[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4374 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4374

    To require Medicare providers to disclose publicly staffing and 
   performance in order to promote improved consumer information and 
                                choice.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 17, 2004

 Mr. Hinchey 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 require Medicare providers to disclose publicly staffing and 
   performance in order to promote improved consumer information and 
                                choice.

    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 ``Patient Safety Act of 2004''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) The past decade has been a turbulent time for health 
        care facilities and nurses.
            (2) Recent research published in the Journal of the 
        American Medical Association has shown that registered nurse 
        staffing levels have a significant impact on preventable deaths 
        in hospitals, and that the odds of patient mortality increase 7 
        percent for every additional patient added to the average 
        registered nurse's workload.
            (3) Recent research supported by the Agency for Health Care 
        Research and Quality, the Centers for Medicare & Medicaid 
        Services, and the National Institute for Nursing Research shows 
        that inadequate registered nurse staffing is directly related 
        to serious complications such as pneumonia, upper 
        gastrointestinal bleeding, and urinary tract infections, as 
        well as failure to stop deaths caused by shock, cardiac arrest, 
        sepsis, and deep vein thrombosis in hospitalized patients.
            (4) The Joint Commission on the Accreditation of Healthcare 
        Organizations recently reported that inadequate nurse staffing 
        contributes to nearly a quarter of all unexpected incidents 
        that kill or injure hospitalized patients.
            (5) The Institute of Medicine has reported that both 
        nursing-to-resident staffing levels and the ratio of 
        professional nurses to other nursing personnel are important 
        indicators of high quality of care, and that the participation 
        of registered nurses in direct care giving and in the provision 
        of hands-on guidance to nurse assistants is positively 
        associated with quality of care in nursing facilities.
            (6) Recent research conducted by the Centers for Medicare & 
        Medicaid Services found strong, objective proof that nurse 
        staffing in nursing homes is directly related to quality 
        measures such as sepsis, urinary tract infections, incidence of 
        pressure sores, resisting care improvement, and weight loss.
            (7) As a payer for inpatient and outpatient hospital 
        services for individuals entitled to benefits under the 
        medicare and medicaid programs established under titles XVIII 
        and XIX of the Social Security Act, the Federal Government has 
        a compelling interest in promoting the safety of such 
        individuals by requiring providers participating in such 
        programs to provide these individuals with information 
        regarding nurse staffing levels.

SEC. 3. PUBLIC DISCLOSURE OF STAFFING AND OUTCOMES DATA.

    (a) Disclosure of Staffing and Outcomes.--Any provider under the 
medicare program shall, as a condition of continued participation in 
such program, make publicly available information regarding nurse 
staffing and patient outcomes as specified by the Secretary. Such 
information shall include at least the following:
            (1) The number of registered nurses providing direct 
        patient care. This information shall be expressed both in raw 
        numbers, in terms of total hours of nursing care per patient 
        (including adjustment for case mix and acuity), and as a 
        percentage of nursing staff, and shall be broken down in terms 
        of the total nursing staff, each unit, and each shift.
            (2) The number of licensed practical nurses or licensed 
        vocational nurses providing direct care. This information shall 
        be expressed both in raw numbers, in terms of total hours of 
        nursing care per patient (including adjustment for case mix and 
        acuity), and as a percentage of nursing staff, and shall be 
        broken down in terms of the total nursing staff, each unit, and 
        each shift.
            (3) Numbers of unlicensed personnel utilized to provide 
        direct patient care. This information shall be expressed both 
        in raw numbers and as a percentage of nursing staff and shall 
        be broken down in terms of the total nursing staff, each unit, 
        and each shift.
            (4) The average number of patients per registered nurse, 
        licensed practical nurse, or unlicensed personnel providing 
        direct patient care. This information shall be broken down in 
        terms of the total nursing staff, each unit, and each shift.
            (5) Risk-adjusted patient mortality rate (in raw numbers 
        and by diagnosis or diagnostic-related group).
            (6) Incidence of adverse patient care incidents, including 
        as such incidents at least medication errors, patient injury, 
        pressure ulcers, nosocomial infections, and nosocomial urinary 
        tract infections.
            (7) Methods used for determining and adjusting staffing 
        levels and patient care needs and the provider's compliance 
        with these methods.
    (b) Disclosure of Complaints.--Data regarding complaints filed with 
the State agency, the Centers for Medicare & Medicaid Services, or an 
accrediting agency, compliance with the standards of which have been 
deemed to demonstrate compliance with conditions of participation under 
the medicare program, and data regarding investigations and findings as 
a result of those complaints and the findings of scheduled inspection 
visits, shall be made publicly available.
    (c) Information on Data.--All data made publicly available under 
this section shall indicate the source and currency of the data 
provided.
    (d) Waiver for Small Providers.--The Secretary may reduce reporting 
requirements under this section in the case of a small provider (as 
defined by the Secretary) for whom the imposition of the requirements 
would be unduly burdensome.
    (e) Reporting to Secretary.--Providers shall submit to the 
Secretary in a uniform manner (as prescribed by the Secretary) the 
nursing staff information described in subsection (a) through 
electronic means not less frequently than quarterly.
    (f) Secretarial Responsibilities.--The Secretary shall--
            (1) make the information submitted pursuant to subsection 
        (a) publicly available, including by publication of such 
        information on the Internet site of the Department of Health 
        and Human Services; and
            (2) provide for the auditing of such information for 
        accuracy as a part of the process of determining whether a 
        provider is eligible for continued participation in the 
        medicare program.
    (g) Definitions.--For purposes of this section:
            (1) Licensed practical nurse or licensed vocational 
        nurse.--The term ``licensed practical nurse or licensed 
        vocational nurse'' means an individual who is entitled under 
        State law or regulation to practice as a licensed practical 
        nurse or a licensed vocational nurse.
            (2) Publicly available.--The term ``publicly available'' 
        means, with respect to information of a provider, information 
        that is--
                    (A) provided to the Secretary and to any State 
                agency responsible for licensing or accrediting the 
                provider;
                    (B) provided to any State agency which approves or 
                oversees health care services delivered by the provider 
                directly or through an insuring entity or corporation; 
                and
                    (C) provided to any member of the public which 
                requests such information directly from the provider.
            (3) Medicare program.--The term ``medicare program'' means 
        the programs under title XVIII of the Social Security Act.
            (4) Provider.--The term ``provider'' means an entity that 
        is--
                    (A) a psychiatric hospital described in section 
                1861(f) of the Social Security Act (42 U.S.C. 
                1395x(f));
                    (B) a provider of services described in section 
                1861(u) of such Act (42 U.S.C. 1395x(u)), other than a 
                skilled nursing facility, as defined in section 1819(a) 
                of such Act (42 U.S.C. 1395i-3(a));
                    (C) a rural health clinic described in section 
                1861(aa)(2) of such Act (42 U.S.C. 1395x(aa)(2));
                    (D) an ambulatory surgical center described in 
                section 1832(a)(2)(F)(i) of such Act (42 U.S.C. 
                1395k(a)(2)(F)(i)); or
                    (E) a renal dialysis facility described in section 
                1881(b)(1)(A) of such Act (42 U.S.C. 1395rr(b)(1)(A)).
            (5) Registered nurse.--The term ``registered nurse'' means 
        an individual who is entitled under State law or regulation to 
        practice as a registered nurse.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 4. PUBLIC DISCLOSURE OF ACCURATE DATA ON NURSING FACILITY 
              STAFFING.

    (a) Medicare.--Section 1819(b)(8) of the Social Security Act (42 
U.S.C. 1395i-3(b)) is amended--
            (1) in subparagraph (A), by adding at the end the following 
        new sentence: ``The information posted under this subparagraph 
        shall include information regarding nurse staffing with respect 
        to beds made available by reason of an agreement under section 
        1883.''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(C) Submission and posting of data.--
                            ``(i) In general.--Beginning on January 1, 
                        2005, a skilled nursing facility shall submit 
                        to the Secretary in a uniform manner (as 
                        prescribed by the Secretary) the nursing staff 
                        data described in section 3(a) of the Patient 
                        Safety Act of 2004 through electronic means not 
                        less frequently than quarterly and the 
                        Secretary shall make such data publicly 
                        available (as defined in section 3(g)(2) of 
                        such Act), including by posting such data on an 
                        Internet website.
                            ``(ii) Information on nurse aides.--In 
                        addition to the nursing staff data described in 
                        clause (i), a skilled nursing facility shall 
                        submit to the Secretary the numbers of nurse 
                        aides (as defined in paragraph (5))(F)) 
                        utilized to provide direct patient care. This 
                        information shall be expressed both in raw 
                        numbers and as a percentage of nursing staff 
                        and shall be broken down in terms of the total 
                        nursing staff, each unit, and each shift.
                    ``(D) Audit of data.--As part of each standard 
                survey conducted under subsection (g)(2)(A), there 
                shall be an audit of the nursing staff data reported 
                under subparagraph (C) to ensure that such data are 
                accurate.''.
    (b) Medicaid.--Section 1919(b)(8) of the Social Security Act (42 
U.S.C. 1395r(b)(8)) is amended--
            (1) in subparagraph (A), by adding at the end the following 
        new sentence: ``The information posted under this subparagraph 
        shall include information regarding nurse staffing with respect 
        to beds made available by reason of an agreement under section 
        1883.''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(C) Submission and posting of data.--
                            ``(i) In general.--Beginning on January 1, 
                        2005, a nursing facility shall submit to the 
                        Secretary in a uniform manner (as prescribed by 
                        the Secretary) the nursing staff data described 
                        in section 3(a) of the Patient Safety Act of 
                        2004 through electronic means not less 
                        frequently than quarterly and the Secretary 
                        shall make such data publicly available (as 
                        defined in section 3(g)(2) of such Act), 
                        including by posting such data on an Internet 
                        website.
                            ``(ii) Information on nurse aides.--In 
                        addition to the nursing staff data described in 
                        clause (i), a skilled nursing facility shall 
                        submit to the Secretary the numbers of nurse 
                        aides (as defined in paragraph (5))(F)) 
                        utilized to provide direct patient care. This 
                        information shall be expressed both in raw 
                        numbers and as a percentage of nursing staff 
                        and shall be broken down in terms of the total 
                        nursing staff, each unit, and each shift.
                    ``(D) Audit of data.--As part of each standard 
                survey conducted under subsection (g)(2)(A), there 
                shall be an audit of the nursing staff data reported 
                under subparagraph (C) to ensure that such data are 
                accurate.''.

SEC. 5. CREATING A STAFFING QUALITY MEASURE FOR CONSUMERS TO COMPARE 
              NURSING FACILITIES.

    (a) In General.--Beginning no later than 90 days after the date of 
the enactment of this Act, and for as long as the Secretary of Health 
and Human Services publishes quality measures to help the public 
compare the quality of care that nursing facilities provide, these 
quality measures shall include a quality measure for nursing staff 
that--
            (1) reflects the average daily total nursing hours worked 
        for the quarterly reporting period for which data are submitted 
        under sections 1819(b)(8)(C) and 1919(b)(8)(C) of the Social 
        Security Act (as added by subsections (a)(2) and (b)(2), 
        respectively, of section 4), as well as, in the case of a 
        skilled nursing facility, other information required to be 
        reported under section 3(a);
            (2) is sensitive to case mix and quality outcomes;
            (3) indicates the percentile in which each nursing facility 
        falls compared with other nursing facilities in the State;
            (4) indicates the rate of retention of registered nurses, 
        licensed practical nurses, and certified nurse assistants; and
            (5) includes such other measures as the Secretary 
        determines to be appropriate.
The Secretary shall not be required to comply with the requirements of 
paragraph (2) to the extent that the development of a methodology to 
comply with such requirement would delay the implementation of this 
section.
    (b) Form and Manner.--The nursing facility comparative staffing 
measure described in subsection (a) shall be displayed in the same form 
and manner as information that the Secretary displays to help the 
public compare the quality of care that nursing facilities provide.

SEC. 6. PROTECTION OF CERTAIN ACTIVITIES BY EMPLOYEES OF MEDICARE 
              PROVIDERS.

    (a) In General.--Subject to subsection (c), no provider under the 
medicare program shall terminate or take other adverse employment 
action (including the failure to promote an individual or provide any 
employment-related benefit, an adverse evaluation or decision made in 
relation to accreditation, certification, credentialing or licensing of 
an individual, or other adverse personnel action) against any employee 
or group of employees for actions taken for the purpose of--
            (1) notifying the provider of conditions which the employee 
        or group of employees identifies, in communications with the 
        provider, as dangerous or potentially dangerous or injurious 
        to--
                    (A) patients who currently receive services from 
                the provider;
                    (B) individuals who are likely to receive services 
                from the provider; or
                    (C) employees of the provider;
            (2) notifying a Federal or State agency or an accreditation 
        agency, compliance with the standards of which have been deemed 
        to demonstrate compliance with conditions of participation 
        under the medicare program, of such conditions as are 
        identified in paragraph (1);
            (3) notifying other individuals of conditions which the 
        employee or group of employees reasonably believe to be such as 
        are described in paragraph (1);
            (4) discussing such conditions as are identified in 
        paragraph (1) with other employees for the purposes of 
        initiating action described in paragraph (1), (2), or (3); or
            (5) other related activities as specified in regulations 
        promulgated by the Secretary of Health and Human Services.
    (b) Sanction.--A provider that takes an action in violation of 
subsection (a) is subject to a civil money penalty of not more than 
$20,000 for each such action. The provisions of section 1128A of the 
Social Security Act (other than subsections (a) and (b)) shall apply to 
civil money penalties under this subsection in the same manner as they 
apply to a penalty or proceeding under section 1128A(a) of such Act.
    (c) Exception.--The provisions of subsection (a) shall not apply to 
the knowing or reckless provision of substantially false information by 
an employee or group of employees.

SEC. 7. REPORT.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall submit to Congress a 
report on--
            (1) the manner in which the Secretary intends to implement 
        reporting of additional nurse staffing variables such as unit 
        worked, day of week (weekday and weekend), and type of care 
        (direct or administrative) provided; and
            (2) the most effective mechanisms for auditing nurse 
        staffing data under sections 1819(b)(8)(D) and 1919(b)(8)(D) of 
        the Social Security Act (as added by subsections (a)(2) and 
        (b)(2), respectively, of section 4) and for auditing nurse 
        staffing date under section 3(f)(2).
                                 <all>