care commensurate with 
                the assessment of the resident under this subsection. 
                Such data shall include the total number of nursing 
                staff hours furnished during each covered period by the 
                facility to residents for which payment is made under 
                section 1888(e) broken down by total certified nurse 
                aide hours, total licensed practical or vocational 
                nurse hours, and total registered nurse hours.
                    ``(B) Adjustment in payment amount for inadequate 
                staffing.--If the nursing staff data discloses that the 
                aggregate nursing staff hours furnished during the 
                covered period by the facility for residents for which 
                payment is made under section 1888(e) during the period 
                is less than the aggregate amount corresponding to the 
                nursing staff hours which is the basis of the case mix 
                reimbursement (under section 1888(e)(4)(G)(i)) for such 
                residents for the facility for that period, the 
                Secretary shall make proportionate adjustments in the 
                payment amounts determined under section 1888(e) to the 
                facility.
                    ``(C) Covered period defined.--
                            ``(i) In general.--For purposes of this 
                        paragraph, the term `covered period' means the 
                        lesser of 32 days or the facility billing 
                        period described in clause (ii).
                            ``(ii) Facility billing period described.--
                        A facility billing period referred to in clause 
                        (i) the aggregate number of days between 
                        periods that the Secretary makes payment for 
                        claims for services furnished by the facility 
                        under this title.''.
            (2) Inclusion of nursing staffing levels in annual 
        survey.--Section 1819(g)(2)(A)(ii) of such Act (42 U.S.C. 
        1395i-3(g)(2)(A)(ii)) is amended--
                    (A) by striking ``and'' at the end of subclause 
                (II);
                    (B) by striking the period at the end of subclause 
                (III) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(IV) a review of the sufficiency 
                                and distribution of staffing in the 
                                skilled nursing facility to meet the 
                                needs of residents 24 hours a day, 7 
                                days a week.''.
            (3) Development of standard cost reporting form for all 
        skilled nursing facilities.--Section 1888(e) of the Social 
        Security Act (42 U.S.C. 1395yy(e)) is amended by adding at the 
        end the following new paragraph:
            ``(13) Required uniform cost reporting forms.--For cost 
        reporting periods beginning on or after October 1, 2001, a 
        skilled nursing facility shall submit to the Secretary a cost 
        report for the cost reporting period involved using the 
        standard, uniform cost reporting form developed by the 
        Secretary for such purpose. Such standard, uniform form shall 
        be developed in a manner to enable the Secretary to assess 
        amounts of direct patient care furnished by nursing staff of 
the facility and to determine whether payments made for such care are 
appropriate.''.
    (b) Medicaid.--
            (1) Analysis of spending for patient care in audits of 
        nursing facility cost reports.--
                    (A) In general.--A State shall carry out periodic 
                audits of cost reports submitted by a nursing facility 
                (as defined in section 1919(a) of the Social Security 
                Act (42 U.S.C. 1396r(a))) operating in the State. Such 
                audits shall (i) determine the aggregate expenditures 
                made by the nursing facility during the cost reporting 
                period on direct patient care furnished by licensed 
                health professionals (as defined in subparagraph (G) of 
                section 1919(b)(5) of such Act (42 U.S.C. 1396r(b)(5))) 
                and by nurse aides (as defined in subparagraph (F) of 
                such section) and (ii) compare such aggregate 
                expenditures to payments made by the State for such 
                direct patient care.
                    (B) Study.--The Secretary of Health and Human 
                Services shall conduct a study to determine the 
                feasibility of developing and administering a 
                standardized, uniform cost reporting form for all 
                nursing facilities furnishing services for which 
                payment is made under title XIX of the Social Security 
                Act. Any such form should enable the Secretary to 
                assess the amount of direct patient care referred to in 
                subparagraph (A) furnished by each nursing facility and 
                to determine whether payments made for such direct 
                patient care are appropriate.
            (2) Inclusion of nursing staffing levels in annual 
        survey.--Section 1919(g)(2)(A)(ii) of the Social Security Act 
        (42 U.S.C. 1396r(g)(2)(A)(ii)) is amended--
                    (A) by striking ``and'' at the end of subclause 
                (II);
                    (B) by striking the period at the end of subclause 
                (III) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(IV) a review of the sufficiency 
                                and distribution of staffing in the 
                                skilled nursing facility to meet the 
                                needs of residents 24 hours a day, 7 
                                days a week.''.

SEC. 102. INFORMATION ON NURSING FACILITY STAFFING.

    (a) Medicare Amendments.--
            (1) In general.--Section 1819(b) of the Social Security Act 
        (42 U.S.C. 1395i-3(b)), as amended by section 2(a), is further 
        amended by adding at the end the following new paragraph:
            ``(9) Information on nurse staffing.--
                    ``(A) In general.--A skilled nursing facility shall 
                post daily for each nursing unit of the facility and 
                for each shift the current number of licensed and 
                unlicensed nursing staff directly responsible for 
                resident care and the current ratios of residents to 
                staff, stated separately for the ratio of the number of 
                residents to such licensed nursing staff and the ratio 
                of the number of residents to such unlicensed nursing 
                staff. The information shall be displayed in a uniform 
                manner and in a clearly visible place. The facility 
                shall also post in a clearly visible place annual 
                average daily staffing ratios per shift for the last 
                cost reporting period.
                    ``(B) Publication of data.--
                            ``(i) In general.--A skilled nursing 
                        facility shall, upon request, make available to 
                        the public nursing staff data to the same 
extent and in the same manner as cost reporting information.
                            ``(ii) Internet.--Not later than 60 days 
                        after the date of completion of an annual 
                        survey under subsection (g)(2), the Secretary 
                        shall provide for the publication on the 
                        Internet Site of the Department of Health and 
                        Human Services known as Nursing Home Compare 
                        the facility-specific nursing staff information 
                        collected under such survey. The Secretary 
                        shall update such information periodically.''.
            (2) Penalty for failure to post required information.--
        Section 1819(h)(2) of such Act (42 U.S.C. 1395i-3(h)(2)), is 
        amended by adding at the end the following new subparagraph:
                    ``(F) Mandatory civil money penalty for failure to 
                post required information.--Notwithstanding any other 
                provision of law, the Secretary shall impose a civil 
                monetary penalty upon a skilled nursing facility that 
                fails to meet the posting requirement of subsection 
                (b)(9). The penalty shall be in the amount of $1,000 
                for each day upon which the facility fails to meet 
                fully such requirement. The provisions of section 1128A 
                of the Social Security Act (other than subsections (a) 
                and (b)) shall apply to civil money penalties under 
                this subparagraph in the same manner as they apply to a 
                penalty or proceeding under section 1128A(a) of such 
                Act.''.
    (b) Medicaid Amendments.--
            (1) In general.--Section 1919(b) of the Social Security Act 
        (42 U.S.C. 1396r(b)) is amended by adding at the end the 
        following new paragraph:
            ``(8) Information on nurse staffing.--
                    ``(A) In general.--A skilled nursing facility shall 
                post daily for each nursing unit of the facility and 
                for each shift the current number of licensed and 
                unlicensed nursing staff directly responsible for 
                resident care and the current ratios of residents to 
                staff, stated separately for the ratio of the number of 
                residents to such licensed nursing staff and the ratio 
                of the number of residents to such unlicensed nursing 
                staff. The information shall be displayed in a uniform 
                manner and in a clearly visible place. The facility 
                shall also post in a clearly visible place annual 
                average daily staffing ratios per shift for the last 
                cost reporting period.
                    ``(B) Publication of data.--
                            ``(i) In general.--A skilled nursing 
                        facility shall, upon request, make available to 
                        the public nursing staff data to the same 
                        extent and in the same manner as cost reporting 
                        information.
                            ``(ii) Internet.--Not later than 60 days 
                        after the date of completion of an annual 
                        survey under subsection (g)(2), the Secretary 
                        shall provide for the publication on the 
                        Internet Site of the Department of Health and 
                        Human Services known as Nursing Home Compare 
                        the facility-specific nursing staff information 
                        collected under such survey. The Secretary 
                        shall update such information periodically.''.
            (2) Section 1919(h)(3) of such Act (42 U.S.C. 1396r(h)(3)), 
        is amended by adding at the end the following new subparagraph:
                    ``(E) Mandatory civil money penalty for failure to 
                post required information.--Notwithstanding any other 
                provision of law, the Secretary shall impose a civil 
                monetary penalty upon a nursing facility that fails to 
                meet the posting requirement of subsection (b)(9). The 
                penalty shall be in the amount of $1,000 for each day 
                upon which the facility fails to meet fully such 
                requirement. The provisions of section 1128A of the 
                Social Security Act (other than subsections (a) and 
                (b)) shall apply to civil money penalties under this 
                subparagraph in the same manner as they apply to a 
                penalty or proceeding under section 1128A(a) of such 
                Act. This subparagraph shall not apply to a failure for 
                which a civil money penalty is imposed under section 
                1819(h)(2)(F).''.

SEC. 103. DIRECT SPENDING FOR ADMINISTRATIVE EXPENSES OF STATE AGENCIES 
              DETERMINING COMPLIANCE BY PROVIDERS OF SERVICES WITH 
              CONDITIONS OF PARTICIPATION.

    (a) In General.--Section 1864 of the Social Security Act (42 U.S.C. 
1395aa) is amended by adding at the end the following new subsection:
    ``(f) Appropriation of Certain Funds To Administer This Section.--
The Secretary shall pay expenses incurred in the administration of this 
section from funds in the Federal Hospital Insurance Trust Fund 
(established under section 1817) and the Federal Supplementary Medical 
Insurance Trust Fund (established under section 1841), in such amounts 
from each of such trust funds as the Secretary shall deem to be fair 
and equitable after taking into consideration the expenses attributable 
to the administration of this section with respect to items and 
services furnished under this title attributable to parts A and B and 
under title XI with respect to those parts, without regard to amounts 
appropriated in advance in appropriations Acts, in the same manner as 
payments are made for services furnished directly to individuals 
entitled to benefits under this title. The Secretary shall make such 
transfers of monies between such trust funds as may be appropriate to 
settle accounts between them in cases where expenses properly payable 
from one such trust fund have been paid from the other trust fund.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect October 1, 2000.

SEC. 104. COMPREHENSIVE REPORT ON CERTIFIED NURSE AIDE TRAINING.

    Not later than 18 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall submit to 
Congress a comprehensive report on training of certified nurse aides, 
and shall include in that comprehensive report recommendations for the 
following:
            (1) Whether training standards in effect on the date of the 
        enactment of this Act for certified nurse aides should be 
        increased from 75 hours (the Federal minimum number of hours of 
        training for certification) to 160 hours, or some other minimum 
        standard.
            (2) Whether Federal curriculum standards should require 
        more focus on each of the following:
                    (A) The recognition of the symptoms of 
                malnutrition, dehydration, pain, confusion, and 
                anxiety.
                    (B) The prevention and treatment of infections, bed 
                sores, incontinence, and lack of mobility.
                    (C) Appropriate strategies for preventing physical 
                and mental abuse of residents of nursing facilities, 
                such as conflict resolution and stress management.
                    (D) Appropriate care for residents diagnosed with 
                dementia or dementia-related disease.
                    (E) Care for residents with diminished visual or 
                audio acuity.

SEC. 105. EFFECTIVE DATE.

    The amendments made by sections 101 and 102 take effect on the 
first day of the first month that begins at least 6 months after the 
date of the enactment of this Act.

 TITLE II--GRANTS TO IMPROVE QUALITY OF NURSING HOME AND LONG-TERM CARE

SEC. 201. IMPROVEMENT OF TRAINING OF LONG-TERM CARE PROFESSIONALS AND 
              WORKERS.

    (a) Grant Program.--
            (1) Establishment of training centers.--The Secretary 
        shall, in accordance with the provisions of this section, award 
        grants to a qualified entity to establish education and 
        training programs for individuals who furnish direct resident 
        care services in nursing facilities, including registered 
        professional nurses, licensed practical nurses, and certified 
        nurse aides.
            (2) Discretion to award grants to existing training 
        programs.--The Secretary may award grants to fund programs of 
        such education and training carried out by the following:
                    (A) A qualified entity.
                    (B) An accredited educational institution.
                    (C) An institutional health care provider, 
                including a nursing facility.
            (3) Priority of grant awards.--In awarding grants under 
        this section, the Secretary shall give priority to nursing 
        facilities with approved applications filed in partnership with 
        labor representatives.
            (4) Deadline for initial grant awards.--The Secretary shall 
        award grants under this section by not later than 6 months 
        after the date of the enactment of this Act.
    (b) Applications.--
            (1) Applications required.--Each qualified or other entity 
        referred to in subsection (a) that wishes to receive a grant 
        under this section shall submit an application at such time, in 
        such form, and complete with such information as the Secretary 
        shall by regulation require, except that any such application 
        shall include at least--
                    (A) a statement of the objectives for which the 
                grant is sought; and
                    (B) a description of the types of programs and 
                activities for which the grant is sought.
            (2) Notice of approval or disapproval.--Each qualified or 
        other entity referred to in subsection (a) submitting an 
        application under paragraph (1) shall, not later than 60 days 
        after the date of its submission, be notified in writing as to 
        whether such application is approved or disapproved.
            (3) Requirement of prior approval from collective 
        bargaining agency.--In the case of a nursing facility applying 
        for a grant under this section that has a collective bargaining 
        agent, the application filed by the facility shall include 
        written approval from that agent for the facility's proposed 
        use of the grant award.
    (c) Duration.--A grant under this section may extend over a period 
of not more than three years.
    (d) Annual Approval.--The provision of payments under a grant under 
this section shall be subject to annual approval by the Secretary and 
subject to the availability of appropriations for each fiscal year to 
make the payments.
    (e) Use of Grant Funds.--
            (1) Authorized uses.--A grant made under this section may 
        be used only to carry out to establish or fund education and 
        training centers for individuals who furnish direct resident 
        care services in nursing facilities. Each qualified or other 
        entity referred to in subsection (a) awarded a grant under this 
        section shall develop curricula and interdisciplinary programs 
        to enhance direct care workers' abilities to provide quality 
        care, including for the following:
                    (A) New training that focuses on--
                            (i) recognizing signs of malnutrition, 
                        dehydration, pain, confusion, and anxiety,
                            (ii) prevention and treatment of 
                        infections, bed sores, incontinence, and lack 
                        of mobility,
                            (iii) strategies for preventing abuse of 
                        residents of nursing facilities, such as 
                        conflict resolution and stress management, and
                            (iv) recognizing symptoms in residents of 
                        nursing facilities of dementia or dementia-
                        related disease.
                    (B) Continuing education for licensed providers in 
                the care of the chronically ill and disabled or 
                gerontological nursing, or both.
            (2) Prohibited uses.--A grant may not be used to pay for 
        the minimum number of training hours required for certified 
        nurse aide certification.
    (f) Reports.--A qualified or other entity referred to in subsection 
(a) awarded a grant under this section shall submit to the Secretary 
such reports, and within such time frames, as the Secretary may 
require.
    (g) Regulations.--Any regulations to carry out this section shall 
be prescribed not later than 60 days after the date of enactment of 
this section.
    (h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated to the Secretary 
$25,000,000 for each of fiscal years 2001, 2002, and 2003. 60 percent 
of such appropriation shall be payable from the Federal Hospital 
Insurance Trust Fund, and 40 percent of such appropriation shall be 
payable from the Federal Supplementary Medical Insurance Trust Fund 
under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t).
    (i) Definitions.--In this section:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``qualified entity'' means--
                    (A) a nursing facility as defined in section 
                1919(a) of the Social Security Act (42 U.S.C. 
                1396r(a));
                    (B) a skilled nursing facility (as defined in 
                section 1819(a) of such Act (42 U.S.C. 1395i-3(a));
                    (C) a labor union;
                    (D) a community-based nonprofit organization;
                    (E) a State long-term care Ombudsman; community-
                based citizen advocacy groups;
                    (F) a State deparment on aging; and
                    (G) such other entities approved by the Secretary.

SEC. 202. UPWARD MOBILITY OF LONG-TERM CARE WORKERS.

    (a) Grant Program.--
            (1) In general.--The Secretary shall, in accordance with 
        the provisions of this section, award grants to qualified 
        entities to provide for such additional or advanced education 
        and training of certified nursing aides who furnish services in 
        the facility. Such education and training shall be designed to 
        enable such staff to provide care in accordance with the 
        limitations of State nurse practice laws or regulations and 
        with principles of nurse delegations.
            (2) Priority of grant awards.--In awarding grants under 
        this section, the Secretary shall give priority to nursing 
        facilities with approved applications filed in partnership with 
        labor representatives.
            (3) Deadline for initial grant awards.--The Secretary shall 
        award grants under this section by not later than 6 months 
        after the date of the enactment of this Act.
    (b) Applications.--
            (1) Applications required.--Each qualified entity that 
        wishes to receive a grant under this section shall submit an 
        application at such time, in such form, and complete with such 
        information as the Secretary shall by regulation require, 
        except that any such application shall include at least--
                    (A) a statement of the objectives for which the 
                grant is sought; and
                    (B) a description of the types of programs and 
                activities for which the grant is sought.
            (2) Notice of approval or disapproval.--Each qualified 
        entity submitting an application under paragraph (1) shall, not 
        later than 60 days after the date of its submission, be 
        notified in writing as to whether such application is approved 
        or disapproved.
            (3) Requirement of prior approval from collective 
        bargaining agency.--In the case of a nursing facility applying 
        for a grant under this section that has a collective bargaining 
        agent, the application filed by the facility shall include 
        written approval from that agent for the facility's proposed 
        use of the grant award.
    (c) Duration.--A grant under this section may extend over a period 
of not more than three years.
    (d) Annual Approval.--The provision of payments under a grant under 
this section shall be subject to annual approval by the Secretary and 
subject to the availability of appropriations for each fiscal year to 
make the payments.
    (e) Use of Grant Funds.--A grant made under this section may be 
used only to carry out to establish education and training programs 
referred to in subsection (a)(1).
    (f) Reports.--A qualified entity awarded a grant under this section 
shall submit to the Secretary such reports, and within such time 
frames, as the Secretary may require.
    (g) Regulations.--Any regulations to carry out this section shall 
be prescribed not later than 60 days after the date of enactment of 
this section.
    (h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated to the Secretary 
$25,000,000 for each of fiscal years 2001, 2002, and 2003. 60 percent 
of such appropriation shall be payable from the Federal Hospital 
Insurance Trust Fund, and 40 percent of such appropriation shall be 
payable from the Federal Supplementary Medical Insurance Trust Fund 
under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t).
    (i) Definitions.--In this section:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``qualified entity'' means--
                    (A) a nursing facility as defined in section 
                1919(a) of the Social Security Act (42 U.S.C. 
                1396r(a));
                    (B) a skilled nursing facility (as defined in 
                section 1819(a) of such Act (42 U.S.C. 1395i-3(a));
                    (C) a labor union;
                    (D) a community-based nonprofit organization;
                    (E) a State long-term care Ombudsman; community-
                based citizen advocacy groups;
                    (F) a State deparment on aging; and
                    (G) such other entities approved by the Secretary.

SEC. 203. RETENTION OF LONG-TERM CARE PROFESSIONALS AND WORKERS IN 
              MEDICALLY UNDERSERVED AREAS.

    (a) Grant Program.--
            (1) In general.--The Secretary shall, in accordance with 
        the provisions of this section, award grants to nursing 
        facilities to establish programs to retain individuals who 
        furnish direct resident care services in nursing facilities 
        located in medically underserved areas, including registered 
        professional nurses, licensed practical nurses, and certified 
        nurse aides.
            (2) Deadline for initial grant awards.--The Secretary shall 
        award grants under this section by not later than 6 months 
        after the date of the enactment of this Act.
    (b) Applications.--
            (1) Applications required.--Each nursing facility that 
        wishes to receive a grant under this section shall submit an 
        application at such time, in such form, and complete with such 
        information as the Secretary shall by regulation require, 
        except that any such application shall include at least--
                    (A) a statement of the objectives for which the 
                grant is sought; and
                    (B) a description of the types of programs and 
                activities for which the grant is sought.
            (2) Notice of approval or disapproval.--Each nursing 
        facility submitting an application under paragraph (1) shall, 
        not later than 60 days after the date of its submission, be 
        notified in writing as to whether such application is approved 
        or disapproved.
    (c) Duration.--A grant under this section may extend over a period 
of not more than three years.
    (d) Annual Approval.--The provision of payments under a grant under 
this section shall be subject to annual approval by the Secretary and 
subject to the availability of appropriations for each fiscal year to 
make the payments.
    (e) Use of Grant Funds.--
            (1) Authorized uses.--A grant made under this section shall 
        be used by the nursing facility, with respect to individuals 
        who furnish direct resident care services in nursing 
        facilities, including registered professional nurses, licensed 
        practical nurses, and certified nurse aides, to do any or all 
        of the following:
                    (A) Increase the salary of such individuals.
                    (B) Reimburse all or part of the outstanding 
                balance of any education loan undertaken by the 
                individual.
                    (C) Reduce payments due under other obligations 
                imposed under an agreement of a program under the 
                Public Health Service Act (42 U.S.C. 201 et seq.).
                    (D) With respect to certified nurse aides, 
                subsidize the costs of (i) the employee share of 
                employer-based health care coverage, and (ii) child 
                care expenses of the aides.
                    (E) Subsidize the costs of transportation to and 
                from the nursing facility of such individuals.
            (2) Prohibited uses.--A grant may not be used by a nursing 
        facility to offset salary and benefits that would be otherwise 
        payable by the facility to such individuals in the absence of 
        the grant.
    (f) Reports.--A nursing facility awarded a grant under this section 
shall submit to the Secretary such reports, and within such time 
frames, as the Secretary may require. The report shall include such 
information and data as the Secretary requires to determine compliance 
of the nursing facility with the provisions of this section.
    (g) Regulations.--Any regulations to carry out this section shall 
be prescribed not later than 60 days after the date of enactment of 
this section.
    (h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated to the Secretary 
$25,000,000 for each of fiscal years 2001, 2002, and 2003. 60 percent 
of such appropriation shall be payable from the Federal Hospital 
Insurance Trust Fund, and 40 percent of such appropriation shall be 
payable from the Federal Supplementary Medical Insurance Trust Fund 
under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t).
    (i) Definitions.--In this section:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``nursing facility'' has the meaning given 
        that term in section 1919(a) of the Social Security Act (42 
        U.S.C. 1396r(a)), and includes a skilled nursing facility (as 
        defined in section 1819(a) of such Act (42 U.S.C. 1395i-3(a)).

SEC. 204. IMPROVEMENT IN WORKER SAFETY.

    (a) Grant Program.--
            (1) In general.--The Secretary shall, in accordance with 
        the provisions of this section, award grants to nursing 
        facilities to establish model workplace safety programs. Such 
        programs shall be designed to result in a significant reduction 
        in the incidence of accidents and injuries at the nursing 
        facility to employees of the nursing facility.
            (2) Priority of grant awards.--In awarding grants under 
        this section, the Secretary shall give priority to nursing 
        facilities with approved applications filed in partnership with 
        labor representatives.
            (3) Deadline for initial grant awards.--The Secretary shall 
        award grants under this section by not later than 6 months 
        after the date of the enactment of this Act.
            (4) Coordination with the secretary of labor.--The 
        Secretary shall coordinate the implementation of the grant 
        program established under this section with the Secretary of 
        Labor.
    (b) Applications.--
            (1) Applications required.--Each nursing facility that 
        wishes to receive a grant under this section shall submit an 
        application at such time, in such form, and complete with such 
        information as the Secretary shall by regulation require, 
        except that any such application shall include at least--
                    (A) a statement of the objectives for which the 
                grant is sought;
                    (B) a description of the types of programs and 
                activities for which the grant is sought;
                    (C) a plan for the timely implementation of the 
                program and evaluation of the program in the facility; 
                and
                    (D) consultation with a State long-term care 
                Ombudsman or a community-based citizen advocacy group.
            (2) Notice of approval or disapproval.--Each nursing 
        facility submitting an application under paragraph (1) shall, 
        not later than 60 days after the date of its submission, be 
        notified in writing as to whether such application is approved 
        or disapproved.
            (3) Requirement of prior approval from collective 
        bargaining agency.--In the case of a nursing facility applying 
        for a grant under this section that has a collective bargaining 
        agent, the application filed by the facility shall include 
        written approval from that agent for the facility's proposed 
        use of the grant award.
    (c) Duration.--A grant under this section may extend over a period 
of not more than three years.
    (d) Annual Approval.--The provision of payments under a grant under 
this section shall be subject to annual approval by the Secretary and 
subject to the availability of appropriations for each fiscal year to 
make the payments.
    (e) Use of Grant Funds.--A grant made under this section may be 
used only to establish and carry out the model workplace safety program 
referred to in subsection (a)(1).
    (f) Reports.--A nursing facility awarded a grant under this section 
shall submit to the Secretary such reports, and within such time 
frames, as the Secretary may require.
    (g) Regulations.--Any regulations to carry out this section shall 
be prescribed not later than 60 days after the date of enactment of 
this section.
    (h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated to the Secretary 
$25,000,000 for each of fiscal years 2001, 2002, and 2003. 60 percent 
of such appropriation shall be payable from the Federal Hospital 
Insurance Trust Fund, and 40 percent of such appropriation shall be 
payable from the Federal Supplementary Medical Insurance Trust Fund 
under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t).
    (i) Definitions.--In this section:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``nursing facility'' has the meaning given 
        that term in section 1919(a) of the Social Security Act (42 
        U.S.C. 1396r(a)), and includes a skilled nursing facility (as 
        defined in section 1819(a) of such Act (42 U.S.C. 1395i-3(a)).
            (3) The term ``model safety workplace program'' means a 
        program certified by an appropriate worker safety training 
        expert (as determined by the Secretary) to reduce the incidence 
        of accidents and injuries at nursing facilities, including such 
        accidents and injuries associated with the lifting and 
        transportation of residents of the facility, stress reduction 
        activities, and compliance with workplace safety standards 
        (such as standards to reduce accidental needle stick injuries).

SEC. 205. DEMONSTRATION PROGRAM TO IMPLEMENT QUALITY IMPROVEMENT MODELS 
              IN NURSING FACILITY SETTINGS.

    (a) Quality Improvement Models.--
            (1) In general.--The Secretary shall provide for a 
        demonstration project under this section under which grants are 
        made to 4 States to implement innovative quality improvement 
        models (described in paragraph (2) to improve the quality of 
        care furnished to residents of nursing facilities operating in 
        the State.
            (2) Models described.--A model referred to in paragraph (1) 
        is a model developed by the Agency for Healthcare Research and 
        Quality, the American Medical Directors Association, and the 
        Nutrician Institute to reduce the incidence and prevalence of 
        infections, bed sores, incontinence, and lack of mobility among 
        such residents.
    (b) Application.--
            (1) Applications required.--Each State that wishes to 
        receive a grant under this section shall submit an application 
        at such time, in such form, and complete with such information 
        as the Secretary shall by regulation require, except that any 
        such application shall include at least--
                    (A) a statement of the objectives for which the 
                grant is sought;
                    (B) a description of the types of programs and 
                activities for which the grant is sought; and
                    (C) consultation with a State long-term care 
                Ombudsman or a community-based citizen advocacy group.
            (2) Notice of approval or disapproval.--Each State 
        submitting an application under paragraph (1) shall, not later 
        than 60 days after the date of its submission, be notified in 
        writing as to whether such application is approved or 
        disapproved.
    (c) Duration.--A grant under this section may extend over a period 
of not more than three years.
    (d) Annual Approval.--The provision of payments under a grant under 
this section shall be subject to annual approval by the Secretary and 
subject to the availability of appropriations for each fiscal year to 
make the payments.
    (e) Use of Grant Funds.--A grant made under this section may be 
used only to carry out to innovative quality improvement models 
referred to in subsection (a).
    (f) Reports.--
            (1) In general.--A State awarded a grant under this section 
        shall submit to the Secretary such reports, and within such 
        time frames, as the Secretary may require.
            (2) Review by gao.--The Comptroller General of the United 
        States shall submit to Congress a report on the results of the 
        demonstration project under this section, including in such 
        report an analysis of the models developed by each State and 
        the effectiveness of each such model in reducing incontinence 
        and pressure sores among residents of nursing facilities in 
        each such State.
    (g) Regulations.--Any regulations to carry out this section shall 
be prescribed not later than 60 days after the date of enactment of 
this section.
    (h) Authorization of Appropriations.--For purposes of carrying out 
this section, there are authorized to be appropriated to the Secretary 
$25,000,000 for each of fiscal years 2001, 2002, and 2003. 60 percent 
of such appropriation shall be payable from the Federal Hospital 
Insurance Trust Fund, and 40 percent of such appropriation shall be 
payable from the Federal Supplementary Medical Insurance Trust Fund 
under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t).
    (i) Definitions.--In this section:
            (1) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (2) The term ``nursing facility'' has the meaning given 
        that term in section 1919(a) of the Social Security Act (42 
        U.S.C. 1396r(a)), and includes a skilled nursing facility (as 
        defined in section 1819(a) of such Act (42 U.S.C. 1395i-3(a)).
                                 <all>