[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6161 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6161

To amend titles XVIII and XIX of the Social Security Act to expand the 
 nursing home patients' bill of rights to include the right to receive 
care from a credible caregiver by requiring background checks on direct 
    access employees and the right to a safe environment during an 
   emergency or natural disaster by requiring nursing long-term care 
    facilities to establish disaster emergency and evacuation plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 25, 2006

   Ms. Ginny Brown-Waite of Florida (for herself, Mr. Kirk, and Mr. 
 Fitzpatrick of Pennsylvania) 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 expand the 
 nursing home patients' bill of rights to include the right to receive 
care from a credible caregiver by requiring background checks on direct 
    access employees and the right to a safe environment during an 
   emergency or natural disaster by requiring nursing long-term care 
    facilities to establish disaster emergency and evacuation plans.

    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 ``Senior Safety and Dignity Act of 
2006''.

SEC. 2. SECURING RIGHT TO RECEIVE CARE FROM A CREDIBLE CAREGIVER BY 
              REQUIRING PERFORMANCE OF BACKGROUND CHECKS ON DIRECT 
              ACCESS EMPLOYEES OF LONG-TERM CARE FACILITIES OR 
              PROVIDERS.

    (a) Addition to Nursing Home Patients' Bill of Rights of Right To 
Receive Care From a Credible Caregiver.--Sections 1819(c)(1)(A) and 
1919(c)(1)(A) of the Social Security Act (42 U.S.C. 1395i-3(c)(1)(A), 
1396r(c)(1)(A)) are each amended--
            (1) by redesignating clause (xi) as clause (xiii); and
            (2) by inserting after clause (x) the following new clause:
                            ``(xi) Receipt of care from credible 
                        caregiver.--The right to receive care from a 
                        credible caregiver.''.
    (b) Screening of Skilled Nursing Facility and Nursing Facility 
Employee Applicants.--
            (1) Medicare program.--Section 1819(b) of the Social 
        Security Act (42 U.S.C. 1395i-3(b)) is amended by adding at the 
        end the following:
            ``(9) Screening of skilled nursing facility workers.--
                    ``(A) Background checks on applicants.--Before 
                hiring a skilled nursing facility worker, a skilled 
                nursing facility shall conduct a background check on 
                the employee in accordance with such procedures as the 
                Secretary shall establish.
                    ``(B) Prohibition on hiring of abusive workers.--
                            ``(i) In general.--Subject to clause (ii), 
                        a skilled nursing facility may not knowingly 
                        employ any skilled nursing facility worker who 
                        has any disqualifying information (as defined 
                        in subparagraph (F)(ii)).
                            ``(ii) Provisional employment.--A skilled 
                        nursing facility may provide for a provisional 
                        period of employment for a skilled nursing 
                        facility worker pending completion of the 
                        background check required under subparagraph 
                        (A). Such facility shall maintain direct 
                        supervision of the covered individual during 
                        the worker's provisional period of employment.
                    ``(C) Procedures.--The procedures established by 
                the Secretary under subparagraph (A) shall--
                            ``(i) provide a process by which a skilled 
                        nursing facility worker may appeal or dispute 
                        the accuracy of the information obtained in a 
                        background check conducted under this 
                        paragraph;
                            ``(ii) take into account the needs of 
                        skilled nursing facilities that serve a low 
                        volume of patients (as determined by the 
                        Secretary) with respect to providing 
                        supervision for provisional employees who are 
                        awaiting the results of a background check 
                        conducted under this paragraph; and
                            ``(iii) provide for the reimbursement of 
                        nursing facilities for 100 percent of the costs 
                        incurred by such facilities in complying with 
                        the requirements of this section.
                    ``(D) Immunity from liability.--A skilled nursing 
                facility that, in denying employment for an applicant, 
                reasonably relies upon information about such applicant 
                provided by the criminal background check shall not be 
                liable in any action brought by such applicant based on 
                the employment determination resulting from the 
                information.
                    ``(E) Civil penalty.--
                            ``(i) In general.--A skilled nursing 
                        facility that violates the provisions of this 
                        paragraph shall be subject to a civil penalty 
                        in an amount not to exceed--
                                    ``(I) for the first such violation, 
                                $2,000; and
                                    ``(II) for the second and each 
                                subsequent violation within any 5-year 
                                period, $5,000.
                            ``(ii) Knowing retention of worker.--In 
                        addition to any civil penalty under clause (i), 
                        a skilled nursing facility that knowingly 
                        continues to employ a skilled nursing facility 
                        worker in violation of subparagraph (A) or (B) 
                        shall be subject to a civil penalty in an 
                        amount not to exceed $5,000 for the first such 
                        violation, and $10,000 for the second and each 
                        subsequent violation within any 5-year period.
                    ``(F) Definitions.--In this paragraph:
                            ``(i) Conviction for a relevant crime.--The 
                        term `conviction for a relevant crime' means 
                        any Federal or State criminal conviction for--
                                    ``(I) any offense described in 
                                section 1128(a); and
                                    ``(II) such other types of offenses 
                                as the Secretary may specify in 
                                regulations.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Skilled nursing facility worker.--
                        The term `skilled nursing facility worker' 
                        means any individual that has direct access to 
                        a patient of a skilled nursing facility under 
                        an employment or other contract, or both, with 
                        such facility. Such term includes individuals 
                        who are licensed or certified by the State to 
                        provide long-term care services, and 
                        nonlicensed individuals providing such 
                        services, as defined by the Secretary, 
                        including nurse assistants, nurse aides, home 
                        health aides, and personal care workers and 
                        attendants.''.
            (2) Medicaid program.--Section 1919(b) of the Social 
        Security Act (42 U.S.C. 1396r(b)) is amended by adding at the 
        end the following new paragraph:
            ``(9) Screening of nursing facility workers.--
                    ``(A) Background checks on applicants.--Before 
                hiring a nursing facility worker, a nursing facility 
                shall conduct a background check on the employee in 
                accordance with such procedures as the Secretary shall 
                establish.
                    ``(B) Prohibition on hiring of abusive workers.--
                            ``(i) In general.--Subject to clause (ii), 
                        a nursing facility may not knowingly employ any 
                        nursing facility worker who has any 
                        disqualifying information (as defined in 
                        subparagraph (F)(ii)).
                            ``(ii) Provisional employment.--A nursing 
                        facility may provide for a provisional period 
                        of employment for a nursing facility worker 
                        pending completion of the background check 
                        required under subparagraph (A). Such facility 
                        shall maintain direct supervision of the 
                        covered individual during the worker's 
                        provisional period of employment.
                    ``(C) Procedures.--The procedures established by 
                the Secretary under subparagraph (A) shall--
                            ``(i) provide a process by which a nursing 
                        facility worker may appeal or dispute the 
                        accuracy of the information obtained in a 
                        background check conducted under this 
                        paragraph;
                            ``(ii) take into account the needs of 
                        nursing facilities that serve a low volume of 
                        patients (as determined by the Secretary) with 
                        respect to providing supervision for 
                        provisional employees who are awaiting the 
                        results of a background check conducted under 
                        this paragraph; and
                            ``(iii) provide for the reimbursement of 
                        nursing facilities for 100 percent of the costs 
                        incurred by such facilities in complying with 
                        the requirements of this section.
                    ``(D) Immunity from liability.--A nursing facility 
                that, in denying employment for an applicant, 
                reasonably relies upon information about such applicant 
                provided by the criminal background check shall not be 
                liable in any action brought by such applicant based on 
                the employment determination resulting from the 
                information.
                    ``(E) Civil penalty.--
                            ``(i) In general.--A nursing facility that 
                        violates the provisions of this paragraph shall 
                        be subject to a civil penalty in an amount not 
                        to exceed--
                                    ``(I) for the first such violation, 
                                $2,000; and
                                    ``(II) for the second and each 
                                subsequent violation within any 5-year 
                                period, $5,000.
                            ``(ii) Knowing retention of worker.--In 
                        addition to any civil penalty under clause (i), 
                        a nursing facility that knowingly continues to 
                        employ a nursing facility worker in violation 
                        of subparagraph (A) or (B) shall be subject to 
                        a civil penalty in an amount not to exceed 
                        $5,000 for the first such violation, and 
                        $10,000 for the second and each subsequent 
                        violation within any 5-year period.
                    ``(F) Definitions.--In this paragraph:
                            ``(i) Conviction for a relevant crime.--The 
                        term `conviction for a relevant crime' means 
                        any Federal or State criminal conviction for--
                                    ``(I) any offense described in 
                                section 1128(a); and
                                    ``(II) such other types of offenses 
                                as the Secretary may specify in 
                                regulations.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Nursing facility worker.--The term 
                        `nursing facility worker' means any individual 
                        that has direct access to a patient of a 
                        nursing facility under an employment or other 
                        contract, or both, with such facility. Such 
                        term includes individuals who are licensed or 
                        certified by the State to provide long-term 
                        care services, and nonlicensed individuals 
                        providing such services, as defined by the 
                        Secretary, including nurse assistants, nurse 
                        aides, home health aides, and personal care 
                        workers and attendants.''.
            (3) Effective date.--The amendments made by this subsection 
        and subsection (a) shall take effect on the date that is 1 year 
        after the date on which the evaluation is completed under 
        subsection (d)(1).
    (c) Application to Other Long-Term Care Facilities or Providers.--
            (1) Medicare.--Part E of title XVIII of the Social Security 
        Act (42 U.S.C. 1395x et seq.) is amended by adding at the end 
        the following:

 ``application of skilled nursing facility preventive abuse provisions 
               to long-term care facilities and providers

    ``Sec. 1898. 
    ``(a) In General.--The provisions of section 1819(b)(9) shall apply 
to a long-term care facility or provider (as defined in subsection (b)) 
in the same manner as such provisions apply to a skilled nursing 
facility.
    ``(b) Long-Term Care Facility or Provider.--In this section, the 
term `long-term care facility or provider' means the following 
facilities or providers which receive payment for services under this 
title or title XIX:
            ``(1) A home health agency.
            ``(2) A provider of hospice care.
            ``(3) A long-term care hospital.
            ``(4) A provider of personal care services.
            ``(5) A residential care provider that arranges for, or 
        directly provides, long-term care services.
            ``(6) An intermediate care facility for the mentally 
        retarded (as defined in section 1905(d)).''.
            (2) Medicaid.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a) is amended--
                    (A) in paragraph (69), by striking ``and'' at the 
                end;
                    (B) in paragraph (70), by striking the period and 
                inserting ``; and''; and
                    (C) by inserting after paragraph (70) the 
                following:
            ``(71) provide that the provisions of section 1919(b)(9) 
        apply to a long-term care facility or provider (as defined in 
        section 1898(b)) in the same manner as such provisions apply to 
        a nursing facility.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on the date that is 1 year after the date on 
        which the evaluation is completed under subsection (c)(1).
    (d) National Criminal Background Check Program.--
            (1) Completion of pilot program evaluation.--Not later than 
        the date that is 6 months after the completion of the pilot 
        program for national and State background checks on direct 
        patient access employees of long-term care facilities or 
        providers established under section 307 of the Medicare 
        Prescription Drug, Improvement, and Modernization Act of 2003 
        (Public Law 108-173), the Secretary shall complete the 
        evaluation required under subsection (e) of such section of 
        such Act.
            (2) Establishment.--
                    (A) In general.--Not later than the date that is 1 
                year after the completion of the evaluation of the 
                program described in paragraph (1), the Secretary, in 
                consultation with the Attorney General, shall establish 
                a national criminal background check program in order 
                to prevent abuse of nursing facility and skilled 
                nursing facility residents and individuals receiving 
                home health care services and other long-term care 
                services under the medicare or medicaid programs, 
                taking into account the findings and recommendations 
                contained in the evaluation.
                    (B) Use in conducting required background checks.--
                The national criminal background check program shall be 
                made available to a long-term care facility or provider 
                for the purpose of conducting criminal background 
                checks, including the criminal background checks 
                required under sections 1819(b)(9) and 1919(b)(9) of 
                the Social Security Act (42 U.S.C. 1395i-3(b), 
                1396r(b)) (as added by subsection (a)).
                    (C) Conduct of background checks by the federal 
                bureau of investigation.--The Secretary, in 
                consultation with the Attorney General, shall establish 
                procedures for the background checks to be conducted by 
                the Federal Bureau of Investigation, in cooperation 
                with appropriate State and Federal agencies.
                    (D) Consultation.--In establishing the national 
                criminal background check program, the Secretary shall 
                consult with appropriate interested parties, 
                including--
                            (i) representatives of long-term care 
                        facilities or providers;
                            (ii) representatives of employees of long-
                        term care facilities or providers;
                            (iii) consumers of long-term care services;
                            (iv) consumer advocates; and
                            (v) appropriate Federal and State 
                        officials.
            (3) Definitions.--In this subsection:
                    (A) Long-term care facility or provider.--The term 
                ``long-term care facility or provider'' means the 
                following facilities or providers which receive payment 
                for services under title XVIII or XIX of the Social 
                Security Act:
                            (i) A nursing facility (as defined in 
                        subparagraph (B)).
                            (ii) A skilled nursing facility (as defined 
                        in subparagraph (C)).
                            (iii) A home health agency.
                            (iv) A provider of hospice care (as defined 
                        in section 1861(dd)(1) of the Social Security 
                        Act) (42 U.S.C. 1395x(dd)(1)).
                            (v) A long-term care hospital (as described 
                        in section 1886(d)(1)(B)(iv) of such Act) (42 
                        U.S.C. 1395ww(d)(1)(B)(iv)).
                            (vi) A provider of personal care services.
                            (vii) A residential care provider that 
                        arranges for, or directly provides, long-term 
                        care services.
                            (viii) An intermediate care facility for 
                        the mentally retarded (as defined in section 
                        1905(d) of such Act) (42 U.S.C. 1396d(d)).
                    (B) Nursing facility.--The term ``nursing 
                facility'' has the meaning given such term in section 
                1919(a) of the Social Security Act (42 U.S.C. 
                1396r(a)).
                    (C) Skilled nursing facility.--The term ``skilled 
                nursing facility'' has the meaning given such term in 
                1819(a) of the Social Security Act (42 U.S.C. 1395i-
                3(a)).

SEC. 3. SECURING THE RIGHT TO A SAFE ENVIRONMENT IN LONG-TERM CARE 
              FACILITIES DURING AN EMERGENCY OR NATURAL DISASTER BY 
              REQUIRING THESE FACILITIES TO ESTABLISH DISASTER 
              EMERGENCY AND EVACUATION PLANS.

    (a) Addition to Nursing Home Patients' Bill of Rights of Right to a 
Safe Environment During an Emergency or Natural Disaster.--Sections 
1819(c)(1)(A) and 1919(c)(1)(A) of the Social Security Act (42 U.S.C. 
1395i-3(c)(1)(A), 1396r(c)(1)(A)), as amended by section 2(a), are each 
amended by inserting after clause (xi) the following new clause:
                            ``(xii) Safe environment during emergency 
                        or natural disaster.--The right to a safe 
                        environment during an emergency or natural 
                        disaster.''.
    (b) Application Under Medicare.--Section 1819(d)(4) of such Act (42 
U.S.C. 1395i-3(d)(4)) is amended--
            (1) by redesignating subparagraph (B) as subparagraph (C); 
        and
            (2) by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) Disaster emergency and evacuation plans.--A 
                skilled nursing facility must--
                            ``(i) have a clear and pre-established 
                        disaster plan to ensure the safety of all its 
                        patients during an emergency or natural 
                        disaster and possible evacuation; and
                            ``(ii) inform residents and next-of-kin 
                        regarding such plan and the location of 
                        possible evacuation in case of an emergency or 
                        disaster.''.
    (c) Medicaid.--Section 1919(d)(4) of such Act (42 U.S.C. 
1396r(d)(4)) is amended--
            (1) by redesignating subparagraph (B) as subparagraph (C); 
        and
            (2) by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) Disaster emergency and evacuation plans.--A 
                nursing facility must--
                            ``(i) have a clear and pre-established 
                        disaster plan to ensure the safety of all its 
                        patients during an emergency or natural 
                        disaster and possible evacuation; and
                            ``(ii) inform residents and next-of-kin 
                        regarding such plan and the location of 
                        possible evacuation in case of an emergency or 
                        disaster.''.
    (d) Application to Other Long-Term Care Facilities.--Section 
1898(a) of such Act, as added by section 2(c)(1), is amended by 
inserting ``and section 1819(d)(4)(B)'' after ``section 1819(b)(1)''.
    (e) Effective Date.--The amendments made by this section shall 
apply as of the date that is one year after the date of the enactment 
of this Act.
                                 <all>