110 HR 4082 IH: Long-term Care Quality and Modernization Act of
U.S. House of Representatives
2007-11-06
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited as the Long-term Care Quality and Modernization Act of
2007
.
(b)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. Demonstration program for joint training of surveyors
and providers in nursing facilities.
Sec. 102. Resumption of nurse aide training program after
correction of deficiencies.
Sec. 103. 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. 104. Exclusion of all ambulance services from the Medicare
prospective payment system for skilled nursing facilities.
Sec. 105. Authority to exclude additional items and services
from the Medicare prospective payment system for skilled nursing
facilities.
Sec. 106. Payment for blood glucose tests administered as part
of a physician, nurse practitioner, or clinical nurse specialist prescribed
protocol of blood glucose monitoring.
Sec. 107. Counting of observation days for purposes of applying
the Medicare post-hospital requirement for coverage of skilled nursing facility
care.
Sec. 108. Payment for therapy services.
Sec. 109. Expansion of telehealth services to skilled nursing
facilities.
Sec. 110. Physical therapy grant program.
Sec. 111. Long-Term Care Quality Advisory Commission and
demonstration projects.
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. 15-year recovery period for qualified long-term care
improvement property.
<enum>I</enum><header>Medicare and
Medicaid Modernization</header>
<section id="H0A1A1DC72EFC4FA4AF5831EDE7EB9B61"><enum>101.</enum><header>Demonstration
program for joint training of surveyors and providers in nursing
facilities</header>
<subsection id="HB44B67CF7FA845AC0065B77D00B1A38"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall conduct a
demonstration program under which the Secretary, under sections 1819(e) and
1919(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3">42 U.S.C. 1395i–3(e)</external-xref>, 1396r(e)), shall
require a State to establish a process for joint training and education of
surveyors and providers for skilled nursing facilities and nursing facilities
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.</text>
</subsection><subsection id="HB842A3188044411C8859EEF7933803D"><enum>(b)</enum><header>Demonstration
States</header><text display-inline="yes-display-inline">The demonstration
program under this section shall be conducted in 5 States. In selecting the
States in which to conduct the demonstration program, the Secretary shall
ensure that the States vary in geographic location and include States with high
levels of deficiencies as well as States with low levels of
deficiencies.</text>
</subsection><subsection id="H591E51700BCA4AFBBF3B00BB21407002"><enum>(c)</enum><header>Duration</header><text>The
Secretary shall conduct the demonstration program under this section for a
2-year period.</text>
</subsection><subsection id="H96EF21A8D80E44C294C23943F83047D0"><enum>(d)</enum><header>Waiver
authority</header><text>The Secretary may waiver such requirements of titles
XI, XVIII, and XIX of the Social Security Act as may be necessary for purposes
of carrying out the demonstration program under this section.</text>
</subsection><subsection id="HFCEDD01CD997499592C7CC6BCE6E78C1"><enum>(e)</enum><header>Report</header>
<paragraph id="HEB84E1F8482448CAB247AA036E00AB5"><enum>(1)</enum><header>In
general</header><text>Not later than 6 months after the completion of the
demonstration program under this section, the Secretary shall submit a report
to Congress on the project.</text>
</paragraph><paragraph id="H56A35242CE464B649E35E1B576CDBD4"><enum>(2)</enum><header>Requirements</header><text>The
report submitted under paragraph (1) shall include—</text>
<subparagraph id="H33B3C9879A294D86985C0064E1A2F922"><enum>(A)</enum><text>the results of the
demonstration program as they relate to the rate and type of deficiencies in
skilled nursing facilities and nursing facilities in the States selected under
subsection (b) compared to those States not so selected;</text>
</subparagraph><subparagraph id="H9D3204024A94462C00CEB449C676762"><enum>(B)</enum><text>an evaluation of
added efficiencies or deficiencies in care for patients in skilled nursing
facilities and nursing facilities that directly resulted from the demonstration
program; and</text>
</subparagraph><subparagraph id="H8F8BCDD3AF3A46D699D025AF88B5B39"><enum>(C)</enum><text>recommendations for
such legislation and administrative action as the Secretary determines
appropriate.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The results
and evaluation under subparagraphs (A) and (B) shall include an examination of
the current baseline.</continuation-text></paragraph></subsection></section><section id="H4F6EB95F374A4A24959E136B5DFFE803"><enum>102.</enum><header>Resumption of
nurse aide training program after correction of deficiencies</header>
<subsection id="H65A5DB4EB29343ED90E5147DB3E5004E"><enum>(a)</enum><header>Resumption of
nurse aide training program for skilled nursing
facilities</header><text>Section 1819(f)(2) of the Social Security Act (42
U.S.C. 1395i–3(f)(2)) is amended—</text>
<paragraph id="HE2782E5C145B47FBB02EB3FF2D7D948B"><enum>(1)</enum><text>in subparagraph
(B)(iii), in the matter preceding subclause (I), by striking <quote>(C) and
(D)</quote> and inserting <quote>(C), (D), and (E)</quote>; and</text>
</paragraph><paragraph id="HF957F4680C114BE4BDE13F8100ECDE35"><enum>(2)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H25C97CE330864F81BC33D1B6774EDF3" style="OLC">
<subparagraph id="HCEC333006BF04A1082AE65120099BDDD"><enum>(E)</enum><header>Resumption of
nurse aide training program after correction of
deficiencies</header><text>Clause (iii)(I) of subparagraph (B) shall not apply
to a program offered by or in a skilled nursing facility if the facility
has—</text>
<clause id="HA7525E883A334B1CBED788AB333AE7E"><enum>(i)</enum><text>corrected any
deficiencies that resulted in the prohibition of approval of such program;
and</text>
</clause><clause id="H5F95C0970B504A43BFB28300B883A68D"><enum>(ii)</enum><text>demonstrated
compliance with the requirements of subsections (b), (c), and (d) of this
section.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HAB658E2D42584D618644EAA3BF3788F1"><enum>(b)</enum><header>Resumption of
nurse aide training program for nursing facilities</header><text>Section
1919(f)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r">42 U.S.C. 1396r(f)(2)</external-xref>) is
amended—</text>
<paragraph id="H35DCB768917340BF8DAF58EBB98E6072"><enum>(1)</enum><text>in subparagraph
(B)(iii), in the matter preceding subclause (I), by striking <quote>(C) and
(D)</quote> and inserting <quote>(C), (D), and (E)</quote>; and</text>
</paragraph><paragraph id="HCA5EB977E1EC4233BD8672B12DF58932"><enum>(2)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H4DC4F1F0BBE44D089342A2C00794C0E8" style="OLC">
<subparagraph id="H08387378D2E240DDBDF3CAB2D120D361"><enum>(E)</enum><header>Resumption of
nurse aide training program after correction of
deficiencies</header><text>Clause (iii)(I) of subparagraph (B) shall not apply
to a program offered by or in a nursing facility if the facility has—</text>
<clause id="HF45C67DDEC4A4024004C17D3CC9408D1"><enum>(i)</enum><text>corrected any
deficiencies that resulted in the prohibition of approval of such program;
and</text>
</clause><clause id="HBD769A9FC9574135958F1B005EAE03F7"><enum>(ii)</enum><text>demonstrated
compliance with the requirements of subsections (b), (c), and (d) of this
section.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H1A678938CC444D6EB3BF4B017DEB52BF"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on
January 1, 2008.</text>
</subsection></section><section id="H2CE1EC5379E1435E951489EC4C92508E"><enum>103.</enum><header>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</header>
<subsection id="HCC93E7CD80974535A6EF6B44B891D523"><enum>(a)</enum><header>In
general</header><text>Section 1888(e)(2)(A)(iii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395yy(e)(2)(A)(iii)) is amended—</text>
<paragraph id="H642761A068044033B99D669D7626DFE1"><enum>(1)</enum><text>by redesignating
subclauses (IV) and (V) as subclauses (V) and (VI), respectively; and</text>
</paragraph><paragraph id="HF51BA915DCB843FA986E4999BB9EBE5"><enum>(2)</enum><text>by
inserting after subclause (III) the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H977604862EB24A9CBCF1D53E9EB5BDB1" style="OLC">
<subclause id="HF378397A41D24E8D8009B805A2C7C96"><enum>(IV)</enum><text>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.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H0096D2EC93A04B61AFC3068BDF565083"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall apply to drugs
furnished on or after October 1, 2008.</text>
</subsection></section><section id="HC9A31EED4ACD46E28DF0138E15A2CA8F"><enum>104.</enum><header>Exclusion of
all ambulance services from the Medicare prospective payment system for skilled
nursing facilities</header>
<subsection id="HEB56B206C14348D19CCBB07D9016DDDC"><enum>(a)</enum><header>In
general</header><text>Section 1888(e)(2)(A)(iii)(I) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395yy(e)(2)(A)(iii)(I)) is amended by striking <quote>furnished to</quote> and
all that follows before the period.</text>
</subsection><subsection id="H36835B4AE7CA4C95B940BA6B308D3D2F"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to services
furnished on or after October 1, 2008.</text>
</subsection></section><section id="HFA54335AF8374619B9CCB1F800C63D4C"><enum>105.</enum><header>Authority to
exclude additional items and services from the Medicare prospective payment
system for skilled nursing facilities</header>
<subsection id="H9BB8B972F9B1419E8316DEE998EFC1FC"><enum>(a)</enum><header>Authority</header><text>Section
1888(e)(2)(A) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(2)(A)</external-xref>) is amended—</text>
<paragraph id="HF10B9BAF56E3445CB6AE1F00A4486189"><enum>(1)</enum><text>in clause (i)(II),
by striking <quote>and (iv)</quote> and inserting <quote>(iv), and
(v)(I)</quote>; and</text>
</paragraph><paragraph id="H6FBCB54261E142F1001B34D6E8AAE335"><enum>(2)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H4763FBC162D444A3B0BEB64C256DD38" style="OLC">
<clause id="H67AD5808FB694704967F050091FC4D84"><enum>(v)</enum><header>Exclusion of
additional items and services determined appropriate by the Secretary</header>
<subclause id="H3AACA1F92AF04508BC665EB1E3D2CA16"><enum>(I)</enum><header>In
general</header><text>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.</text>
</subclause><subclause id="H60F1E38BC3D14717BC68D83E3F26DBF4"><enum>(II)</enum><header>Annual
update</header><text>The Secretary shall annually update the items and services
described in subclause (I) to take into account changes in the practice of
medicine.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H35223688C9D1465C821211AA444B93FF"><enum>(b)</enum><header>Clarification</header><text>Items
and services described in section 1888(e)(2)(A)(v)(I) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</subsection><subsection id="H734CA30EB6C94E6497A4303D39EB413B"><enum>(c)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect on
October 1, 2008.</text>
</subsection></section><section id="H72AE0BADC542415FB5D9B5F86C484E49"><enum>106.</enum><header>Payment for
blood glucose tests administered as part of a physician, nurse practitioner, or
clinical nurse specialist prescribed protocol of blood glucose
monitoring</header><text display-inline="no-display-inline">Section 1835(a) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395n">42 U.S.C. 1395n(a)</external-xref>) is amended—</text>
<paragraph id="H00D8067A33874E1C82D1C33512220072"><enum>(1)</enum><text>in paragraph (2),
in the matter preceding subparagraph (A), by inserting <quote>, or, as provided
in the last 2 sentences of this subsection with respect to blood glucose tests,
a physician, a nurse practitioner, or a clinical nurse specialist,</quote>
after <quote>physician</quote>; and</text>
</paragraph><paragraph id="H0141492D91B64115B197A1E81CAF5450"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new
sentences: “With respect to paragraph (2)(B), a physician, or a nurse
practitioner or a clinical nurse specialist in accordance with State law, may
certify that a prescribed series of blood glucose tests, furnished over a
specified and limited period of time to monitor an individual’s blood glucose
levels, are medically required. For purposes of the preceding sentence, neither
a physician’s, a nurse practitioner's, or a clinical nurse specialist's order
for a prescribed series of blood glucose tests nor a physician’s, a nurse
practitioner's, or a clinical nurse specialist's certification that such tests
are medically required constitutes a standing order.”.</text>
</paragraph></section><section id="H5E4F416A0086422FA5954E5EA1F87F58"><enum>107.</enum><header>Counting of
observation days for purposes of applying the Medicare post-hospital
requirement for coverage of skilled nursing facility care</header>
<subsection id="HE9EE81F95D714A368D30F1E672618380"><enum>(a)</enum><header>In
general</header><text>Section 1861(i) of the Social Security Act (42 U.S.C.
1395x(i)) is amended by adding at the end the following: <quote>For purposes of
this subsection, an individual shall be treated as an inpatient of a hospital
for a day if the individual is staying as an inpatient in the hospital
overnight for observation for that day.</quote>.</text>
</subsection><subsection id="HB1B50E12EE704C0AB24E946FEDF30F9"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to
observation days occurring on or after the first day of the month beginning
more than 60 days after the date of the enactment of this Act.</text>
</subsection></section><section id="H40A4EB01F73D4B46B3DA3C08549CA9B"><enum>108.</enum><header>Payment for
therapy services</header>
<subsection id="H273A87103C374BEA8D4FB1BA707EAF06"><enum>(a)</enum><header>Extension of
exceptions process for medicare therapy caps</header><text>Section 1833(g)(5)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(g)(5)</external-xref>), as amended by section 201
of the Medicare Improvements and Extension Act of 2006 (division B of Public
Law 109–432), is amended by striking <quote>2007</quote> and inserting
<quote>2009</quote>.</text>
</subsection><subsection id="HECAFD2526F0A4C90B42EBCFF5DCE77"><enum>(b)</enum><header>Study and
report</header>
<paragraph id="H935E4D0840104F78A1F234EF0046F8FC"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services,
in consultation with appropriate stakeholders, including the national
professional associations representing long-term care providers and each
therapy discipline (including physical therapy, speech-language pathology, and
occupational therapy), shall conduct a study or studies to develop utilization
management alternatives to the Medicare payment cap under section 1833(g) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(g)</external-xref>) for physical therapy services and
speech-language pathology services, described in paragraph (1) of such section
and occupational therapy services described in paragraph (3) of such
section.</text>
</paragraph><paragraph id="H94CF013323634E2399C64ECE0025DE1"><enum>(2)</enum><header>Considerations</header><text display-inline="yes-display-inline">Such study or studies shall—</text>
<subparagraph id="HFD1D214614E74B568FB5A4E9AD4D02D9"><enum>(A)</enum><text>identify, test,
and utilize standardized patient assessment instruments that can collect
general and discipline-specific data elements, including rehabilitation
diagnosis, age, illness, caregiver support, setting, co-morbidities, and
functional status;</text>
</subparagraph><subparagraph id="H4B91EBC54019487480EA9CA7A4533DB"><enum>(B)</enum><text display-inline="yes-display-inline">assure that assessment instruments are
compatible with a uniform electronic health record to collect the data and keep
discipline-specific data; and</text>
</subparagraph><subparagraph id="H390289F8FD7D4061B1CF3547745B1C00"><enum>(C)</enum><text display-inline="yes-display-inline">utilize such assessment instruments and
resulting data to develop a utilization management system that—</text>
<clause id="H00293C9BBA344047802EEB48D06500F6"><enum>(i)</enum><text>assures
appropriate access to medically necessary services;</text>
</clause><clause id="H6E6E6E5B730C4A0D9598E380311930E8"><enum>(ii)</enum><text>employs the use
of practice guidelines,</text>
</clause><clause id="HC5CD2D0AC011408EB5A15F09DAC5B33"><enum>(iii)</enum><text>outcomes tracking
and other appropriate quality measurement mechanisms;</text>
</clause><clause id="H2ACB42D2314F46F9BC8C04E0E614791F"><enum>(iv)</enum><text>includes, with
respect to Medicare reimbursement for outpatient therapy services, the
development of the systems described in paragraph (3); and</text>
</clause><clause id="HEBFC85DB6A7A4ED18C04DAC3B0AF606B"><enum>(v)</enum><text>applies the
extension and the refinement of an exceptions process and other methods of
utilization control, such as the creation of multiple payment classifications
based on the clinical diagnosis (including comorbidities), setting,
rehabilitation potential, functional status and other patient characteristics;
and</text>
</clause></subparagraph><subparagraph id="HBACDDE0612584695B3732B0035C45458"><enum>(D)</enum><text display-inline="yes-display-inline">include a variety of geographic sites and
practice settings, including all settings or facilities in which the therapy
disciplines furnish services under part B of the Medicare program.</text>
</subparagraph></paragraph><paragraph id="HD7A7FB854C7941B8A2C9E27E6038AAD"><enum>(3)</enum><header>Systems</header><text display-inline="yes-display-inline">The systems described in this paragraph are
the following:</text>
<subparagraph id="H0A9CB4A64EF64A0C9E0748F254ECFA24"><enum>(A)</enum><text display-inline="yes-display-inline">A utilization management system based on
classifying the individual beneficiary’s need for therapy.</text>
</subparagraph><subparagraph id="HF1F462112E4846E3A37055BF00D8C21F"><enum>(B)</enum><text display-inline="yes-display-inline">A prospective payment system, including an
episode-based utilization management system, for services described in
paragraph (1).</text>
</subparagraph></paragraph><paragraph id="HB99F1315F69E4FD6BE6DA25377A56013"><enum>(4)</enum><header>Report</header><text>Not
later than January 1, 2009, the Secretary shall submit to Congress a report on
the study conducted under paragraph (1).</text>
</paragraph></subsection></section><section id="HB3D1990A220D4F3A9432ED1557E7152D"><enum>109.</enum><header>Expansion of
telehealth services to skilled nursing facilities</header>
<subsection id="H518C8532139F4E8CB747A440BF46D5B3"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section
1834(m)(4)(C)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)(4)(C)(ii)</external-xref>) is
amended by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="HAA5C59588D0C49E59100858D5156D3C" style="OLC">
<subclause id="HDC90294CDDF44EAB90BEAA4E4337D25E"><enum>(IV)</enum><text display-inline="yes-display-inline">A skilled nursing facility (as defined in
section
1819(a)).</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H1504332C6E9B4E2792A912CA17084B8"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to
telehealth services furnished on or after January 1, 2009.</text>
</subsection></section><section id="H6DE59F5783F64346BD22FD274186E760"><enum>110.</enum><header>Physical
therapy grant program</header><text display-inline="no-display-inline">Subpart
2 of part E of title VII of the Public Health Service Act (42 U.S.C. 295 et
seq.) is amended by inserting after section 769, the following:</text>
<quoted-block display-inline="no-display-inline" id="H45FAC5A3796144A7A2E466CFE1F4A5C" style="OLC">
<section id="H1D3DD88E65DE49A6B0FE1E8CCC17EB87"><enum>769A.</enum><header>Physical
therapy</header>
<subsection id="H58536AC08ED544CF8B55FC3B1B8F0025"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary may
make grants to, and enter into contracts with, programs of physical therapy for
the purpose of planning and implementing projects to recruit and retain faculty
and students, develop curriculum, support the distribution of physical therapy
practitioners in underserved areas, or support the continuing development of
these professions.</text>
</subsection><subsection id="HE15C09D42B354C6884F32378007027D3"><enum>(b)</enum><header>Preference in
Making Grants</header><text display-inline="yes-display-inline">In making
grants under subsection (a), the Secretary shall give preference to qualified
applicants that seek to educate physical therapists in rural or urban medically
underserved communities, or to expand post-professional programs for the
advanced education of physical therapist practitioners.</text>
</subsection><subsection id="HEC5C5F216E5F42BD8369368291E02007"><enum>(c)</enum><header>Peer
review</header><text display-inline="yes-display-inline">Each peer review group
under section 799(f) that is reviewing proposals for grants or contracts under
subsection (a) shall include not fewer than 2 physical therapists.</text>
</subsection><subsection id="H35A3048EF2444C71A2D93268514B1D39"><enum>(d)</enum><header>Report to
Congress</header>
<paragraph id="H4D389AEB8EC243A28C9B7D82A2E54033"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary shall
prepare a report that—</text>
<subparagraph id="HE27B3A77D56B4A5CB800322E8863B08C"><enum>(A)</enum><text>summarizes the
applications submitted to the Secretary for grants or contracts under
subsection (a);</text>
</subparagraph><subparagraph id="H56D4140A78414DB49000E8AA9372002F"><enum>(B)</enum><text>specifies the
identity of entities receiving the grants or contracts; and</text>
</subparagraph><subparagraph id="H79A2F88796094DBBA66825521D2C7BFF"><enum>(C)</enum><text>evaluates the
effectiveness of the program based upon the objectives established by the
entities receiving the grants or contracts.</text>
</subparagraph></paragraph><paragraph id="H51E08FC483DA4A7D930018BFD52FEA79"><enum>(2)</enum><header>Date certain for
submission</header><text display-inline="yes-display-inline">Not later than
February 1, 2009, the Secretary shall submit the report prepared under
paragraph (1) to the Committee on Energy and Commerce and the Committee on
Appropriations of the House of Representatives, the Committee on Health,
Education, Labor, and Pensions and the Committee on Appropriations of the
Senate.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H04B51F006A084393A6020500005EA3F"><enum>111.</enum><header>Long-Term Care
Quality Advisory Commission and demonstration projects</header>
<subsection id="H9901B3619FFC49B2A26D62C05D146000"><enum>(a)</enum><header>Long-Term Care
Quality Advisory Commission</header>
<paragraph id="HE65562DE372345E6BF378582D5D12333"><enum>(1)</enum><header>Establishment</header><text>Not
later than 6 months after the date of the enactment of this section, the
Secretary of Health and Human Services (in this section referred to as the
<quote>Secretary</quote>) shall establish a commission to be known as the Long
Term Care Quality Advisory Commission (in this section referred to as the
<quote>Commission</quote>).</text>
</paragraph><paragraph id="H960C87ADCFD14F7481896CF33187CC72"><enum>(2)</enum><header>Duties of
commission</header>
<subparagraph id="HBE367459D2DF47C08D72AC907BEBE4EE"><enum>(A)</enum><header>National
plan</header><text>The Commission shall develop, coordinate, and facilitate
implementation of a national plan for long-term care quality improvement. The
national plan shall—</text>
<clause id="HE6C016EA162C4B97A013D900E56FE308"><enum>(i)</enum><text>identify
objectives for long-term care quality improvement;</text>
</clause><clause id="HFA2F665FB3FC46198E13F68BC2A93B61"><enum>(ii)</enum><text>identify
strategies to eliminate known gaps in long-term care health system capacity and
improve long-term care quality; and</text>
</clause><clause id="H6F021696DDDF4C2AB35DC7C96070BB08"><enum>(iii)</enum><text>provide for
Federal programs to identify opportunities for strengthening and aligning
policies and programs to improve long-term care quality.</text>
</clause></subparagraph><subparagraph id="HD5B8BFFF73C74A059E7E394B764C8C70"><enum>(B)</enum><header>Demonstration
projects</header><text>The Commission shall design demonstration projects to
test alternative models for long-term care quality improvement, including with
respect to both personal and population health.</text>
</subparagraph><subparagraph id="H03EB82806ED04BECB2C9BD05DD8F903"><enum>(C)</enum><header>Monitoring</header><text>The
Commission shall monitor progress toward the objectives identified pursuant to
paragraph (1)(A).</text>
</subparagraph></paragraph><paragraph id="H3BD3D379746A428A9EF9603BF956F133"><enum>(3)</enum><header>Membership</header>
<subparagraph id="HD16428F34FFF429B993DA100BDADBA94"><enum>(A)</enum><header>Number</header><text>The
Commission shall be composed of 11 members appointed by the Secretary.</text>
</subparagraph><subparagraph id="H43CFFD92B169434900007E58D108E1A9"><enum>(B)</enum><header>Selection</header><text>The
Secretary shall select the members of the Commission from among individuals
with significant long-term care and health care quality expertise, including
expertise in clinical health care, health care quality research, population or
public health, rehabilitation care, or consumer organizations.</text>
</subparagraph></paragraph><paragraph id="HB4DC1383C3C44E359C29B2301D67E7F"><enum>(4)</enum><header>Contracting
authority</header><text>Subject to the availability of funds, the Commission
may enter into contracts and make other arrangements, as may be necessary to
carry out the duties described in paragraph (2).</text>
</paragraph><paragraph id="H46C1FE605314476989C809BFDA17ED07"><enum>(5)</enum><header>Staff</header><text>Upon
the request of the Commission, the Secretary may detail, on a reimbursable
basis, any of the personnel of the Administration on Aging, the Agency for
Health Care Quality and Research, or the Centers for Medicare & Medicaid
Services to the Commission to assist in carrying out this subsection.</text>
</paragraph><paragraph id="H5AFB0F29E22444028BA6F4D0C4FCBC3D"><enum>(6)</enum><header>Reports to
congress</header><text>Not later than 1 year after the establishment of the
Commission, and annually thereafter, the Commission shall submit a report to
the Congress on long-term care quality. Each such report shall include the
following:</text>
<subparagraph id="HCEAEA5F10548437FA55EF388F1B91C9"><enum>(A)</enum><text>An inventory of
relevant programs and recommendations for improved coordination and integration
of policy and programs.</text>
</subparagraph><subparagraph id="H4D5B7FCBB6FC498C8CCA766339AA0055"><enum>(B)</enum><text>An assessment of
achievement of the objectives identified in the national plan developed under
paragraph (2) and recommendations for realizing such objectives.</text>
</subparagraph><subparagraph id="H3742EF6DEDB94AC58BACCF801B115533"><enum>(C)</enum><text>Recommendations on
Federal legislation, regulations, or administrative policies to enhance
long-term care quality and outcomes.</text>
</subparagraph></paragraph></subsection><subsection id="H0C3687DAF1F54844BEEEE9B7BC397420"><enum>(b)</enum><header>Long-Term Care
Quality Demonstration Projects</header>
<paragraph id="H04CDB5156CA2492BA6D869888100F9C0"><enum>(1)</enum><header>In
general</header><text>Not later than 270 days after the date of the enactment
of this Act, the Secretary, in consultation with the Administration on Aging,
the Agency for Healthcare Research and Quality, and the Centers for Medicare
& Medicaid Services, shall make grants to eligible entities for 5
demonstration projects to implement and evaluate methods for improving the
quality of health care in long-term care settings. Each such demonstration
project shall include—</text>
<subparagraph id="H27C82B53C1974048B5C1A5A322EC19A5"><enum>(A)</enum><text>alternative
community models that—</text>
<clause id="H9DABD9F83E5940A5931E584E41BDFDFF"><enum>(i)</enum><text>will
achieve greater integration of personal and population health services;
and</text>
</clause><clause id="H7D22F2A2DE254666B5DC6C2917E0A744"><enum>(ii)</enum><text>address safety,
effectiveness, patient- or community-centeredness, timeliness, efficiency, and
equity (the six aims identified by the Institute of Medicine of the National
Academies in its report entitled <quote>Crossing the Quality Chasm: A New
Health System for the 21st Century</quote> released on March 1, 2001);</text>
</clause></subparagraph><subparagraph id="H62CD81B3EB1A499CA5F0DA82040010B0"><enum>(B)</enum><text>innovative
approaches to the financing and delivery of health services to achieve
long-term care quality goals; and</text>
</subparagraph><subparagraph id="H15F394036EF94C2486003C8D41C9B4E"><enum>(C)</enum><text>development of
quality improvement support structures to assist long-term care systems and
professionals (such as workforce support structures, quality monitoring and
reporting, clinical care protocols, and information technology
applications).</text>
</subparagraph></paragraph><paragraph id="H5B46632A439C4399AD451140A7229100"><enum>(2)</enum><header>Eligible
entities</header><text>In this subsection, the term <quote>eligible
entity</quote> means a consortium that—</text>
<subparagraph id="H8A382205B6B74E6A81099292D9837757"><enum>(A)</enum><text>shall
include—</text>
<clause id="H15B1DCD8968B4D458B71FB911D80DFC1"><enum>(i)</enum><text>at
least one health care provider or health care delivery system; and</text>
</clause><clause id="H87B3989AEB9D40D6BD9E30298ECE5FA2"><enum>(ii)</enum><text>at
least one organization representing multiple community stakeholders; and</text>
</clause></subparagraph></paragraph><paragraph id="H824D517B055B4E77BAF7A7C862849E6C"><enum>(3)</enum><header>Consultation</header><text>In
developing the program for awarding grants under this subsection, the Secretary
shall consult with the Administrator of the Agency for Healthcare Research and
Quality, long-term care providers, long-term care researchers, and private and
non-profit groups (including national associations) which are undertaking
similar efforts.</text>
</paragraph><paragraph id="H6E6061557DAD46F2B058387CBDF9269B"><enum>(4)</enum><header>Expedited
waivers</header><text>The Secretary shall expedite the processing of any waiver
that—</text>
<subparagraph id="HE33BEB40E4AF43FE986FC0D6A12C343"><enum>(A)</enum><text>is authorized under
title XVIII or XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>);
and</text>
</subparagraph><subparagraph id="HF47DE3A325944E819958C255A59D1C85"><enum>(B)</enum><text>is necessary to
carry out a demonstration project under this subsection.</text>
</subparagraph></paragraph><paragraph id="H6E50BD436E264E4E9291890171DF6005"><enum>(5)</enum><header>Demonstration
project sites</header><text>The Secretary shall ensure that the 5 demonstration
projects funded under this subsection are conducted at a variety of sites
representing the diversity of geographic locations in the Nation.</text>
</paragraph><paragraph id="H5430DA5AA20B4D4FAA0018A21761A6F9"><enum>(6)</enum><header>Duration</header><text>Each
demonstration project under this subsection shall be for a period of 4
years.</text>
</paragraph><paragraph id="H89B2705DBE7344B6A472D3481CA7937F"><enum>(7)</enum><header>Independent
evaluation</header><text>The Secretary shall enter into an arrangement with an
entity that has experience working directly with long-term care systems for the
conduct of an independent evaluation of the program carried out under this
subsection.</text>
</paragraph><paragraph id="H13944A939AF34567B5F855B80011E133"><enum>(8)</enum><header>Report</header><text>Not
later than one year after the conclusion of all of the demonstration projects
funded under this subsection, the Secretary shall submit a report to the
Congress on the results of such projects. The report shall include—</text>
<subparagraph id="H3E0158B573064CF0AFFD73E69815EC6"><enum>(A)</enum><text>an evaluation of
patient access to care, patient outcomes, and an analysis of the cost
effectiveness of each such project; and</text>
</subparagraph><subparagraph id="H84B4A0729D5D42D393A6CFA1845E62B1"><enum>(B)</enum><text>recommendations on
Federal legislation, regulations, or administrative policies to enhance
long-term care quality and outcomes.</text>
</subparagraph></paragraph></subsection><subsection id="HE9CED0F38E644A4FBED58342B1FAF33F"><enum>(c)</enum><header>Appropriation</header><text display-inline="yes-display-inline">For the purpose of carrying out this
section, there is authorized to be appropriated such sums as may be
necessary.</text>
</subsection></section><enum>II</enum><header>Workforce
Support</header>
<section id="H2CF27D030F8A42189151A65B428550DC"><enum>201.</enum><header>Nursing loan
repayment program</header><text display-inline="no-display-inline">Section
846(a) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/297n">42 U.S.C. 297n(a)</external-xref>) is amended by
striking the last sentence.</text>
</section><section id="H00FDAD5E2315494198A195B4B1CA9458"><enum>202.</enum><header>National
nursing database</header>
<subsection id="H029BED7267624F64ADEF7BD854289735"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall provide
for the establishment of a national nursing database (including geriatric
nursing) to be used to predict future nursing shortages.</text>
</subsection><subsection id="H8BE2C60B43D6438096ED12D88164849F"><enum>(b)</enum><header>Information in
database</header><text>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.</text>
</subsection><subsection id="H8C7ADBB923F040C891B246EF9942A79D"><enum>(c)</enum><header>Funding</header><text>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.</text>
</subsection></section><section id="H68B6BD6E7D4644158DB207CFB492992D"><enum>203.</enum><header>Reports on
nursing levels</header><text display-inline="no-display-inline">Section 806 of
the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/296e">42 U.S.C. 296e</external-xref>) is amended by adding at the end
the following:</text>
<quoted-block display-inline="no-display-inline" id="H7017C0C7277A4038965412C38DB301D7" style="OLC">
<subsection id="HC228478E0700465AA284026F5FA2FBC9"><enum>(i)</enum><header>Reports
concerning nursing levels</header>
<paragraph id="H7EA1A99258584FBAA8BA5511D82522F6"><enum>(1)</enum><header>In
general</header><text>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 (including with respect to
geriatric nursing).</text>
</paragraph><paragraph id="H70D1FAE0E1FF4CE18713465FF06E2347"><enum>(2)</enum><header>Entities
described</header><text>An entity is described in this paragraph if such entity
is—</text>
<subparagraph id="H82773CDE111D44979D3BDDC466858147"><enum>(A)</enum><text>an entity that
receives a grant or contract under this title;</text>
</subparagraph><subparagraph id="H8728BCE2868D4AAAA6A87F662E23E7F6"><enum>(B)</enum><text>a school of
nursing that receives student loan funds under this title;</text>
</subparagraph><subparagraph id="HB7D8C0F8B4074B1B88E52440A8A1A944"><enum>(C)</enum><text>a school of
nursing that receives nurse faculty student loan funds under this title;
and</text>
</subparagraph><subparagraph id="H4327581B41E745919927D137D8118266"><enum>(D)</enum><text>any other entity
that receives assistance under this
title.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>III</enum><header>Tax
Incentives</header>
<section id="H84113FE4512042B283BB40A84C00F100"><enum>301.</enum><header>15-year
recovery period for qualified long-term care improvement property</header>
<subsection id="H040498375FFB4C4AB429DD719C7FCEDC"><enum>(a)</enum><header>In
general</header><text>Subparagraph (E) of section 168(e)(3) of the Internal
Revenue Code of 1986 (relating to 15-year property) is amended by striking
<quote>and</quote> at the end of clause (vii), by striking the period at the
end of clause (viii) and inserting <quote>, and</quote>, and by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H7934E0EB8A2948D5B4DB208D416A6E0" style="OLC">
<clause id="HC9818602B96C44BE82EDD33CC731BC74"><enum>(ix)</enum><text>any qualified
long-term care improvement
property.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H80E6754FB06E40C2BCEFB41BEB911F0"><enum>(b)</enum><header>Qualified
long-term care improvement property</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HF5D5BDEFA60843880046D8FE21BF44B2" style="OLC">
<paragraph id="HD2A3212389044D909F75829160B4B02"><enum>(8)</enum><header>Qualified
long-term care improvement property</header><text>The term <term>qualified
long-term care improvement property</term> means any section 1250 property
which is an improvement to a building if—</text>
<subparagraph id="H4D62ACD521C54AA89723DB84B3F14F5F"><enum>(A)</enum><text>such improvement
is placed in service more than 3 years after the date such building was first
placed in service, and</text>
</subparagraph><subparagraph id="HAB71F575BD7B4DADB975D7FEA7AF3BF4"><enum>(B)</enum><text>such building is,
or is a part of, a nursing 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.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HC66A93FF248244219DFD933C00DDCFEC"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to property
placed in service after the date of the enactment of this Act.</text>
</subsection></section>