[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5646 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5646

To amend titles XVIII and XIX of the Social Security Act to provide for 
   increased accountability of nursing facilities and adequate nurse 
             staffing for patient needs in the facilities.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 7, 2000

  Mr. Stark 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 titles XVIII and XIX of the Social Security Act to provide for 
   increased accountability of nursing facilities and adequate nurse 
             staffing for patient needs in the facilities.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nursing Facility Staffing 
Improvement Act of 2000''.

SEC. 2. INTERIM SURVEYS FOR NURSING HOMES FOR DEFICIENCIES ATTRIBUTABLE 
              TO INADEQUATE NURSE STAFFING.

    (a) Interim Surveys for Quality Deficiencies Attributable to 
Inadequate Nurse Staffing.--
            (1) Establishment of requirement for interim surveys.--
        Sections 1819(g)(2) and 1919(g)(2) of the Social Security Act 
        (42 U.S.C. 1395i-3(g)(2) and 1396r(g)(2)) are each amended--
                    (A) in subparagraph (A)(ii)--
                            (i) in subclause (II), by striking ``and'' 
                        at the end;
                            (ii) in subclause (III), by striking the 
                        period and inserting ``, and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(IV) for each quality deficiency 
                                identified in the survey that resulted 
                                in actual harm to a resident of the 
                                facility or that posed a risk of 
                                immediate jeopardy to the health or 
                                safety of the resident, an assessment 
                                of whether inadequate nurse staffing is 
                                a contributing factor to that 
                                deficiency.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Interim surveys for inadequate staffing.--
                            ``(i) In general.--With respect to each 
                        quality deficiency of a facility identified in 
                        a survey to which inadequate nurse staffing is 
                        determined to be a contributing factor under 
                        subparagraph (A)(ii)(IV), the facility shall be 
                        subject to interim surveys under this 
                        subparagraph.
                            ``(ii) Initial 2 mandatory surveys.--
                                    ``(I) Period for conduct of interim 
                                surveys.--Two interim surveys shall be 
                                conducted during the period beginning 
                                on the date of the implementation by 
                                the facility of a plan of correction 
                                for such quality deficiencies and 
                                ending before the date of the 
                                succeeding standard survey conducted 
                                under subparagraph (A).
                                    ``(II) Required assessment of 
                                interim surveys.--Such surveys shall 
                                assess the adequacy of nurse staffing 
                                at the facility and the continued 
                                compliance of the facility with such 
                                plan of correction.
                                    ``(III) Conduct of interim surveys 
                                without notice to facility.--Such 
                                surveys shall be conducted without any 
                                prior notice to the facility. Any 
                                individual who notifies (or causes to 
                                be notified) a facility of the time or 
                                date on which such a survey is 
                                scheduled to be conducted is subject to 
                                a civil money penalty in the same 
                                manner as provided for under the second 
                                and third sentences of subparagraph 
                                (A)(i).
                            ``(iii) Finding of inadequate nurse 
                        staffing in an interim survey.--In the case of 
                        a finding in a facility of a quality deficiency 
                        that is identified in an interim survey under 
                        clause (ii) to which inadequate nurse staffing 
                        is determined to be a contributing factor, 
                        during the two-year period beginning on the 
                        date of such finding, the facility shall be 
                        subject to such additional interim surveys as 
                        the State determines appropriate to verify the 
                        maintenance of adequate nurse staffing in the 
                        facility and continued compliance by the 
                        facility with the plan of correction.
                            ``(iv) Nurse staffing defined.--In this 
                        paragraph and subsection (b)(1)(B), the term 
                        `nurse staffing' means nursing staff consisting 
                        of registered professional nurses, licensed 
                        practical nurses, or certified nurse aides.''.
            (2) Conforming amendment.--Section 1864(d) of the Social 
        Security Act (42 U.S.C. 1395aa(d)) is amended by inserting 
        ``(including interim surveys under section 1819(g)(2)(F))'' 
        after ``section 1819(g)''.
    (b) Prompt Implementation of Plans of Correction for Deficiencies 
Attributable to Inadequate Nurse Staffing.--Sections 1819(b)(1)(B) and 
1919(b)(1)(B) of the Social Security Act (42 U.S.C. 1395i-3(b)(1)(B) 
and 1396r(b)(1)(B)) are each amended by adding at the end the 
following: ``In the case of a plan of correction to correct quality 
deficiencies of a facility identified in a survey to which inadequate 
nurse staffing is determined to be a contributing factor under 
subsection (g)(2)(A)(ii)(IV), such plan shall specify the number 
and type of additional nurse staff necessary to provide the requisite 
care required under paragraph (2) for each resident of the facility and 
shall be implemented not later than 30 days after receipt of notice of 
the deficiency.''.
    (c) Collection of Data on Nurse Staffing Levels.--
            (1) Medicare.--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) Collection of data.--
                    ``(A) Submission to secretary.--
                            ``(i) On staffing levels.--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.
                            ``(ii) 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) 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.
                    ``(C) Review of data.--The Secretary shall 
                determine for each year from data collected under 
                subparagraph (A) whether a facility maintains adequate 
                nurse staffing for resident care in the facility.''.
            (2) Medicaid.--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:
            ``(9) Submission of data.--
                    ``(A) Submission to secretary.--
                            ``(i) On staffing levels.--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 
                        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.
                            ``(ii) 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 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) 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.
                    ``(C) Review of data.--The Secretary shall 
                determine for each year from data collected under 
                subparagraph (A) whether a facility maintains adequate 
                nurse staffing for resident care in the facility.''.
    (d) Effective Date.--The amendments made by this section apply with 
respect to surveys conducted on or after the date that is 6 months 
after the date of the enactment of this Act.
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