[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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