[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6199 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6199

       To improve the quality of, and access to, long-term care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 2006

Ms. Ginny Brown-Waite of Florida (for herself and Mr. Camp) 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 improve the quality of, and access to, long-term care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Long-term Care 
Quality and Modernization Act of 2006''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
              TITLE I--MEDICARE AND MEDICAID MODERNIZATION

Sec. 101. Joint training of surveyors and providers.
Sec. 102. Facility-based training for new surveyors.
Sec. 103. Resumption of nurse aide training program after correction of 
                            deficiencies.
Sec. 104. Clarifying and eliminating the distinction between physician 
                            supervision requirements for skilled 
                            nursing facilities and nursing facilities.
Sec. 105. Permitting split or shared billing by physicians and nurse 
                            practitioners in skilled nursing 
                            facilities.
Sec. 106. Permitting nurse practitioners employed by skilled nursing 
                            facilities to certify skilled care.
Sec. 107. Modernization of therapy caps.
Sec. 108. Establishment of a Medicare skilled nursing facility specific 
                            wage index.
Sec. 109. Authority to exclude high cost and low probability drugs used 
                            in the treatment of cancer from the 
                            Medicare prospective payment system for 
                            skilled nursing facilities.
Sec. 110. Exclusion of all ambulance services from the Medicare 
                            prospective payment system for skilled 
                            nursing facilities.
Sec. 111. Authority to exclude additional items and services from the 
                            Medicare prospective payment system for 
                            skilled nursing facilities.
Sec. 112. Elimination of Medicare 3-day post-hospital stay requirement 
                            for coverage of skilled nursing facility 
                            services.
                      TITLE II--WORKFORCE SUPPORT

Sec. 201. Nursing loan repayment program.
Sec. 202. National nursing database.
Sec. 203. Reports on nursing levels.
                       TITLE III--TAX INCENTIVES

Sec. 301. 10-year recovery period for qualified long-term care 
                            improvement property.

              TITLE I--MEDICARE AND MEDICAID MODERNIZATION

SEC. 101. JOINT TRAINING OF SURVEYORS AND PROVIDERS.

    (a) Medicare Program.--Section 1819(e) of the Social Security Act 
(42 U.S.C. 1395i-3(e)) is amended by adding at the end the following 
new paragraph:
            ``(6) Joint surveyor/provider training.--The Secretary 
        shall require the State to establish a process for joint 
        training and education of surveyors and providers at least 
        annually and periodically as changes to regulations, 
        guidelines, and policy governing nursing facility operations 
        are implemented and used in surveys of participating 
        facilities.''.
    (b) Medicaid Program.--Section 1919(e) of the Social Security Act 
(42 U.S.C. 1396r(e)) is amended by adding at the end the following new 
paragraph:
            ``(8) Joint surveyor/provider training.--The State shall 
        establish a process for joint training and education to 
        surveyors and providers at least annually and periodically as 
        changes to regulations, guidelines, and policy governing 
        nursing facility operations are implemented and used in surveys 
        of participating facilities.''
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2007.

SEC. 102. FACILITY-BASED TRAINING FOR NEW SURVEYORS.

    (a) Medicare Program.--Section 1819(e) of the Social Security Act 
(42 U.S.C. 1395i-3(e)), as amended by section 101(a), is amended by 
adding at the end the following new paragraph:
            ``(7) Facility-based training for new surveyors.--The 
        Secretary shall require the State to establish a process for 
        assuring that--
                    ``(A) each individual newly hired as a nursing home 
                surveyor, as part of the individual's basic training, 
                is assigned full-time to a participating nursing 
                facility for at least 5 days within a 7-day period to 
                observe actual operations outside of the survey process 
                before the individual begins oversight 
                responsibilities;
                    ``(B) such individual shall not assume oversight 
                responsibility during this training period and such 
                observations may not be the sole basis of a deficiency 
                citation against the facility; and
                    ``(C) such individual shall not be assigned as a 
                member of a survey team for the facility in which the 
                individual received training for two standard surveys 
                following the training period in the facility.''.
    (b) Medicaid Program.--Section 1919(e) of the Social Security Act 
(42 U.S.C. 1396r(e)), as amended by section 101(b), is amended by 
adding at the end the following new paragraph:
            ``(9) Facility-based training for new surveyors.--The State 
        shall establish a process for assuring that--
                    ``(A) each individual newly hired as a nursing home 
                surveyor, as part of the individual's basic training, 
                is assigned full-time to a participating nursing 
                facility for at least 5 days within a 7-day period to 
                observe actual operations outside of the survey process 
                before the individual begins oversight 
                responsibilities;
                    ``(B) such individual shall not assume oversight 
                responsibility during this training period and such 
                observations may not be the sole basis of a deficiency 
                citation against the facility; and
                    ``(C) such individual shall not be assigned as a 
                member of a survey team for the facility in which the 
                individual received training for two standard surveys 
                following the training period in the facility.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2007.

SEC. 103. RESUMPTION OF NURSE AIDE TRAINING PROGRAM AFTER CORRECTION OF 
              DEFICIENCIES.

    (a) Resumption of Nurse Aide Training Program for Skilled Nursing 
Facilities.--Section 1819(f)(2) of the Social Security Act (42 U.S.C. 
1395i-3(f)(2)) is amended--
            (1) in paragraph (B)(iii), in the matter preceding 
        subclause (I), by striking ``(C) and (D)'' and inserting ``(C), 
        (D), and (E)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Resumption of nurse aide training program 
                after correction of deficiencies.--Clause (iii)(I) of 
                subparagraph (B) shall not apply to a program offered 
                by or in a skilled nursing facility if the facility 
                has--
                            ``(i) corrected any deficiencies that 
                        resulted in the prohibition of approval of such 
                        program; and
                            ``(ii) demonstrated compliance with the 
                        requirements of subsections (b), (c), and (d) 
                        of this section.''.
    (b) Resumption of Nurse Aide Training Program for Nursing 
Facilities.--Section 1919(f)(2) of the Social Security Act (42 U.S.C. 
1396r(f)(2)) is amended--
            (1) in paragraph (B)(iii), in the matter preceding 
        subclause (I), by striking ``(C) and (D)'' and inserting ``(C), 
        (D), and (E)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Resumption of nurse aide training program 
                after correction of deficiencies.--Clause (iii)(I) of 
                subparagraph (B) shall not apply to a program offered 
                by or in a nursing facility if the facility has--
                            ``(i) corrected any deficiencies that 
                        resulted in the prohibition of approval of such 
                        program; and
                            ``(ii) been determined to be in compliance 
                        with the requirements of subsections (b), (c), 
                        and (d) of this section.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2007.

SEC. 104. CLARIFYING AND ELIMINATING THE DISTINCTION BETWEEN PHYSICIAN 
              SUPERVISION REQUIREMENTS FOR SKILLED NURSING FACILITIES 
              AND NURSING FACILITIES.

    (a) Physician Supervision Requirements for Skilled Nursing 
Facilities.--Section 1819(b)(6)(A) of the Social Security Act (42 
U.S.C. 1395i-3(b)(6)(A)) is amended by inserting ``(or, at the option 
of a State, under the supervision of a nurse practitioner, clinical 
nurse specialist, or physician assistant who is working in 
collaboration with a physician)'' before the semicolon at the end.
    (b) Clarifying Physician Supervision Requirements for Nursing 
Facilities.--Section 1919(b)(6)(A) of the Social Security Act (42 
U.S.C. 1396r(b)(6)(A)) is amended by striking ``who is not an employee 
of the facility but''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2007.

SEC. 105. PERMITTING SPLIT OR SHARED BILLING BY PHYSICIANS AND NURSE 
              PRACTITIONERS IN SKILLED NURSING FACILITIES.

    (a) In General.--Section 1888(e) of the Social Security Act (42 
U.S.C. 1395yy(e)) is amended by adding at the end the following new 
paragraph:
            ``(13) Permitting split or shared billing by physicians and 
        nurse practitioners in skilled nursing facilities.--
        Notwithstanding section 1861(s)(2)(K)(ii), a physician and a 
        nurse practitioner may each submit a claim for payment for 
        their portion of a service provided to a resident of a skilled 
        nursing facility, except that, in no case may the total amount 
        paid under this title be greater than it would have been if 
        only one person had submitted a claim for such service.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2007.

SEC. 106. PERMITTING NURSE PRACTITIONERS EMPLOYED BY SKILLED NURSING 
              FACILITIES TO CERTIFY SKILLED CARE.

    (a) In General.--Section 1814(a)(2) of the Social Security Act (42 
U.S.C. 1395f(a)(2)) is amended by striking ``or a nurse practitioner 
or'' and inserting ``a nurse practitioner, or a''.
    (b) Effective Date.--The amendment made by this section shall take 
effect on January 1, 2007.

SEC. 107. MODERNIZATION OF THERAPY CAPS.

    Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is 
amended--
            (1) in paragraph (4)--
                    (A) by striking ``This subsection'' and inserting 
                ``Except as provided in paragraph (6), this 
                subsection''; and
                    (B) by inserting ``and with respect to services 
                furnished on or after January 1, 2009'' before the 
                period at the end; and
            (2) by adding at the end the following new paragraph:
            ``(6) In the case of services described in paragraph (1), 
        with respect to such services furnished on or after January 1, 
        2009, the Secretary shall establish and implement a condition-
        based system based on medical necessity for necessary and 
        clinically appropriate services. Such system shall utilize a 
        standardized patient assessment tool to evaluate the level of 
        such services that are needed by an individual and impose a 
        limitation on coverage of such services under this part based 
        on such tool.''.

SEC. 108. ESTABLISHMENT OF A MEDICARE SKILLED NURSING FACILITY SPECIFIC 
              WAGE INDEX.

    Section 1888(e)(4)(G)(ii) of the Social Security Act (42 U.S.C. 
1395yy(e)(4)(G)(ii)) is amended by inserting after the first sentence 
the following new sentence: ``For services furnished on or after 
October 1, 2008, in making the adjustment under the preceding sentence, 
the Secretary shall utilize an area wage index for skilled nursing 
facilities based on wage data from such facilities and not from 
hospitals.''

SEC. 109. AUTHORITY TO EXCLUDE HIGH COST AND LOW PROBABILITY DRUGS USED 
              IN THE TREATMENT OF CANCER FROM THE MEDICARE PROSPECTIVE 
              PAYMENT SYSTEM FOR SKILLED NURSING FACILITIES.

    (a) In General.--Section 1888(e)(2)(A)(iii) of the Social Security 
Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended--
            (1) by redesignating subclauses (IV) and (V) as subclauses 
        (V) and (VI), respectively; and
            (2) by inserting after subclause (III) the following new 
        subclause:
                                    ``(IV) Any drugs (not otherwise 
                                described in subclause (II)) used in 
                                the treatment of cancer, including 
                                antineoplastic drugs, antiemetics, and 
                                supportive medications, that the 
                                Secretary determines to be 
                                appropriate.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to drugs furnished on or after October 1, 2007.

SEC. 110. EXCLUSION OF ALL AMBULANCE SERVICES FROM THE MEDICARE 
              PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NURSING 
              FACILITIES.

    (a) In General.--Section 1888(e)(2)(A)(iii)(I) of the Social 
Security Act (42 U.S.C. 1395yy(e)(2)(A)(iii)(I)) is amended by striking 
``furnished to'' and all that follows before the period.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after October 1, 2007.

SEC. 111. AUTHORITY TO EXCLUDE ADDITIONAL ITEMS AND SERVICES FROM THE 
              MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NURSING 
              FACILITIES.

    (a) Authority.--Section 1888(e)(2)(A) of the Social Security Act 
(42 U.S.C. 1395yy(e)(2)(A)) is amended--
            (1) in clause (i)(II), by striking ``and (iv)'' and 
        inserting ``(iv), and (v)(I)''; and
            (2) by adding at the end the following new clause:
                            ``(v) Exclusion of additional items and 
                        services determined appropriate by the 
                        secretary.--
                                    ``(I) In general.--Items and 
                                services described in this clause are 
                                any items and services not otherwise 
                                described in clauses (ii), (iii), or 
                                (iv), that the Secretary determines to 
                                be appropriate.
                                    ``(II) Annual update.--The 
                                Secretary shall annually update the 
                                items and services described in 
                                subclause (I) to take into account 
                                changes in the practice of medicine.''.
    (b) Clarification.--Items and services described in section 
1888(e)(2)(A)(v)(I) of the Social Security Act (42 U.S.C. 
1395yy(e)(2)(A)(v)(I)), as added by subsection (a), may include items 
and services furnished in a freestanding clinic to an individual who is 
a resident of a skilled nursing facility.
    (c) Effective Date.--The amendment made by subsection (a) shall 
take effect on October 1, 2007.

SEC. 112. ELIMINATION OF MEDICARE 3-DAY POST-HOSPITAL STAY REQUIREMENT 
              FOR COVERAGE OF SKILLED NURSING FACILITY SERVICES.

    (a) In General.--Section 1812(a)(2) of the Social Security Act (42 
U.S.C. 1395d(a)(2)) is amended--
            (1) by striking ``(A) post-hospital'' and
            (2) by striking ``, and (B)'' and all that follows up to 
        the period at the end.
    (b) Conforming Amendments.--
            (1) Title XVIII of the Social Security Act are each amended 
        by striking ``post-hospital'' before ``extended care services'' 
        each place it appears.
            (2) Section 1812(f) of such Act is repealed.
            (3) Section 1861(i) of such Act is repealed.
            (4) Section 1888(e)(2)(A)(i)(I) of such Act is amended by 
        striking ``section 1861(i)'' and inserting ``section 1861(h)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to extended care services furnished in periods of stay beginning 
on or after January 1, 2007.

                      TITLE II--WORKFORCE SUPPORT

SEC. 201. NURSING LOAN REPAYMENT PROGRAM.

    Section 846(a) of the Public Health Service Act (42 U.S.C. 297n(a)) 
is amended by striking the last sentence.

SEC. 202. NATIONAL NURSING DATABASE.

    (a) In General.--The Secretary of Health and Human Services shall 
provide for the establishment of a national nursing database to be used 
to predict future nursing shortages.
    (b) Information in Database.--The database established under 
subsection (a) shall be designed to include nursing workforce data 
across all healthcare provider settings, including nursing educators, 
as determined by the Secretary of Health and Human Services to be 
appropriate for use in the analysis of trends in the supply and demand 
of nurses and to create an educational model to predict future nursing 
workforce needs.
    (c) Funding.--The Secretary of Health and Human Services may 
transfer, from amounts appropriated for the National Center for Health 
Workforce Analysis, such sums as may be necessary to carry out this 
section.

SEC. 203. REPORTS ON NURSING LEVELS.

    Section 806 of the Public Health Service Act (42 U.S.C. 296e), as 
amended by section 202, is further amended by adding at the end the 
following:
    ``(j) Reports Concerning Nursing Levels.--
            ``(1) In general.--The entities described in paragraph (2) 
        shall annually submit to the Secretary a report concerning how 
        assistance under this title is being used by such entities to 
        increase the number of nurses, nursing educators, and nurse 
        education enrollment slots.
            ``(2) Entities described.--An entity is described in this 
        paragraph if such entity is--
                    ``(A) an entity that receives a grant or contract 
                under this title;
                    ``(B) a school of nursing that receives student 
                loan funds under this title;
                    ``(C) a school of nursing that receives nurse 
                faculty student loan funds under this title; and
                    ``(D) any other entity that receives assistance 
                under this title.''.

                       TITLE III--TAX INCENTIVES

SEC. 301. 10-YEAR RECOVERY PERIOD FOR QUALIFIED LONG-TERM CARE 
              IMPROVEMENT PROPERTY.

    (a) In General.--Subparagraph (D) of section 168(e)(3) of the 
Internal Revenue Code of 1986 (relating to 10-year property) is amended 
by striking ``and'' at the end of clause (i), by striking the period at 
the end of clause (ii) and inserting ``, and'', and by adding at the 
end the following new clause:
                            ``(iii) any qualified long-term care 
                        improvement property.''.
    (b) Qualified Long-Term Care Improvement Property.--Section 168(e) 
of the Internal Revenue Code of 1986 (relating to classification of 
property) is amended by adding at the end the following new paragraph:
            ``(8) Qualified long-term care improvement property.--The 
        term `qualified long-term care improvement property' means any 
        section 1250 property which is an improvement to a building 
        if--
                    ``(A) such improvement is placed in service more 
                than 3 years after the date such building was first 
                placed in service, and
                    ``(B) such building is, or is a part of, a nursing 
                facility, assisted living facility, residential care 
                facility, intermediate care facility for the mentally 
                retarded, or similar facility designed to provide 
                housing and healthcare for the elderly and disabled.''.
    (c) Alternative System.--The table contained in section 
168(g)(3)(B) of the Internal Revenue Code of 1986 (relating to special 
rule for certain property assigned to classes) is amended by inserting 
after the item relating to subparagraph (D)(ii) the following:


 
 
 
 
  ``(D)(iii)..........    10''.
 

    (d) Effective Date.--The amendments made by this section shall 
apply to property placed in service after the date of the enactment of 
this Act.
                                 <all>