[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5243 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5243

 To establish a program to provide grants to States to test innovative 
   ways to increase nursing home staff levels, reduce turnover, and 
 improve quality of care for residents in nursing homes, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 21, 2000

    Mr. Holt (for himself, Mr. Gephardt, Mr. Waxman, and Mr. Stark) 
 introduced the following bill; which was referred to the Committee on 
  Commerce, and in addition to the Committee on Ways and Means, 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 establish a program to provide grants to States to test innovative 
   ways to increase nursing home staff levels, reduce turnover, and 
 improve quality of care for residents in nursing homes, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCES IN ACT.

    (a) Short Title.--This Act may be cited as the ``Nursing Home 
Staffing and Quality Improvement Act of 2000''.
    (b) References.--Except where otherwise specifically provided, 
references in this Act shall be considered to be made to the Social 
Security Act, or to a section or other provision thereof, and 
references to the ``Secretary'' shall be considered to be made to the 
Secretary of Health and Human Services.

SEC. 2. GRANTS TO STATES FOR IMPROVEMENTS IN NURSING HOME STAFFING AND 
              QUALITY.

    (a) Secretary's Authority To Award Grants.--The Secretary shall 
establish a program of competitive grants to States, in accordance with 
the provisions of this section, for the purpose of improving the 
quality of care furnished in nursing homes operating in the State.
    (b) Applications and Eligibility for Grants.--
            (1) Initial application.--A State seeking a grant to 
        conduct a project under this section shall submit an 
        application containing such information and assurances as the 
        Secretary may require, including--
                    (A) a commitment to submit annual reports 
                describing the State's progress in increasing staffing 
                levels and making other quality improvements in nursing 
                homes in the State; and
                    (B) a description of a plan for evaluation of the 
                activities carried out under the grant, including a 
                plan for measurement of progress toward the goals and 
                objectives of the program, consistent with the 
                principles of the Government Performance and Results 
                Act.
            (2) Consultation with public.--Before submitting an 
        application for a grant under this section, States shall 
        solicit and consider the views of members of the public, 
        nursing home residents or their representatives, and other 
        persons concerned with the administration of nursing homes 
        within the State with respect to the design of the proposed 
        State program.
            (3) Eligibility.--
                    (A) Initial eligibility.--A State shall not be 
                eligible for a grant award under this section unless it 
                makes assurances satisfactory to the Secretary that the 
                skilled nursing facilities (as defined in section 
                1819(a)) and nursing facilities (as defined in section 
                1919(a)) within the State will reach or exceed the 
                minimum staff level described in subsection (d)(2) 
                within two years after enactment of this Act and will 
                maintain such level throughout the remainder of the 
                grant program.
                    (B) Continuing eligibility.--A State shall not be 
                eligible for the continuation of grant funding under a 
                multi-year grant under this section unless the State 
                demonstrates to the Secretary's satisfaction that it 
                continues to meet the requirement described in 
                subparagraph (A) and has made sufficient progress in 
                meeting the goals described in its grant application.
    (c) Use of Grant Funds.--Funds received by a State under this 
section may be provided to entities including nursing homes, labor 
management partnerships, and educational institutions, and may be used 
for any or all of the following purposes:
            (1) To enable a nursing home to recruit additional nursing 
        staff or to retain existing nursing staff (including through 
        the use of reasonable financial incentives or reasonable 
        benefit enhancements).
            (2) To increase education and training of nursing staff 
        (including designing or implementing programs to promote the 
        career advancement of certified nurse aides).
            (3) To provide bonuses to nursing homes meeting State 
        quality standards or avoiding serious quality violations for a 
        period of one or more years.
            (4) Such other nursing home staffing and quality 
        improvement initiatives as the Secretary may approve.
    (d) Distribution of Funds.--
            (1) In general.--Subject to subsection (b), in awarding 
        grants under this section, the Secretary shall award no more 
        than 25 percent of the funds to States in which, as of the date 
        of the enactment of this section, skilled nursing facilities 
        (as defined in section 1819(a)) and nursing facilities (as 
        defined in section 1919(a)) have reached or exceeded the 
        minimum staff level specified in paragraph (2) (as determined 
        by the Secretary).
            (2) Minimum nursing home staff level.--
                    (A) In general.--Subject to subparagraph (B), for 
                purposes of subsection (b) and paragraph (1), the level 
                specified in this paragraph for a skilled nursing 
                facility or nursing facility is a staff level 
                sufficient to ensure that each resident receives from a 
                certified nurse aide at least 2 hours per day of direct 
                care (including repositioning the resident and changing 
                wet clothes, assisting with feeding, exercise, and 
                toileting, and working to enhance a resident's 
                independence with respect to activities of daily 
                living).
                    (B) Secretary's authority to increase minimum staff 
                level.--The Secretary may establish a minimum staff 
                level that is higher than that specified in 
                subparagraph (A). Any such revised staff level shall be 
                effective no earlier than six months after the date on 
                which Secretary provides notice to States of the new 
                requirement.
            (3) Multi-year grant funds.--The Secretary shall award any 
        multi-year grant under this section from amounts appropriated 
        (or available pursuant to subsection (e)(2)) for the first 
        fiscal year of the grant.
    (e) Appropriations and Availability of Civil Money Penalty (CPM) 
Collections.--
            (1) Appropriations.--There are appropriated for all costs 
        to the Secretary for carrying out the program under this 
        section $200,000,000 for each of fiscal years 2001 through 
        2005, such funds to remain available to the Secretary through 
        the end of the first succeeding fiscal year.
            (2) Availability of cmp collections.--In addition to the 
        amounts appropriated pursuant to paragraph (1), there shall be 
        available to the Secretary for such costs for such fiscal years 
        any amounts deposited in the Nursing Facility Civil Money 
        Penalties Collection Account established under section 4.

SEC. 3. ENHANCED NURSING FACILITY REPORTING REQUIREMENTS.

    (a) Medicare.--
            (1) Submission of nursing staff level data to the 
        secretary.--Section 1819(b) (42 U.S.C. 1395i-3(b)) is amended 
        by adding at the end the following new paragraph:
            ``(8) Data on staffing levels.--
                    ``(A) Submission to secretary.--A skilled nursing 
                facility shall submit to the Secretary, in such form 
                and manner and at such intervals as the Secretary may 
                require, data with respect to nursing staff of the 
                facility. Such data shall include the total number of 
                nursing staff hours furnished during the period 
                specified by the Secretary (including totals for each 
                shift worked during such 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, and shall also 
                include the average wage rate for each class of nursing 
                staff employed by the facility.
                    ``(B) Publication.--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 
pursuant to subparagraph (A). The Secretary shall update such 
information periodically.''.
            (2) Posting of information on nursing facility staffing.--
        Section 1819(b) (42 U.S.C. 1395i-3(b)), as amended by paragraph 
        (1), 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. The information shall be displayed in a 
                uniform manner (as specified by the Secretary) and in a 
                clearly visible place.
                    ``(B) Publication of data.--A skilled nursing 
                facility shall, upon request, make available to the 
                public the nursing staff data described in subparagraph 
                (A).''.
            (3) Information concerning patient classification.--Section 
        1819(b)(4)(C) (42 U.S.C. 1395i-3(b)(4)(C)) is amended by adding 
        at the end the following new clause:
                            ``(iii) Information concerning residents.--
                        The skilled nursing facility shall provide the 
                        Secretary, in such form and manner and at such 
                        intervals as the Secretary may require, a 
                        classification of all residents of the skilled 
                        nursing facility that accords with the patient 
                        classification system described in section 
                        1888(e)(3)(B)(ii), or such successor system as 
                        the Secretary may identify.''.
    (b) Medicaid.--
            (1) In general.--Section 1919(b) (42 U.S.C. 1396r) is 
        amended by adding at the end the following new paragraph:
            ``(8) Data on staffing levels.--
                    ``(A) Submission to secretary.--A nursing facility 
                shall submit to the Secretary, in such form and manner 
                and at such intervals as the Secretary may require, 
                data with respect to nursing staff of the facility. 
                Such data shall include the total number of nursing 
                staff hours furnished during the period specified by 
                the Secretary (including totals for each shift worked 
                during such period) by the facility to residents for 
                which payment is made under this title, broken down by 
                total certified nurse aide hours, total licensed 
                practical or vocational nurse hours, and total 
                registered nurse hours, and shall also include the 
                average wage rate for each class of nursing staff 
                employed by the facility.
                    ``(B) Publication.--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 pursuant to subparagraph (A). The Secretary 
                shall update such information periodically.''.
            (2) Posting of information on nursing facility staffing.--
        Section 1919(b) (42 U.S.C. 1395r(b)), as amended by paragraph 
        (1), is further amended by adding at the end the following new 
        paragraph:
            ``(9) Information on nurse staffing.--
                    ``(A) In general.--A 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. The information shall be displayed in a 
                uniform manner (as specified by the Secretary) and in a 
                clearly visible place.
                    ``(B) Publication of data.--A nursing facility 
                shall, upon request, make available to the public the 
                nursing staff data described in subparagraph (A).''.
            (3) Information concerning patient classification.--Section 
        1919(b)(4)(C) (42 U.S.C. 1396r(b)(4)(C)) is amended by adding 
        at the end the following new clause:
                            ``(iv) Information concerning residents.--
                        The nursing facility shall provide the 
                        Secretary, in such form and manner and at such 
                        intervals as the Secretary may require, a 
                        classification of all residents of the nursing 
                        facility that accords with the patient 
                        classification system described in section 
                        1888(e)(3)(B)(ii), or such successor system as 
                        the Secretary may identify.''.

SEC. 4. NURSING FACILITY CIVIL MONEY PENALTY COLLECTIONS.

    (a) Establishment of nursing facility civil money penalty 
collections account.--Section 1128A (42 U.S.C. 1320a-7a) is amended by 
adding at the end the following new subsection:
    ``(o) Establishment of Nursing Facility Civil Money Penalty 
Collections Account.--There is hereby established an account to be 
known as the ``Nursing Facility Civil Money Penalties Collection 
Account'' (hereafter in this subsection referred to as the 
``Account''). Notwithstanding any other provision of law, there shall 
be deposited into the Account the Secretary's share of any civil 
monetary penalties collected under sections 1819 and 1919, all such 
amounts to be available without fiscal year limitation for repaying the 
Secretary's share of amounts owed to nursing facilities or skilled 
nursing facilities pursuant to the final sentence of sections 
1819(h)(2)(B)(ii) and 1919(h)(2)(B)(ii), and for awarding grants under 
section 2 of the Nursing Home Staffing and Quality Improvement Act of 
2000.''.
    (b) Authority To Collect CMPS Immediately.--
            (1) Medicare.--Section 1819(h)(2)(B)(ii) (42 U.S.C. 1395i-
        3(h)(2)(B)(ii)) is amended by inserting before the final period 
        ``, except that, notwithstanding section 1128A(c)(2) or any 
        other provision of law, the Secretary, upon determining that a 
        civil money penalty should be imposed against a skilled nursing 
        facility pursuant to this paragraph, shall take immediate 
        action to collect such penalty (except where the Secretary 
        finds that such action could jeopardize the health or welfare 
        of residents of the skilled nursing facility). In collecting 
        such penalty, the Secretary may deduct the amount of the 
        penalty from amounts otherwise payable to the facility under 
        this title or take such other actions as the Secretary 
        considers appropriate. If the Secretary's imposition of a 
        penalty under this paragraph is set aside, in whole or in part, 
        as a result of a hearing under section 1128A(c)(2) (or an 
        appeal therefrom) or by a court of competent jurisdiction, and 
        the Secretary elects not to pursue an appeal of such judgment; 
        or has exhausted all appeals, the Secretary shall repay any 
        amount owed to the skilled nursing facility with accrued 
        interest.''
            (2) Medicaid.--Section 1919(h)(3)(B)(ii) (42 U.S.C. 
        1396r(h)(3)(B)(ii)) is amended by inserting before the final 
        period ``, except that, notwithstanding section 1128A(c)(2) or 
        any other provision of law, the Secretary, upon determining 
        that a civil money penalty should be imposed against a nursing 
        facility pursuant to this paragraph, shall take immediate 
        action to collect the penalty (except where the Secretary finds 
        that such action could jeopardize the health or welfare of 
        residents of the nursing facility). In collecting such penalty, 
        the Secretary may direct the State to deduct the amount of the 
        penalty from amounts otherwise payable to the nursing facility 
        under this title or take such other actions as the Secretary, 
        in consultation with the State, considers appropriate. If the 
        Secretary's imposition of a penalty under this paragraph is set 
        aside, in whole or in part, as a result of a hearing under 
        section 1128A(c)(2) (or an appeal therefrom) or by a court of 
        competent jurisdiction, and the Secretary elects not to pursue 
        an appeal of such judgment, or has exhausted all appeals, the 
        Secretary shall repay, or shall direct the State to repay, any 
        amount owed to the nursing facility with accrued interest.''
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