[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4949 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4949

To amend title XIX of the Social Security Act to improve the quality of 
                    care furnished in nursing homes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 25, 2000

  Mr. Waxman (for himself, Mr. Gephardt, Mr. Dingell, Mr. Stark, Mr. 
  Brown of Ohio, Mr. George Miller of California, Ms. Schakowsky, Mr. 
 Forbes, Mr. Holt, Mr. Lantos, Ms. Lee, Mr. Blagojevich, Mr. Hinchey, 
and Mr. Wynn) introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to improve the quality of 
                    care furnished in nursing homes.

    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) In General.--This Act may be cited as the ``Nursing Home 
Quality Protection Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Increased sanctions for substandard care furnished in nursing 
                            homes.
Sec. 3. Increased resources to improve the quality of care furnished in 
                            nursing homes.
Sec. 4. Increased public disclosure of nursing home conditions.

SEC. 2. INCREASED SANCTIONS FOR SUBSTANDARD CARE FURNISHED IN NURSING 
              HOMES.

    (a) In General.--Section 1919 of the Social Security Act (42 U.S.C. 
1396r) is amended--
            (1) by redesignating subsection (i) as subsection (j); and
            (2) by inserting after subsection (h) the following new 
        subsection:
    ``(i) Refund of Federal Moneys for Substandard Nursing Care.--
            ``(1) In general.--From amounts paid under a State plan to 
        a nursing facility, the nursing facility shall refund to the 
        Secretary (for deposit in the Account established in subsection 
        (j)) for deficiencies identified in a survey under subsection 
        (g) the following amounts:
                    ``(A) $2,000 for each deficiency that had the 
                potential to cause more than minimal harm to a resident 
                of the nursing facility.
                    ``(B) $10,000 for each deficiency that caused 
                actual harm to a resident of the nursing facility.
                    ``(C) $25,000 for each deficiency that placed a 
                resident of the nursing facility in immediate jeopardy.
        Amounts under this subparagraph shall be adjusted annually to 
        account for inflation in the manner provided for in section 
        1924(g).
            ``(2) Deadline for substandard care refund.--Payment of the 
        amounts payable by a nursing facility to the Secretary under 
        paragraph (1) shall be made not later than 30 days after the 
        nursing facility receives notice of the deficiencies and the 
        amount of substandard care refund due.
            ``(3) Withholding of payments for failure to pay a 
        substandard care refund to the secretary.--In the case of a 
        nursing facility that does not pay a substandard care refund 
        required under paragraph (1), in order to ensure that payments 
        under the State plan to the facility are reduced by the amount 
        of substandard care refund due from the facility, the Secretary 
        shall withhold from payments attributable to this section the 
        amount of such substandard care refund.
            ``(4) Appeal.--
                    ``(A) In general.--The Secretary shall establish a 
                procedure for a nursing facility to appeal to the 
                Secretary a substandard care refund paid or an amount 
                withheld under this paragraph.
                    ``(B) Repayments by the secretary.--If a nursing 
                facility is successful on appeal, the Secretary shall 
                pay to the nursing facility an amount equal to the 
                amount of the substandard care refund paid under 
                paragraph (1), or the amount withheld under paragraph 
                (3), or both, if applicable, plus interest accruing on 
                such amount at the rate applicable under section 
                1903(d)(5).
            ``(5) Relation to other sanctions.--
                    ``(A) In general.--A substandard care refund paid 
                by or an amount withheld from a nursing facility for a 
                deficiency under this paragraph--
                            ``(i) shall not affect the authority of a 
                        State or the Secretary to take enforcement 
                        actions or impose sanctions against the nursing 
                        facility under any other provision of law with 
                        respect to the deficiency;
                            ``(ii) shall be deducted from civil money 
                        penalties assessed by the Secretary with 
                        respect to the deficiency under other 
                        provisions of this Act; and
                            ``(iii) shall not affect any remedy 
                        available to an individual at common law.
                    ``(B) Preserving right to appeal.--The failure of a 
                nursing facility to appeal a substandard care refund 
                paid by or amount withheld from the facility for a 
                deficiency under this paragraph shall have no effect on 
                the right of the facility to appeal any enforcement 
                action taken or sanction imposed by the Secretary with 
                respect to the deficiency under other provisions of 
                this Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to surveys conducted on or after the date that is 
one year after the date of the enactment of this Act, without regard to 
whether or not final regulations to carry out such amendments have been 
promulgated by such date.

SEC. 3. INCREASED RESOURCES TO IMPROVE THE QUALITY OF CARE FURNISHED IN 
              NURSING HOMES.

    (a) Reinstitution of Boren Amendment Payment Methodology.--
            (1) Purpose.--In 1997, Congress repealed the Boren 
        amendment, which required that the States make reasonable and 
        adequate payments to nursing homes and other health care 
        facilities in order to provide quality care to residents. The 
        purpose of this section is to restore the Boren amendment so 
        that those facilities can provide better care to residents.
            (2) Provision for payment of reasonable and adequate 
        costs.--Section 1902(a)(13) of the Social Security Act (42 
        U.S.C. 1396a(a)(13)) is amended to read as follows:
            ``(13) provide for payment of services through the use of 
        rates determined under this paragraph as in effect on August 1, 
        1997;''.
            (3) Effective date.--The amendment made by paragraph (2) 
        shall apply to services furnished on or after the date that is 
        one year after the date of the enactment of this Act.
    (b) Grant Program To Improve Quality of Care Furnished in Nursing 
Homes.--Section 1919 of the Social Security Act (42 U.S.C. 1396r), as 
amended by section 2(a), is further amended--
            (1) by redesignating subsection (j) as subsection (k); and
            (2) by inserting after subsection (i) the following new 
        subsection:
    ``(j) Nursing Facility Quality Improvement Account.--
            ``(1) Establishment of nursing facility quality improvement 
        account.--
                    ``(A) In general.--There is hereby created on the 
                books of the Treasury an expenditure account to be 
                known as the `Nursing Facility Quality Improvement 
                Account' (in this subsection referred to as the 
                `Account').
                    ``(B) Deposit of funds in the account.--The 
                Secretary shall deposit in the Account--
                            ``(i) all substandard care refunds from 
                        nursing facilities under subsection (i)(1); and
                            ``(ii) amounts withheld under subsection 
                        (i)(3).
                    ``(C) Appropriated amounts from substandard care 
                refunds.--There are hereby appropriated to the Account 
                such amounts as the Secretary deposits to the Account 
                under this paragraph.
            ``(2) Grants for improvement of quality of care.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this paragraph, from amounts available in 
                the Account, the Secretary shall make grants to States 
                for the purpose of improving the quality of care 
                furnished in nursing facilities operating in the State.
                    ``(B) Use of grant funds.--Grants made available to 
                States under subparagraph (A) may be used for any or 
                all of the following specified purposes:
                            ``(i) To enable a nursing facility to 
                        recruit additional nursing staff or to retain 
                        existing nursing staff (including through the 
                        use of financial incentives).
                            ``(ii) To increase education and training 
                        of nursing staff.
                            ``(iii) To provide incentives to increase 
                        the level of nursing staff in a nursing 
                        facility.
                            ``(iv) Any other purpose that the Secretary 
                        determines is likely to improve the quality of 
                        care furnished to residents of a nursing 
                        facility.
                    ``(C) Terms and conditions.--The Secretary shall 
                establish such terms and conditions as the Secretary 
                determines to be appropriate for the receipt of grant 
                funds under this paragraph. Such terms and conditions 
                shall include the following requirements:
                            ``(i) A State shall develop a plan for the 
                        use of grant funds.
                            ``(ii) In developing the plan required 
                        under clause (i), the State shall consult with 
                        representatives of nursing facility residents, 
                        of nursing facilities, of nursing staff, and of 
                        other interested parties, and shall provide for 
                        an opportunity for public comment.
                            ``(iii) The State shall submit to the 
                        Secretary annual reports on the use of grant 
                        funds under the plan.
                    ``(D) Aggregate amount of grant funds for states.--
                The amount of a grant to a State under this subsection 
                may not exceed the aggregate amount of substandard care 
                refunds (under subsection (i)) from nursing facilities 
                operating in the State.
                    ``(E) Nonparticipation by states.--Notwithstanding 
                subparagraph (D), if a State does not receive a grant 
                under this subsection, the Secretary may redistribute, 
                in a manner consistent with section 2104(f), the 
                substandard care refunds received from nursing 
                facilities in that State to other States.
                    ``(F) Limitations on use of grant amounts.--A State 
                may not use amounts made available under a grant under 
                this paragraph--
                            ``(i) to satisfy any requirement for the 
                        expenditure of non-Federal funds as a condition 
                        for the receipt of Federal funds; or
                            ``(ii) to make payments to a nursing 
                        facility that is not in compliance with Federal 
                        labor and employment laws or that has a pattern 
                        of violations of such laws.
                Amounts made available under a grant under this 
                paragraph shall be in addition to, and may not be used 
                to supplant, any funds that are or would otherwise be 
                expended under any Federal, State, or local law by a 
                State or local government.
                    ``(G) Definition.--In this subsection and 
                subsection (g)(5)(E), the term `nursing staff' means a 
                registered professional nurse, a licensed practical or 
                licensed vocational nurse, or a certified nurse aide.
            ``(3) Annual Audits.--
                    ``(A) In general.--The Secretary shall conduct 
                annual audits of the use of grant funds made available 
                under paragraph (2). The Secretary shall assess the 
                extent to which such funds have resulted in increased 
                nursing staff, reduced nursing staff turnover, 
                increased training of nursing staff, and improvements 
                in the quality of care furnished in nursing facilities 
                located in States receiving such grant funds.
                    ``(B) Additional terms for receipt of grant 
                funds.--As a part of a plan under paragraph (2)(C), the 
                State shall afford the Secretary access to any records 
                or information relating to the plan for the purposes of 
                an audit of the State's use of grant funds.
                    ``(C) Annual report.--The Secretary shall submit to 
                Congress an annual report on the audits conducted under 
                this paragraph.''.

SEC. 4. INCREASED PUBLIC DISCLOSURE OF NURSING HOME CONDITIONS.

    (a) Internet Disclosure.--Section 1919(g)(5) of the Social Security 
Act (42 U.S.C. 1396r(g)(5)) is amended by adding at the end the 
following new subparagraph:
                    ``(E) Publication on the internet of nursing 
                facility information.--As soon as practicable, but in 
                no case later than January 1, 2002, the Secretary shall 
                make available to the public on the Internet site of 
                the Department of Health and Human Services, and by 
                such other means as the Secretary determines 
                appropriate, the following information with respect to 
                each nursing facility:
                            ``(i) Compliance with facility standards.--
                        A summary of the facility's compliance or 
                        noncompliance with Federal nursing facility 
                        standards.
                            ``(ii) Copies of recent surveys.--A copy of 
                        the three most recent surveys conducted of the 
                        nursing facility under subsection (g).
                            ``(iii) Complaints filed against the 
                        facility.--A summary of each complaint filed 
                        against the nursing facility during the three 
                        most recent years and a summary of the outcome 
or current status of the complaint.
                            ``(iv) Enforcement actions against the 
                        facility.--A summary of each enforcement action 
                        undertaken by the Secretary or a State during 
                        the three most recent years with respect to the 
                        facility and a summary of the outcome or 
                        current status of the action.
                            ``(v) Nurse staffing ratios.--Data on the 
                        nursing staff of the facility for each of the 
                        four previous calendar quarters, including the 
                        following ratios:
                                    ``(I) The ratio of registered 
                                professional nurses to residents of the 
                                facility.
                                    ``(II) The ratio of licensed 
                                practical or licensed vocational nurses 
                                to residents of the facility.
                                    ``(III) The ratio of certified 
                                nurse aides to residents of the 
                                facility.
                                    ``(IV) The ratio of aggregate 
                                nursing staff to residents of the 
                                facility.
                        Such data shall include information on such 
                        ratios by shift. Such ratios shall be 
                        calculated by comparing the number of hours 
                        such staff expend providing nursing care to 
                        residents of the facility to the number of 
                        residents in the facility.
                            ``(vi) Ownership disclosure.--The identity 
                        of the owner and operator of the nursing 
                        facility, including an identification of 
                        whether the facility is a part of a chain of 
                        nursing facilities, and if so, the identity of 
                        the chain and the number of facilities in such 
                        chain.
                            ``(vii) Labor violations.--Violations of 
                        Federal labor and employment laws, and costs 
                        incurred for activities directly related to 
                        influencing employees with respect to 
                        unionization, during the three most recent 
                        years.
                            ``(viii) Other pertinent information.--Any 
                        other information that the Secretary determines 
                        appropriate to inform the public on conditions 
                        and quality of care furnished at the facility.
                After January 1, 2002, the Secretary shall continuously 
                update the information posted on such Internet site and 
                shall ensure that such information is never more than 
                90 days out of date.''.
    (b) Posting of Staffing Information.--Section 1919(c)(8) of the 
Social Security Act (42 U.S.C. 1396r(c)(8)) is amended by inserting 
before the period the following: ``and the nurse staffing ratio 
information under subsection (g)(5)(E)(v)''.
    (c) Recordkeeping and Reporting Requirements.--Section 1919(d) of 
the Social Security Act (42 U.S.C. 1396r(d)) is amended by adding at 
the end the following new paragraph:
            ``(5) Recordkeeping and reporting requirements.--
                    ``(A) In general.--A nursing facility shall 
                maintain such records and make such reports to the 
                Secretary as the Secretary may require for the 
                administration and enforcement of this section, 
                including providing to the Secretary such information 
                as the Secretary may require to implement subsection 
                (g)(5)(E). The Secretary may specify the form and 
                manner of any report required under this section, and 
                shall establish a procedure for the electronic 
                transmission of such records.
                    ``(B) Certification.--A report required under this 
                paragraph shall be certified by the administrator of 
                the nursing facility as being true, accurate, and 
                complete.''.
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