[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 118 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 118
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
January 3, 2001
Mr. Holt introduced the following bill; which was referred to the
Committee on Energy and 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.
This Act may be cited as the ``Nursing Home Staffing and Quality
Improvement Act of 2001''.
SEC. 2. GRANTS TO STATES FOR IMPROVEMENTS IN NURSING HOME STAFFING AND
QUALITY.
(a) Secretary's Authority To Award Grants.--The Secretary of Health
and Human Services 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 of Health and Human Services 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, a State 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 of
Health and Human Services that the skilled nursing
facilities (as defined in section 1819(a) of the Social
Security Act (42 U.S.C. 1395i-3(a))) and nursing
facilities (as defined in section 1919(a) of such Act
(42 U.S.C. 1396r(a))) within the State will reach or
exceed the minimum staff level described in subsection
(d)(2) within two years after the date of the 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 satisfaction of the Secretary of
Health and Human Services 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 of Health and Human
Services may approve.
(d) Distribution of Funds.--
(1) In general.--Subject to subsection (b), in awarding
grants under this section, the Secretary of Health and Human
Services 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 and nursing facilities 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 two 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 of Health and Human Services 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 of Health and
Human Services 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 (CMP)
Collections.--
(1) Appropriations.--There are appropriated to the
Secretary of Health and Human Services, out of any money in the
Treasury not otherwise appropriated, for all costs 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 of Health and Human Services 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) of the Social Security Act (42
U.S.C. 1395i-3(b)), as amended by section 941(a) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (as enacted into law by section 1(a)(6)
of Public Law 106-554), is amended by adding at the end the
following new paragraph:
``(9) 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)(8)(A) of the Social Security Act (42 U.S.C.
1395i-3(b)(8)(A)), as added by such section 941(a), is amended
by striking ``for each shift'' and inserting ``for each nursing
unit of the facility and for each shift''.
(3) Information concerning patient classification.--Section
1819(b)(4)(C) of the Social Security Act (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)(4)(G)(i), or such successor system as
the Secretary may identify.''.
(b) Medicaid.--
(1) In general.--Section 1919(b) of the Social Security Act
(42 U.S.C. 1396r(b)), as amended by section 941(b) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (as enacted into law by section 1(a)(6)
of Public Law 106-554), is amended by adding at the end the
following new paragraph:
``(9) 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)(8)(A) of the Social Security Act (42 U.S.C.
1396r(b)(8)(A)), as added by such section 941(b), is amended by
striking ``for each shift'' and inserting ``for each nursing
unit of the facility and for each shift''.
(3) Information concerning patient classification.--Section
1919(b)(4)(C) of the Social Security Act (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)(4)(G)(i), or such successor system as
the Secretary may identify.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date that is one year after the date of the enactment of
this Act.
SEC. 4. NURSING FACILITY CIVIL MONEY PENALTY COLLECTIONS.
(a) Establishment of Nursing Facility Civil Money Penalty
Collections Account.--Section 1128A of the Social Security Act (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 skilled nursing facilities or 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) of the Social
Security Act (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) of the Social
Security Act (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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