[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3355 Introduced in House (IH)]






108th CONGRESS
  1st Session
                                H. R. 3355

 To amend titles XVIII and XIX of the Social Security Act to establish 
minimum requirements for nurse staffing in nursing facilities receiving 
            payments under the Medicare or Medicaid Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 21, 2003

Mr. Waxman (for himself, Mr. Dingell, Mr. Stark, Mr. Brown of Ohio, Mr. 
 Frost, Mr. George Miller of California, Ms. Schakowsky, Mr. Carson of 
   Oklahoma, Mr. Rodriguez, Mr. Markey, Ms. Norton, Ms. Kaptur, Mr. 
  Sanders, Mr. Hoeffel, Mrs. Maloney, Mr. Grijalva, Mr. Hinchey, Mr. 
  Udall of New Mexico, Mr. Acevedo-Vila, Mr. Kucinich, Mr. Moore, Mr. 
Lantos, Ms. Corrine Brown of Florida, Mr. Thompson of Mississippi, Mr. 
   Berman, Mr. Wexler, Mr. Evans, Ms. Roybal-Allard, Mr. Kildee, Ms. 
Baldwin, Mrs. Capps, Ms. Solis, Mr. Stupak, Mr. Kleczka, Mr. Baca, Mr. 
McGovern, Mr. Holt, Mr. Pallone, Ms. Eshoo, Mr. Brady of Pennsylvania, 
 Mr. Clay, and Mr. McDermott) 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 amend titles XVIII and XIX of the Social Security Act to establish 
minimum requirements for nurse 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; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``Nursing Home 
Staffing Act of 2003''.
    (b) Purpose.--The purpose of this Act is to improve the quality of 
care received by residents of nursing facilities through the 
implementation of the minimum nurse staffing levels identified by the 
Secretary of Health and Human Services in a report to Congress 
submitted on March 21, 2002.

SEC. 2. IMPLEMENTATION OF NURSE STAFFING STANDARDS.

    (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) Deadline for compliance with minimum 
                        standards.--With respect to 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 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 
                                facilities. Such standards shall 
                                provide for sufficient staffing levels 
                                during day, evening, and night shifts 
                                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 subclause (III), standards 
                                promulgated under subclause (I) shall 
                                be, at a minimum, the HHS minimum nurse 
                                staffing ratios (as defined in clause 
                                (iii)).
                                    ``(III) Authority to phase in 
                                facility compliance with standards.--If 
                                the Secretary determines that 
                                compliance with the HHS minimum nurse 
                                staffing ratios 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 the HHS minimum nurse 
                                staffing ratios until the date that is 
                                the end of the 5-year period that 
                                begins on the date of the enactment of 
                                this subparagraph. If the Secretary 
                                delays implementation of the HHS 
                                minimum nurse staffing ratios under the 
                                previous sentence, the Secretary shall 
                                phase in over such 5-year period 
                                alternative minimum staffing standards 
                                that gradually increase in each of the 
                                years of the phase-in until the such 
                                standards meet the HHS minimum nurse 
                                staffing ratios.
                                    ``(IV) Counting.--In determining 
                                compliance with the staffing levels 
                                under this subparagraph, an individual 
                                may not be counted while performing 
                                services that are not direct nursing 
                                care, such as administrative services, 
                                food preparation, housekeeping, 
                                laundry, maintenance services, or other 
                                activities that are not direct nursing 
                                care.
                            ``(iii) HHS minimum nurse staffing 
                        ratios.--The term `HHS minimum nurse staffing 
                        ratios' means the minimum staffing levels 
                        identified in the report to Congress entitled 
                        `Appropriateness of Minimum Nurse Staffing 
                        Ratios in Nursing Homes, Report to Congress: 
                        Phase II Final' submitted by the Secretary on 
                        March 21, 2002, which require--
                                    ``(I) from 2.4 to 2.8 hours of care 
                                per resident per day by a certified 
                                nurse aide, and
                                    ``(II) from 1.15 to 1.3 hours of 
                                care per resident per day by a licensed 
                                practical nurse, a licensed vocational 
                                nurse, or a registered nurse, of which 
                                from 0.55 to 0.75 hours of care per 
                                resident per day shall be provided by a 
                                registered nurse.
                            ``(iv) Construction.--
                                    ``(I) Nonpreemption.--Nothing in 
                                this subparagraph shall be construed as 
                                prohibiting the Secretary or a State 
                                (in the case of title XIX) from 
                                imposing higher minimum staffing levels 
                                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).''.
    (b) Posting of Staffing Information.--
            (1) In general.--The first sentence of subparagraph (A) of 
        sections 1819(b)(8) and 1919(b)(8) of the Social Security Act 
        (42 U.S.C. 1395i-3(b)(8); 1396r(b)(8)) are each amended by 
        inserting before the period the following: ``, a description of 
        the minimum staffing requirements under paragraph (4)(D), and 
        the average number of hours of nursing care that residents of 
        the facility have received for each of the four previous 
        calendar quarters''.
            (2) Reports.--Such sections are each amended by adding at 
        the end the following new subparagraph:
                    ``(C) Reports of staffing data.--A facility shall 
                maintain records on nurse staffing, and shall submit 
                such reports of such records to the Secretary as the 
                Secretary may require for the administration and 
                enforcement of this section. Such records shall be 
                reviewed for accuracy as part of a standard survey 
                required under subsection (g)(2)(A).''.

SEC. 3. INCREASED RESOURCES.

    (a) 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).''.
            (3) Effective date.--The amendment made by this subsection 
        shall apply to services furnished on or after the date that is 
        one year after the date of the enactment of this Act.
    (b) Permanent 1.5 Percent Increase of Medicaid FMAP Beginning With 
Fiscal Year 2004.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by adding at the end the following: ``With 
respect to calendar quarters beginning after October 1, 2003, the 
Federal medical assistance percentage for a State determined under the 
first sentence shall be increased by 1.50 percentage points.''.
    (c) Financial Accountability.--
            (1) In general.--Sections 1819(g)(2) and 1919(g)(2) of the 
        Social Security Act (42 U.S.C. 1395i-3(g)(2); 1396r(g)(2)) are 
        each amended--
                    (A) by redesignating subparagraphs (C), (D), and 
                (E) as subparagraphs (D), (E), and (F); and
                    (B) 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.''.
            (2) Composition of multidisciplinary team.--Sections 
        1819(g)(2)(E)(i) and 1919(g)(2)(E)(i) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(2)(E)(i); 1396r(g)(2)(E)(i)) are each 
        amended by inserting after the period the following: ``This 
        multidisciplinary team may include professionals trained in 
        financial accounting and auditing.''
            (3) Effective date.--The amendments made by paragraph (1) 
        shall apply to surveys conducted on or after the date of the 
        enactment of this Act.
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