[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.''.
                                 <all>