[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3331 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3331
To amend titles XVIII and XIX of the Social Security Act to impose
requirements with respect to staffing in nursing facilities receiving
payments under the Medicare or Medicaid Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 16, 2001
Ms. Schakowsky (for herself, Mr. Waxman, Mr. Blagojevich, Mr. Rush, Mr.
Evans, Mr. Frost, Mrs. McCarthy of New York, and Mr. Sanders)
introduced the following bill; which was referred to the Committee on
Ways and Means, and in addition to the Committee on Energy and
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 impose
requirements with respect to staffing in nursing facilities receiving
payments under the Medicare or Medicaid Program.
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 ``Quality Care for Nursing Home
Patients Act of 2001''.
SEC. 2. NURSE STAFFING REQUIREMENTS.
(a) In General.--Sections 1819(b)(4) and 1919(b)(4) of the Social
Security Act (42 U.S.C. 1395i-3(b)(4); 1396r(b)(4)) are each amended by
adding at the end the following new subparagraph:
``(D) Minimum staffing requirements.--
``(i) Licensed nurses.--A facility shall
have at least one licensed nurse on duty on the
premises for every--
``(I) 15 residents present during
the day,
``(II) 20 residents present during
the evening, and
``(III) 30 residents present during
the night.
``(ii) Direct caregivers.--In addition to
the requirement under clause (i), a facility
shall also have at least one direct caregiver
on duty on the premises for every--
``(I) 5 residents present during
the day,
``(II) 10 residents present during
the evening, and
``(III) 15 residents present during
the night.
``(iii) Counting.--In determining
compliance with the staffing levels under this
subparagraph, an individual may not be counted
while performing noncaregiving services, such
as administrative services, food preparation,
housekeeping, laundry, maintenance services, or
other noncaregiving-related activities.
``(iv) Authority to establish higher
standards.--The Secretary may establish higher
minimum staffing requirements, for resident
case mix and such other factors as the
Secretary determines appropriate, than those
imposed under clauses (i) and (ii).
``(v) Rules of construction.--
``(I) Nonpreemption.--Nothing in
this subparagraph shall be construed to
prohibit a State from imposing higher
minimum staffing requirements on
facilities than those imposed under
this subparagraph.
``(II) Minimum standards only.--
Compliance with the staffing
requirements imposed under this
subparagraph alone shall not be
construed as complying with the
requirement under paragraph (2) to
provide services to attain or maintain
the highest practicable physical,
mental, and psychosocial well-being of
each resident.
``(III) Supplementary
requirements.--The staffing
requirements of this subparagraph are
in addition to the requirements of
subparagraph (C).
``(vi) Definitions.--In this subparagraph
and paragraph (8):
``(I) Licensed nurse.--The term
`licensed nurse' means a registered
professional nurse, licensed practical
nurse, or licensed vocational nurse who
meets State licensing requirements, and
who furnishes any of the following
services:
``(aa) Direct care
(including treatment and
medications).
``(bb) Resident assessment
and observation.
``(cc) Supervision of
direct patient care at the unit
level.
``(dd) Planning or
coordination of nursing
services with other resident
services.
``(II) Direct caregiver.--The term
`direct caregiver' means a certified
nurse assistant who provides direct
care (as defined by the Secretary) or a
licensed nurse who primarily provides
direct care.
``(III) Day.--The term `day' means
an eight-hour period commencing not
earlier than 6 a.m. nor later than 8
a.m.
``(IV) Evening.--The term `evening'
means an eight-hour period commencing
not earlier than 2 p.m. nor later than
4 p.m.
``(V) Night.--The term `night'
means an eight-hour period commencing
not earlier than 10 p.m. nor later than
12 midnight.''.
(b) Adjustment to Payments.--
(1) Medicare.--Section 1888(e)(4)(G) of such Act (42 U.S.C.
1395yy(e)(4)(G)) is amended by adding at the end the following
new clause:
``(iv) Adjustment to reflect costs of
minimum staffing.--The Secretary shall provide
for an appropriate adjustment to account for
the costs attributable to meeting the minimum
staffing requirements of subsections (b)(4)(D)
and (f)(8) of section 1819.''.
(2) Medicaid.--Section 1902(a)(13)(A) of such Act (42
U.S.C. 1396a(a)(13)(A)) is amended--
(A) in clause (iii), by striking the final ``and'';
(B) in clause (iv), by striking the semicolon and
inserting ``, and''; and
(C) by inserting after clause (iv) the following
new clause:
``(v) in the case of nursing facilities,
such rates take into account the costs
attributable to the requirements of section
1919(b)(4)(D).''.
(c) Effective Date.--The amendments made by this section shall
apply to services provided on or after the date that is two years after
the date of enactment of this Act.
(d) Report to Congress on Adequacy of Personnel To Meet Staffing
Requirements.--Not later than one year after the date of enactment of
this Act, the Secretary of Health and Human Services shall submit to
the Congress a report regarding the adequacy of personnel in nursing
facilities covered under titles XVIII and XIX of the Social Security
Act to meet the direct care staffing requirements required under
sections 1819(b)(4)(D) and 1919(b)(4)(D) of the Social Security Act (as
added by subsection (a)) and, if inadequate, recommendations on steps
that should be taken to ensure that adequate numbers of trained staff
are available to meet such requirements, including ways to attract and
retain such direct caregiving personnel.
SEC. 3. DISCLOSURE OF STAFFING LEVELS.
(a) In General.--Section 1819(b)(8) and 1919(b)(8) of the Social
Security Act (42 U.S.C. 1395i-3(b)(8); 1396r(b)(8)), as added by
section 941 of the Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A-585), as enacted into law
by section 1(a)(6) of Public Law 106-554, are each amended to read as
follows:
``(8) Disclosure of staffing levels.--
``(A) In general.--A facility shall conspicuously
post the notices described in subparagraph (B), in the
manner described in subparagraph (C), in each area or
unit of the facility where residents reside.
``(B) Notices described.--Notices referred to in
subparagraph (A) are the following:
``(i) Minimum staffing requirements.--A
notice describing the minimum staffing
requirements set forth in subsection (b)(4)(D).
``(ii) Current staff information.--A notice
showing, separately for each shift in the area
or unit of the facility in which it is posted--
``(I) the name of the direct care
clinical supervisor for that area or
unit;
``(II) the current number of direct
caregivers (including licensed nurses)
present on the premises who perform
resident care and the name and
credential or professional title of
each such caregiver;
``(III) the current ratio of
residents to licensed nurses present on
the premises;
``(IV) the current ratio of
residents to direct caregivers
(including licensed nurses) present on
the premises assigned to that area or
unit; and
``(V) the current number of
residents of such area or unit.
``(C) Manner of posting; format of notice.--
``(i) Manner of posting.--Notices posted
under subparagraph (A) shall be posted adjacent
to each other in each area or unit to which
such notices apply in the facility, and posted
in a manner visible and accessible to
residents, their families, caregivers, and
prospective residents of such facility.
``(ii) Format of notice.--The Secretary
shall develop a uniform format for the notices
referred to in subparagraph (B) for facilities
to carry out the requirements of this
paragraph.
``(D) Recordkeeping.--The facility shall retain
records of such notices for not fewer than two years,
and shall make the information contained in those
notices available upon request.''.
(b) Conforming Amendments.--Sections 1819(b)(4) and 1919(b)(4) of
such Act (42 U.S.C. 1395i-3(b)(4); 1396r(b)(4)) are each amended in
subparagraph (D)(v), as added by section 2(a) of this Act, by inserting
``and paragraph (8)'' after ``this subparagraph''.
(c) Effective Date.--The amendments made by this section shall
apply to services provided on or after the date that is two years after
the date of enactment of this Act.
SEC. 4. ADMINISTRATIVE STAFFING REQUIREMENTS.
(a) In General.--Sections 1819(d)(1) and 1919(d)(1) of the Social
Security Act (42 U.S.C. 1395i-3(d)(1); 1396r(d)(1)) are each amended by
adding at the end the following new subparagraph:
``(D) Administrative staffing.--A facility must
maintain at least the administrative staff described in
the following clauses:
``(i) Director of nursing services.--An
individual who serves full time as a director
of nursing services and who is a registered
professional nurse.
``(ii) Assistant director of nursing
services.--An individual who serves full time
as an assistant director of nursing services
and who is a registered professional nurse,
except that in a facility with fewer than 100
beds, such individual may serve part time and
may also serve as a direct care clinical
nursing supervisor.
``(iii) Director of in-service education.--
An individual who serves full time as a
director of in-service education, who is a
registered professional nurse, and who has, to
the extent practicable and appropriate,
training in adult education and gerontology,
except that in a facility with fewer than 100
beds, such individual may serve part time.
``(iv) Direct care clinical nursing
supervisor.--For each shift each day, an
individual who serves full time as a direct
care clinical nursing supervisor and who is a
registered professional nurse, except that in a
facility with fewer than 100 beds, such an
individual may serve part time and may also
serve as an assistant director of nursing.
An individual may not satisfy more than one requirement
of clauses (i) through (iv), except as specifically
provided.''.
(b) Conforming Amendments.--Sections 1819(b)(4) and 1919(b)(4) of
such Act (42 U.S.C. 1395i-3(b)(4); 1396r(b)(4)) are each amended in
subparagraph (D)(v), as added by section 2(a) and amended by section
3(b) of this Act, by striking ``and paragraph (8)'' and by inserting
``, paragraph (8), and subsection (d)(1)(D)''.
(c) Payment Modification.--
(1) Medicare.--Section 1888(e)(4)(G)(iv) of such Act (42
U.S.C. 1395yy(e)(4)(G)(iv)), as added by section 2(b)(1) of
this Act, is amended by striking ``section 1819(b)(4)(D)'' and
inserting ``subsections (b)(4)(D) and (d)(1)(D) of section
1819''.
(2) Medicaid.--Section 1902(a)(13)(A)(v) of such Act (42
U.S.C. 1396a(a)(13)(A)(v)), as added by section 2(b)(2) of this
Act, is amended by striking ``section 1919(b)(4)(D)'' and
inserting ``subsections (b)(4)(D) and (d)(1)(D) of section
1919''.
(d) Effective Date.--The amendments made by this section shall
apply to services provided on or after the date that is two years after
the date of enactment of this Act.
SEC. 5. APPLICATION OF REQUIREMENTS TO ALL BEDS.
(a) Medicare.--Section 1819 of the Social Security Act (42 U.S.C.
1395i-3) is amended--
(1) by redesignating subsection (i) as subsection (j); and
(2) by inserting after subsection (h) the following new
subsection:
``(i) Applicability of Protections to All Residents.--The
provisions of this section shall apply with respect to all residents of
a skilled nursing facility, without regard to whether the resident is
entitled to have payment made for skilled nursing facility services
under this title.''.
(b) Medicaid.--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:
(1) by redesignating subsection (i) as subsection (j); and
(2) by inserting after subsection (h) the following new
subsection:
``(i) Applicability of Protections to All Residents.--The
provisions of this section shall apply with respect to all residents of
a nursing facility, without regard to whether the resident is entitled
to have payment made for nursing facility services under the State plan
or under any other provision of this Act.''.
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