[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2677 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 2677

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 30, 2001

  Mr. Waxman (for himself, Mr. Gephardt, Mr. Dingell, Mr. Stark, Mr. 
Brown of Ohio, Mr. George Miller of California, Mr. Carson of Oklahoma, 
Ms. Schakowsky, Mr. Rodriguez, Mr. Blagojevich, Mr. Hoeffel, Mr. Holt, 
 Mr. Lantos, Ms. Lee, Mrs. Maloney of New York, Mr. Wexler, Mr. Clay, 
   Ms. DeLauro, Mr. Edwards, Mr. Evans, Mr. Hinchey, Ms. Kaptur, Mr. 
 Lampson, Mr. McGovern, Mr. Murtha, Ms. Norton, Mr. Tierney, Mr. Udall 
 of New Mexico, and Mr. Wynn) introduced the following bill; which was 
            referred to the Committee on Energy and 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) Short Title.--This Act may be cited as the ``Nursing Home 
Quality Protection Act of 2001''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Increased resources.
Sec. 3. Increased nurse staffing.
Sec. 4. Increased sanctions.
Sec. 5. Increased public disclosure.
Sec. 6. Background checks.
Sec. 7. Clarification of applicability of protections.
Sec. 8. Financial accountability.

SEC. 2. INCREASED RESOURCES.

    (a) Purpose.--In 1997, Congress repealed the Boren amendment, which 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.
    (b) Reinstitution of Boren Amendment Payment Methodology.--
            (1) In general.--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 pursuant to the criteria under this paragraph 
        as in effect on August 1, 1997;''.
            (2) Establishment of safe harbor rates.--Section 1902 of 
        such Act (42 U.S.C. 1396a) is amended by adding at the end the 
        following: ``The Secretary may, by regulation, promulgate 
        standards or methodologies for determining rates that comply 
        with paragraph (13), and a State that pays rates that meet such 
        standards or methodologies is deemed to be in compliance with 
        paragraph (13).''.
    (c) Effective Date.--The amendment made by subsection (b) shall 
apply to services furnished on or after the date that is one year after 
the date of the enactment of this Act.

SEC. 3. INCREASED NURSE STAFFING.

    Section 1919(b)(4) of the Social Security Act (42 U.S.C. 
1396r(b)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Minimum staffing levels.--
                            ``(i) Deadline for compliance with minimum 
                        standards.--With respect to nursing facility 
                        services provided after the date that is the 
                        end of the 2-year period beginning on the date 
                        of the enactment of this subparagraph, a 
                        nursing facility shall comply with the minimum 
                        staffing levels promulgated by the Secretary 
                        under clause (ii).
                            ``(ii) Final regulations.--
                                    ``(I) In general.--Not later than 1 
                                year after the date of the enactment of 
                                this subparagraph, and consistent with 
                                the provisions of this clause, the 
                                Secretary shall promulgate standards 
                                for minimum staffing levels for nursing 
                                facilities. Such standards shall be 
                                established to ensure that residents of 
                                nursing facilities receive the level of 
                                care necessary to meet the objectives 
                                of subsection (b)(2), and shall provide 
                                for appropriate adjustments to account 
                                for resident case mix.
                                    ``(II) Minimum standards.--Subject 
                                to subclauses (III) and (IV), standards 
                                promulgated under subclause (I) shall 
                                be, at a minimum, the Hartford staffing 
                                standards (as defined in clause 
                                (v)(I)).
                                    ``(III) Alternative minimum 
                                standards.--Standards promulgated under 
                                subclause (I) may be lower than the 
                                standards described in subclause (II) 
                                if the Secretary determines that use of 
                                the staffing levels under those 
                                standards does not compromise the 
                                ability of facilities to meet the 
                                objectives of subsection (b)(2), but in 
                                no case may standards under this 
                                subclause be lower than the HHS 
                                staffing standards (as defined in 
                                clause (v)(II)).
                                    ``(IV) Authority to phase in 
                                facility compliance with standards.--If 
                                the Secretary determines that 
                                compliance with the Hartford staffing 
                                standards is not feasible for nursing 
                                facilities by the end of the 2-year 
                                period applicable under clause (i), the 
                                Secretary may delay the implementation 
                                of those Hartford staffing standards 
                                until such time as the Secretary 
                                determines such compliance is feasible. 
                                In the interim, facilities shall comply 
                                with standards promulgated by the 
                                Secretary, such standards in no case 
                                being lower than the HHS staffing 
                                standards.
                                    ``(V) Explanation of exercise of 
                                authority.--If the Secretary decides to 
                                exercise the authority under subclauses 
                                (III) or (IV), the Secretary shall 
                                submit to Congress a report describing 
                                the facts and circumstances of the 
                                decision, and shall include the data 
                                and assumptions used in making that 
                                decision and an assessment of the 
                                impact on resident care.
                            ``(iii) Failure to timely promulgate final 
                        regulations.--If the Secretary does not publish 
                        the final regulations under clause (ii) by the 
                        date required under that clause, effective for 
                        services furnished in nursing facilities on or 
                        after the date under clause (ii), such 
                        facilities, at a minimum, shall comply with the 
                        Hartford staffing standards.
                            ``(iv) Increase in payment rate.--Rates 
                        applicable to facilities under section 
                        1902(a)(13) shall reflect appropriate 
                        adjustments for compliance with minimum 
                        standards under this subparagraph.
                            ``(v) Definitions.--In this subparagraph:
                                    ``(I) Hartford staffing 
                                standards.--The term `Hartford staffing 
                                standards' means the staffing standards 
                                recommended in January 2000 by the 
                                Hartford Institute for Geriatric 
                                Nursing and the National Citizens 
                                Coalition for Nursing Home Reform, 
                                appropriately adjusted by the Secretary 
                                to account for resident case mix.
                                    ``(II) HHS staffing standards.--The 
                                term `HHS staffing standards' means the 
                                preferred minimum staffing levels 
                                identified in the report to Congress 
                                entitled `Appropriateness of Minimum 
                                Nurse Staffing Ratios in Nursing Homes' 
                                submitted by the Secretary in the 
                                summer of 2000, appropriately adjusted 
                                by the Secretary to account for 
                                resident case mix.''.

SEC. 4. INCREASED SANCTIONS.

    (a) Refund of Federal Moneys for Substandard Nursing Care.--
            (1) In general.--Section 1919 of the Social Security Act 
        (42 U.S.C. 1396r) is amended--
                    (A) by redesignating subsection (i) as subsection 
                (j); and
                    (B) 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 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, and the State shall 
        withhold such amount from payments to that nursing facility.
            ``(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)(I) shall be deducted from civil 
                        money penalties otherwise assessed and 
                        collected by the Secretary with respect to the 
deficiency under other provisions of this Act, and
                            ``(II) with respect to the amounts so 
                        deducted under subclause (I), those amounts 
                        shall be used only in the same manner and for 
                        the same purposes as such civil money penalties 
                        otherwise assessed and collected; 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.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        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.
    (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 subsection (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), 
                        other than amounts described in subsection 
                        (i)(5)(A)(ii)(II) (relating to deductions from 
                        civil money penalties); and
                            ``(ii) amounts withheld under subsection 
                        (i)(3), other than amounts described in 
                        subsection (i)(5)(A)(ii)(II) (relating to 
                        deductions from civil money penalties).
                    ``(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, including through educational 
                        programs offered by community colleges and 
                        other institutions of higher education.
                            ``(iii) To improve workplace safety for 
                        nursing staff.
                    ``(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)(I) In developing the plan required 
                        under clause (i), the State shall establish 
                        advisory councils comprised of representatives 
                        of nursing facility residents, of nursing 
                        facilities, of nursing staff, and of other 
                        interested parties.
                            ``(II) Such councils shall participate in 
                        determining the manner in which grant funds are 
                        used under the plan, and shall give priority to 
                        proposals for the use of grant funds that are 
                        mutually agreed to by the representatives of 
                        facility residents, of nursing facilities, and 
                        of nursing staff.
                            ``(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 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. 5. INCREASED PUBLIC DISCLOSURE.

    (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.--
                            ``(i) Facility-specific information.--As 
                        soon as practicable, but in no case later than 
                        1 year after the date of the enactment of this 
                        subparagraph, 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 
                                substantiated 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:
                                            ``(aa) The ratio of 
                                        registered professional nurses 
                                        to residents of the facility.
                                            ``(bb) The ratio of 
                                        licensed practical or licensed 
                                        vocational nurses to residents 
                                        of the facility.
                                            ``(cc) The ratio of nurse 
                                        aides to residents of the 
                                        facility.
                                            ``(dd) 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 the date of the enactment of this clause, 
                        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.
                            ``(ii) Establishment and publication of 
                        rating system.--The Secretary shall establish 
                        and implement a rating system to compare the 
                        quality of care furnished to residents by 
                        nursing facilities. Such system shall be based 
                        on the information under clause (i), case mix 
                        of residents of the facility, and such other 
                        information as the Secretary determines 
                        appropriate to provide for meaningful ratings 
                        of quality of care furnished among 
                        facilities.''.
    (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.''.

SEC. 6. BACKGROUND CHECKS.

    (a) In General.--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) Prohibition on employment of certain individuals.--
                    ``(A) Background check on employees.--Beginning 1 
                year after the date of the enactment of this paragraph, 
                each nursing facility shall conduct a background check 
                on each covered employee hired by the facility. The 
                background check shall include a check of all relevant 
                Federal and State databases that contain information 
                on--
                            ``(i) violations of Federal or State 
                        criminal law,
                            ``(ii) abuse of residents of nursing 
                        facilities, or misappropriation of resident 
                        property,
                            ``(iii) abuse of hospital patients, or any 
                        other group of patients that the Secretary may 
                        specify, or misappropriation of patient 
                        property, and
                            ``(iv) abuse of children.
                    ``(B) Prohibition on employment.--
                            ``(i) In general.--A nursing facility may 
                        not knowingly hire a covered employee--
                                    ``(I) who has been convicted of a 
                                felony under Federal or State law for 
                                any offense described in paragraphs (1) 
                                through (4) of section 1128(a);
                                    ``(II) with respect to whom a 
                                Federal or State department or agency 
                                has made a specific documented finding 
                                of resident or patient abuse, 
                                misappropriation of resident or patient 
                                property, or child abuse; or
                                    ``(III) who has been found to have 
                                committed any other offense that the 
                                Secretary specifies in regulations.
                            ``(ii) Authority for exceptions for 
                        specific factors.--The Secretary may provide 
                        for limited exceptions to the prohibition under 
                        clause (i) based on the severity of the offense 
                        or finding or the period of time that has 
                        elapsed since the offense or finding occurred 
                        and the conduct of the background check.
                    ``(C) Employee appeal.--A covered employee, or a 
                candidate for employment, may appeal (under a procedure 
                similar to petitions under subsection (g)(1)(D)) to the 
                State in which the facility is located a decision of a 
                nursing facility to terminate, or deny, employment of 
                the covered employee or candidate in the facility based 
on erroneous information revealed in the background check.
                    ``(D) Prohibition on charging employee for cost of 
                background check.--A nursing facility that conducts a 
                background check on a covered employee, or a candidate 
                for employment, may not directly or indirectly recoup 
                the cost of performing such background check from the 
                employee or candidate.
                    ``(E) Definition.--In this paragraph, the term 
                `covered employee' means any individual who under an 
                employment contract or arrangement with a nursing 
                facility furnishes health care items and services, or 
                furnishes other services in the facility in areas of 
                the facility where residents are present, and who is 
                hired on or after the date that is one year before the 
                date of the enactment of this paragraph.''.
    (b) Procedure for Background Checks.--The Secretary of Health and 
Human Services shall, by regulation, establish uniform procedures--
            (1) for a nursing facility receiving payments under a State 
        plan under title XIX of the Social Security Act to conduct 
        background checks under subparagraph (A) of section 1919(d)(5) 
        of such Act, as added by subsection (a); and
            (2) for a covered employee, or a candidate for employment, 
        to appeal under subparagraph (C) of that section an employment 
        action of a nursing facility to the State in which the facility 
        is located.

SEC. 7. CLARIFICATION OF APPLICABILITY OF PROTECTIONS.

    (a) Survey and Certification.--Section 1919(g) of the Social 
Security Act (42 U.S.C. 1396r(g)) is amended by adding at the end the 
following new paragraph:
            ``(6) Applicability of protections to all residents.--The 
        provisions of this subsection shall apply to all residents of a 
        nursing facility, without regard to whether--
                    ``(A) the resident is entitled to have payment made 
                for nursing facility services under the State plan or 
                under any other provision of this Act, or
                    ``(B) the facility is a distinct part of an 
                institution under subsection (a).''.
    (b) Enforcement.--Section 1919(h) of such Act (42 U.S.C. 1396r(h)) 
is amended by adding at the end the following new paragraph:
            ``(10) Applicability of protections to all residents.--The 
        provisions of this subsection shall apply to all residents of a 
        nursing facility, without regard to whether--
                    ``(A) the resident is entitled to have payment made 
                for nursing facility services under the State plan or 
                under any other provision of this Act, or
                    ``(B) the facility is a distinct part of an 
                institution under subsection (a).''.

SEC. 8. FINANCIAL ACCOUNTABILITY.

    (a) In General.--Section 1919(g)(2) of the Social Security Act (42 
U.S.C. 1396r(g)(2)) is amended--
            (1) by redesignating subparagraphs (C), (D), and (E) as 
        subparagraphs (D), (E), and (F); and
            (2) by inserting after subparagraph (B) the following new 
        subparagraph:
                    ``(C) Financial accountability.--A standard or an 
                extended survey may include an examination of the 
                financial records of a facility to determine whether 
                payments made to the facility under this section for 
                services furnished to residents are being used in a 
                manner consistent with this section.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to surveys conducted on or after the date of the enactment of 
this Act.
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