[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7128 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 7128

To amend titles XVIII and XIX of the Social Security Act to improve the 
 transparency of information on skilled nursing facilities and nursing 
facilities and to clarify and improve the targeting of the enforcement 
            of requirements with respect to such facilities.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2008

  Mr. Stark (for himself and Ms. Schakowsky) 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 improve the 
 transparency of information on skilled nursing facilities and nursing 
facilities and to clarify and improve the targeting of the enforcement 
            of requirements with respect to such facilities.

    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 ``Nursing Home 
Transparency and Quality of Care Improvement Act of 2008''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
   TITLE I--IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING 
                   FACILITIES AND NURSING FACILITIES

Sec. 101. Required disclosure of ownership and additional disclosable 
                            parties information.
Sec. 102. Accountability requirements.
Sec. 103. Nursing home compare Medicare website.
Sec. 104. Reporting of expenditures.
Sec. 105. Standardized complaint form.
Sec. 106. Ensuring staffing accountability.
                    TITLE II--TARGETING ENFORCEMENT

Sec. 201. Civil money penalties.
Sec. 202. National independent monitoring requirements.
Sec. 203. GAO studies and reports on temporary management.
Sec. 204. Notification of facility closure.
Sec. 205. National demonstration projects on culture change and use of 
                            information technology in nursing homes.
                  TITLE III--IMPROVING STAFF TRAINING

Sec. 301. Dementia and abuse prevention training.
Sec. 302. Study and report on training required for certified nurse 
                            aides and supervisory staff.

   TITLE I--IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING 
                   FACILITIES AND NURSING FACILITIES

SEC. 101. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE 
              PARTIES INFORMATION.

    (a) In General.--Section 1124 of the Social Security Act (42 U.S.C. 
1320a-3) is amended by adding at the end the following new subsection:
    ``(c) Required Disclosure of Ownership and Additional Disclosable 
Parties Information.--
            ``(1) Disclosure.--
                    ``(A) In general.--A facility shall have the 
                information described in paragraph (2) available--
                            ``(i) during the period beginning on the 
                        date of enactment of this subsection and ending 
                        on the date such information is made available 
                        through the Online Survey, Certification and 
                        Reporting (OSCAR) data network (or any 
                        successor system) maintained by the Secretary, 
                        for submission to the Secretary, the Inspector 
                        General of the Department of Health and Human 
                        Services, the State in which the facility is 
                        located, and the State long-term care ombudsman 
                        in the case where the Secretary, the Inspector 
                        General, the State, or the State long-term care 
                        ombudsman requests such information; and
                            ``(ii) beginning on the effective date of 
                        the final regulations promulgated under 
                        paragraph (3)(A), for reporting such 
                        information in accordance with such final 
                        regulations.
                Nothing in clause (i) shall be construed as authorizing 
                a facility to dispose of or delete information 
                described in such clause after the effective date of 
                the final regulations promulgated under paragraph 
                (3)(A).
                    ``(B) Public availability of information.--During 
                the period described in subparagraph (A)(i), a facility 
                shall--
                            ``(i) make the information described in 
                        paragraph (2) available to the public upon 
                        request; and
                            ``(ii) post a notice of the availability of 
                        such information in the lobby of the facility 
                        in a prominent manner.
            ``(2) Information described.--
                    ``(A) In general.--The following information is 
                described in this paragraph:
                            ``(i) The information described in 
                        subsections (a) and (b), subject to 
                        subparagraph (C).
                            ``(ii) The identity of and information on--
                                    ``(I) each member of the governing 
                                body of the facility, including the 
                                name, title, and period of service of 
                                each such member;
                                    ``(II) each person or entity who is 
                                an officer, director, member, partner, 
                                trustee, or managing employee of the 
                                facility, including the name, title, 
                                and period of service of each such 
                                person or entity; and
                                    ``(III) each person or entity who 
                                is an additional disclosable party of 
                                the facility.
                            ``(iii) The organizational structure of 
                        each person and entity described in clauses 
                        (ii) and (iii) and a description of the 
                        relationship of each such person or entity to 
                        the facility and to one another.
                    ``(B) Special rule where information is already 
                reported or submitted.--To the extent that information 
                reported by a facility to the Internal Revenue Service 
                on Form 990, information submitted by a facility to the 
                Securities and Exchange Commission, or information 
                otherwise submitted to the Secretary or any other 
                Federal agency contains the information described in 
                clauses (i), (ii), (iii), or (iv) of subparagraph (A), 
                the facility may provide such Form or such information 
                submitted to meet the requirements of paragraph (1).
                    ``(C) Special rule.--In applying subparagraph 
                (A)(i)--
                            ``(i) with respect to subsections (a) and 
                        (b), `ownership or control interest' shall 
                        include direct or indirect interests through 
                        any number of intermediate entities; and
                            ``(ii) subsection (a)(3)(A)(ii) shall 
                        include the owner of a whole or part interest 
                        in any mortgage, deed of trust, note, or other 
                        obligation secured, in whole or in part, by the 
                        entity or any of the property or assets 
                        thereof, if the interest is equal to or exceeds 
                        5 percent of the total property or assets of 
                        the entirety.
            ``(3) Reporting.--
                    ``(A) In general.--Not later than the date that is 
                2 years after the date of enactment of this subsection, 
                the Secretary shall promulgate final regulations 
                requiring, effective on the date that is 90 days after 
                the date on which such final regulations are published 
                in the Federal Register, a facility to report the 
                information described in paragraph (2) to the Secretary 
                in a standardized format, and such other regulations as 
                are necessary to carry out this subsection. Such final 
                regulations shall ensure that the facility certifies, 
                as a condition of participation and payment under the 
                program under title XVIII or XIX, that the information 
                reported by the facility in accordance with such final 
                regulations is accurate and current.
                    ``(B) Guidance.--The Secretary shall provide 
                guidance and technical assistance to States on how to 
                adopt the standardized format under subparagraph (A).
            ``(4) No effect on existing reporting requirements.--
        Nothing in this subsection shall reduce, diminish, or alter any 
        reporting requirement for a facility that is in effect as of 
        the date of enactment of this subsection.
            ``(5) Definitions.--In this subsection:
                    ``(A) Additional disclosable party.--The term 
                `additional disclosable party' means, with respect to a 
                facility, any person or entity who--
                            ``(i) exercises operational, financial, or 
                        managerial control over the facility or a part 
                        thereof, or provides policies or procedures for 
                        any of the operations of the facility, or 
                        provides financial or cash management services 
                        to the facility;
                            ``(ii) leases or subleases real property to 
                        the facility, or owns a whole or part interest 
                        equal to or exceeding 5 percent of the total 
                        value of such real property;
                            ``(iii) lends funds or provides a financial 
                        guarantee to the facility in an amount which is 
                        equal to or exceeds $50,000;
                            ``(iv) provides management or 
                        administrative services, management or clinical 
                        consulting services, or accounting or financial 
                        services to the facility;
                            ``(v) provides therapy, pharmacy, or 
                        hospice services to residents of the facility; 
                        or
                            ``(vi) leases employees to or employs staff 
                        on behalf of the facility.
                    ``(B) Facility.--The term `facility' means a 
                disclosing entity which is--
                            ``(i) a skilled nursing facility (as 
                        defined in section 1819(a)); or
                            ``(ii) a nursing facility (as defined in 
                        section 1919(a)).
                    ``(C) Managing employee.--The term `managing 
                employee' means, with respect to a facility, an 
                individual (including a general manager, business 
                manager, administrator, director, or consultant) who 
                directly or indirectly manages, advises, or supervises 
                any element of the practices, finances, or operations 
                of the facility.
                    ``(D) Organizational structure.--The term 
                `organizational structure' means, in the case of--
                            ``(i) a corporation, the officers, 
                        directors, and shareholders of the corporation 
                        who have an ownership interest in the 
                        corporation which is equal to or exceeds 5 
                        percent;
                            ``(ii) a limited liability company, the 
                        members and managers of the limited liability 
                        company (including, as applicable, what 
                        percentage each member and manager has of the 
                        ownership interest in the limited liability 
                        company);
                            ``(iii) a general partnership, the partners 
                        of the general partnership;
                            ``(iv) a limited partnership, the general 
                        partners and any limited partners of the 
                        limited partnership who have an ownership 
                        interest in the limited partnership which is 
                        equal to or exceeds 10 percent;
                            ``(v) a trust, the trustees of the trust;
                            ``(vi) an individual, contact information 
                        for the individual; and
                            ``(vii) any other person or entity, such 
                        information as the Secretary determines 
                        appropriate.''.
    (b) Public Availability of Information.--
            (1) In general.--Not later than the date that is 1 year 
        after the date on which the final regulations promulgated under 
        section 1124(c)(3)(A) of the Social Security Act, as added by 
        subsection (a), are published in the Federal Register, the 
        Secretary shall make the information reported in accordance 
        with such final regulations available to the public in a 
        similar manner as information with respect to skilled nursing 
        facilities and nursing facilities is made available to the 
        public through the Online Survey, Certification and Reporting 
        (OSCAR) data network (or any successor system) maintained by 
        the Secretary.
            (2) Definitions.--In this subsection:
                    (A) 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)).
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
                    (C) Skilled nursing facility.--The term ``skilled 
                nursing facility'' has the meaning given such term in 
                section 1819(a) of the Social Security Act (42 U.S.C. 
                1395i-3(a)).
    (c) Conforming Amendments.--
            (1) Skilled nursing facilities.--Section 1819(d)(1) of the 
        Social Security Act (42 U.S.C. 1395i-3(d)(1)) is amended by 
        striking subparagraph (B) and redesignating subparagraph (C) as 
        subparagraph (B).
            (2) Nursing facilities.--Section 1919(d)(1) of the Social 
        Security Act (42 U.S.C. 1396r(d)(1)) is amended by striking 
        subparagraph (B) and redesignating subparagraph (C) as 
        subparagraph (B).

SEC. 102. ACCOUNTABILITY REQUIREMENTS.

    (a) Effective Compliance and Ethics Programs.--
            (1) Skilled nursing facilities.--Section 1819(d)(1) of the 
        Social Security Act (42 U.S.C. 1395i-3(d)(1)) is amended by 
        adding at the end the following new subparagraph:
                    ``(D) Compliance and ethics programs.--
                            ``(i) Requirement.--On or after the date 
                        that is 36 months after the date of enactment 
                        of this subparagraph, a skilled nursing 
                        facility shall, with respect to the entity that 
                        operates the facility (in this subparagraph 
                        referred to as the `operating organization' or 
                        `organization'), have in operation a compliance 
                        and ethics program that is effective in 
                        preventing and detecting criminal, civil, and 
                        administrative violations under this Act and in 
                        promoting quality of care consistent with 
                        regulations developed under clause (ii).
                            ``(ii) Development of regulations.--
                                    ``(I) In general.--Not later than 
                                the date that is 2 years after such 
                                date of enactment, the Secretary, in 
                                consultation with the Inspector General 
                                of the Department of Health and Human 
                                Services, shall promulgate regulations 
                                for an effective compliance and ethics 
                                program for operating organizations, 
                                which may include a model compliance 
                                program.
                                    ``(II)  Design of regulations.--
                                Such regulations with respect to 
                                specific elements or formality of a 
                                program may vary with the size of the 
                                organization, such that larger 
                                organizations should have a more formal 
                                program and include established written 
                                policies defining the standards and 
                                procedures to be followed by its 
                                employees. Such requirements may 
                                specifically apply to the corporate 
                                level management of multi-nursing home 
                                chains.
                                    ``(III) Evaluation.--Not later than 
                                3 years after the date of promulgation 
                                of regulations under this clause, the 
                                Secretary shall complete an evaluation 
                                of the compliance and ethics programs 
                                required to be established under this 
                                subparagraph. Such evaluation shall 
                                determine if such programs led to 
                                changes in deficiency citations, 
                                changes in quality performance, or 
                                changes in other metrics of patient 
                                quality of care. The Secretary shall 
                                submit a report to Congress on such 
                                evaluation and shall include in such 
                                report such recommendations regarding 
                                changes in the requirements for such 
                                programs as the Secretary determines 
                                appropriate.
                            ``(iii) Requirements for compliance and 
                        ethics programs.--In this subparagraph, the 
                        term `compliance and ethics program' means, 
                        with respect to a skilled nursing facility, a 
                        program of the operating organization that--
                                    ``(I) has been reasonably designed, 
                                implemented, and enforced so that it 
                                generally will be effective in 
                                preventing and detecting criminal, 
                                civil, and administrative violations 
                                under this Act and in promoting quality 
                                of care; and
                                    ``(II) includes at least the 
                                required components specified in clause 
                                (iv).
                            ``(iv) Required components of program.--The 
                        required components of a compliance and ethics 
                        program of an organization are the following:
                                    ``(I) The organization must have 
                                established compliance standards and 
                                procedures to be followed by its 
                                employees and other agents that are 
                                reasonably capable of reducing the 
                                prospect of criminal, civil, and 
                                administrative violations under this 
                                Act.
                                    ``(II) Specific individuals within 
                                high-level personnel of the 
                                organization must have been assigned 
                                overall responsibility to oversee 
                                compliance with such standards and 
                                procedures and has sufficient resources 
                                and authority to assure such 
                                compliance.
                                    ``(III) The organization must have 
                                used due care not to delegate 
                                substantial discretionary authority to 
                                individuals whom the organization knew, 
                                or should have known through the 
                                exercise of due diligence, had a 
                                propensity to engage in criminal, 
                                civil, and administrative violations 
                                under this Act.
                                    ``(IV) The organization must have 
                                taken steps to communicate effectively 
                                its standards and procedures to all 
                                employees and other agents, such as by 
                                requiring participation in training 
                                programs or by disseminating 
                                publications that explain in a 
                                practical manner what is required.
                                    ``(V) The organization must have 
                                taken reasonable steps to achieve 
                                compliance with its standards, such as 
                                by utilizing monitoring and auditing 
                                systems reasonably designed to detect 
                                criminal, civil, and administrative 
                                violations under this Act by its 
                                employees and other agents and by 
                                having in place and publicizing a 
                                reporting system whereby employees and 
                                other agents could report violations by 
                                others within the organization without 
                                fear of retribution.
                                    ``(VI) The standards must have been 
                                consistently enforced through 
                                appropriate disciplinary mechanisms, 
                                including, as appropriate, discipline 
                                of individuals responsible for the 
                                failure to detect an offense.
                                    ``(VII) After an offense has been 
                                detected, the organization must have 
                                taken all reasonable steps to respond 
                                appropriately to the offense and to 
                                prevent further similar offenses, 
                                including any necessary modification to 
                                its program to prevent and detect 
                                criminal, civil, and administrative 
                                violations under this Act.
                                    ``(VIII) The organization must 
                                periodically undertake reassessment of 
                                its compliance program to identify 
                                changes necessary to reflect changes 
                                within the organization and its 
                                facilities.''.
            (2) Nursing facilities.--Section 1919(d)(1) of the Social 
        Security Act (42 U.S.C. 1396r(d)(1)) is amended by adding at 
        the end the following new subparagraph:
                    ``(D) Compliance and ethics program.--
                            ``(i) Requirement.--On or after the date 
                        that is 36 months after the date of enactment 
                        of this subparagraph, a nursing facility shall, 
                        with respect to the entity that operates the 
                        facility (in this subparagraph referred to as 
                        the `operating organization' or 
                        `organization'), have in operation a compliance 
                        and ethics program that is effective in 
                        preventing and detecting criminal, civil, and 
                        administrative violations under this Act and in 
                        promoting quality of care consistent with 
                        regulations developed under clause (ii).
                            ``(ii) Development of regulations.--
                                    ``(I) In general.--Not later than 
                                the date that is 2 years after such 
                                date of enactment, the Secretary, in 
                                consultation with the Inspector General 
                                of the Department of Health and Human 
                                Services, shall develop regulations for 
                                an effective compliance and ethics 
                                program for operating organizations, 
                                which may include a model compliance 
                                program.
                                    ``(II)  Design of regulations.--
                                Such regulations with respect to 
                                specific elements or formality of a 
                                program may vary with the size of the 
                                organization, such that larger 
                                organizations should have a more formal 
                                program and include established written 
                                policies defining the standards and 
                                procedures to be followed by its 
                                employees. Such requirements may 
                                specifically apply to the corporate 
                                level management of multi-nursing home 
                                chains.
                                    ``(III) Evaluation.--Not later than 
                                3 years after the date of promulgation 
                                of regulations under this clause the 
                                Secretary shall complete an evaluation 
                                of the compliance and ethics programs 
                                required to be established under this 
                                subparagraph. Such evaluation shall 
                                determine if such programs led to 
                                changes in deficiency citations, 
                                changes in quality performance, or 
                                changes in other metrics of patient 
                                quality of care. The Secretary shall 
                                submit a report to Congress on such 
                                evaluation and shall include in such 
                                report such recommendations regarding 
                                changes in the requirements for such 
                                programs as the Secretary determines 
                                appropriate.
                            ``(iii) Requirements for compliance and 
                        ethics programs.--In this subparagraph, the 
                        term `compliance and ethics program' means, 
                        with respect to a nursing facility, a program 
                        of the operating organization that--
                                    ``(I) has been reasonably designed, 
                                implemented, and enforced so that it 
                                generally will be effective in 
                                preventing and detecting criminal, 
                                civil, and administrative violations 
                                under this Act and in promoting quality 
                                of care; and
                                    ``(II) includes at least the 
                                required components specified in clause 
                                (iv).
                            ``(iv) Required components of program.--The 
                        required components of a compliance and ethics 
                        program of an organization are the following:
                                    ``(I) The organization must have 
                                established compliance standards and 
                                procedures to be followed by its 
                                employees and other agents that are 
                                reasonably capable of reducing the 
                                prospect of criminal, civil, and 
                                administrative violations under this 
                                Act.
                                    ``(II) Specific individuals within 
                                high-level personnel of the 
                                organization must have been assigned 
                                overall responsibility to oversee 
                                compliance with such standards and 
                                procedures and has sufficient resources 
                                and authority to assure such 
                                compliance.
                                    ``(III) The organization must have 
                                used due care not to delegate 
                                substantial discretionary authority to 
                                individuals whom the organization knew, 
                                or should have known through the 
                                exercise of due diligence, had a 
                                propensity to engage in criminal, 
                                civil, and administrative violations 
                                under this Act.
                                    ``(IV) The organization must have 
                                taken steps to communicate effectively 
                                its standards and procedures to all 
                                employees and other agents, such as by 
                                requiring participation in training 
                                programs or by disseminating 
                                publications that explain in a 
                                practical manner what is required.
                                    ``(V) The organization must have 
                                taken reasonable steps to achieve 
                                compliance with its standards, such as 
                                by utilizing monitoring and auditing 
                                systems reasonably designed to detect 
                                criminal, civil, and administrative 
                                violations under this Act by its 
                                employees and other agents and by 
                                having in place and publicizing a 
                                reporting system whereby employees and 
                                other agents could report violations by 
                                others within the organization without 
                                fear of retribution.
                                    ``(VI) The standards must have been 
                                consistently enforced through 
                                appropriate disciplinary mechanisms, 
                                including, as appropriate, discipline 
                                of individuals responsible for the 
                                failure to detect an offense.
                                    ``(VII) After an offense has been 
                                detected, the organization must have 
                                taken all reasonable steps to respond 
                                appropriately to the offense and to 
                                prevent further similar offenses, 
                                including any necessary modification to 
                                its program to prevent and detect 
                                criminal, civil, and administrative 
                                violations under this Act.
                                    ``(VIII) The organization must 
                                periodically undertake reassessment of 
                                its compliance program to identify 
                                changes necessary to reflect changes 
                                within the organization and its 
                                facilities.''.
    (b) Quality Assurance and Performance Improvement (QAPI) 
Demonstration Program.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        establish a demonstration program (in this subsection referred 
        to as the ``program'') to be conducted over a 3-year period to 
        test and evaluate models for quality assurance and performance 
        improvement (QAPI) programs with respect to nursing facilities, 
        including skilled nursing facilities.
            (2) Facilities to be included.--The program shall include 
        at least 15, but not more than 30, nursing facilities, 
        including a mix of facilities, such as special focus facilities 
        and high and middle performing facilities, but shall have a 
        focus on lower performing facilities. The nursing facilities 
        included in the program shall reflect large and medium chains 
        and stand alone homes.
            (3) Activities.--The program shall provide funding for 
        quality assurance and performance improvement activities at 
        nursing facilities, such as data analysis, root-cause analysis, 
        and systemic improvements. The results of such analysis shall 
        be reported to, and used by the governing body at such 
        facilities to make systemic improvements in quality of care.
            (4) Evaluation.--
                    (A) In general.--The Secretary, in consultation 
                with the Inspector General of the Department of Health 
                and Human Services, shall conduct an evaluation of the 
                program to determine if quality assurance and 
                performance improvement activities led to changes in 
                deficiency citations, changes in quality performance, 
                or changes in other metrics of patient quality of care. 
                Not later than 1 year after completion of the program, 
                the Secretary shall submit to Congress a report on such 
                evaluation and shall include in such report 
                recommendations on statutory changes needed to modify 
                and strengthen quality assurance and performance 
                improvement programs in skilled nursing facilities and 
                nursing facilities.
                    (B) Best practices manual.--The Secretary, in 
                consultation with the Inspector General of the 
                Department of Health and Human Services, shall use the 
                results of such evaluation to create a resource manual 
                for nursing facilities on best practices in quality 
                assurance and performance improvement.
                    (C) Proposal to revise quality assurance and 
                performance improvement programs.--The Secretary, 
                taking into account the results of such evaluation, 
                shall include in the proposed rule published under 
                section 1888(e) of the Social Security Act (42 U.S.C. 
                1395yy(e)(5)(A)) for the subsequent fiscal year to the 
                extent otherwise authorized under section 1819(b)(1)(B) 
                or 1819(d)(1)(D) of the Social Security Act or other 
                regulatory authority, one or more proposals for skilled 
                nursing facilities to modify and strengthen quality 
                assurance and performance improvement programs in such 
                facilities. At the time of publication of such proposed 
                rule and to the extent otherwise authorized under 
                section 1919(b)(1)(B) or 1919(d)(1)(D) of such Act or 
                other regulatory authority, the Secretary shall 
                promulgate as a proposed rule one or more proposals for 
                nursing facilities to modify and strengthen quality 
                assurance and performance improvement programs in such 
                facilities.
            (5) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to carry out 
        this subsection.
    (c) GAO Study on Nursing Facility Undercapitalization.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study that examines the following:
                    (A) The extent to which corporations that own or 
                operate large numbers of nursing facilities, taking 
                into account ownership type (including private equity 
                and control interests), are undercapitalizing such 
                facilities.
                    (B) The effects of such undercapitalization on 
                quality of care, including staffing and food costs, at 
                such facilities.
                    (C) Options to address such undercapitalization, 
                such as requirements relating to surety bonds, 
                liability insurance, or minimum capitalization.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report on the study conducted under paragraph (1).
            (3) Nursing facility.--In this subsection, the term 
        ``nursing facility'' includes a skilled nursing facility.

SEC. 103. NURSING HOME COMPARE MEDICARE WEBSITE.

    (a) Skilled Nursing Facilities.--
            (1) In general.--Section 1819 of the Social Security Act 
        (42 U.S.C. 1395i-3) is amended--
                    (A) by redesignating subsection (i) as subsection 
                (j); and
                    (B) by inserting after subsection (h) the following 
                new subsection:
    ``(i) Nursing Home Compare Website.--
            ``(1) Inclusion of additional information.--
                    ``(A) In general.--The Secretary shall ensure that 
                the Department of Health and Human Services includes, 
                as part of the information provided for comparison of 
                nursing homes on the official Internet website of the 
                Federal Government for Medicare beneficiaries (commonly 
                referred to as the `Nursing Home Compare' Medicare 
                website) (or a successor website), the following 
                information in a manner that is prominent, easily 
                accessible, readily understandable to consumers of 
                long-term care services, and searchable:
                            ``(i) Information that is reported to the 
                        Secretary under section 1124(c)(3).
                            ``(ii) Information on the `Special Focus 
                        Facility program' (or a successor program) 
                        established by the Centers for Medicare & 
                        Medicaid Services, according to procedures 
                        established by the Secretary. Such procedures 
                        shall provide for the inclusion of information 
                        with respect to, and the names and locations 
                        of, those facilities that, since the previous 
                        quarter--
                                    ``(I) were newly enrolled in the 
                                program;
                                    ``(II) are enrolled in the program 
                                and have failed to significantly 
                                improve;
                                    ``(III) are enrolled in the program 
                                and have significantly improved;
                                    ``(IV) have graduated from the 
                                program; and
                                    ``(V) have closed voluntarily or no 
                                longer participate under this title.
                            ``(iii) Staffing data for each facility 
                        (including resident census data and data on the 
                        hours of care provided per resident per day) 
                        based on data submitted under subsection 
                        (b)(8)(C), including information on staffing 
                        turnover and tenure, in a format that is 
                        clearly understandable to consumers of long-
                        term care services and allows such consumers to 
                        compare differences in staffing between 
                        facilities and State and national averages for 
                        the facilities. Such format shall include--
                                    ``(I) concise explanations of how 
                                to interpret the data (such as a plain 
                                English explanation of data reflecting 
                                ``nursing home staff hours per resident 
                                day'');
                                    ``(II) differences in types of 
                                staff (such as training associated with 
                                different categories of staff);
                                    ``(III) the relationship between 
                                nurse staffing levels and quality of 
                                care; and
                                    ``(IV) an explanation that 
                                appropriate staffing levels vary based 
                                on patient case mix.
                            ``(iv) Links to State internet websites 
                        where information about State survey and 
                        certification programs, Form 2567 inspection 
                        reports (or a successor form), and facility 
                        plans of corrections may be found, along with 
                        information to guide consumers in interpreting 
                        and understanding such reports.
                            ``(v) The standardized complaint form 
                        developed under subsection (f)(8), including 
                        explanatory material on what complaint forms 
                        are, how they are used, and how to file a 
                        complaint with the State survey and 
                        certification program and the State long-term 
                        care ombudsman program.
                            ``(vi) The number of adjudicated instances 
                        of criminal violations by a nursing facility or 
                        crimes committed by an employee of a nursing 
                        facility--
                                    ``(I) that were committed inside of 
                                the facility; and
                                    ``(II) with respect to such 
                                instances of violations or crimes 
                                committed outside of the facility, that 
                                were the violations or crimes of elder 
                                abuse, neglect, and exploitation, 
                                criminal sexual abuse of an elder, or 
                                other violations or crimes that 
                                resulted in the serious bodily injury 
                                of an elder.
                    ``(B) Deadline for provision of information.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), the Secretary shall ensure that 
                        the information described in subparagraph (A) 
                        is included on such website (or a successor 
                        website) not later than 1 year after the date 
                        of enactment of this subsection.
                            ``(ii) Exceptions.--
                                    ``(I) Ownership and affiliated 
                                parties and accountability requirements 
                                information.--The Secretary shall 
                                ensure that the information described 
                                in subparagraph (A)(i) is included on 
                                such website (or a successor website) 
                                not later than the date on which the 
                                requirements under section 1124(c)(3) 
                                are implemented.
                                    ``(II) Staffing data.--The 
                                Secretary shall ensure that the 
                                information described in subparagraph 
                                (A)(iii) is included on such website 
                                (or a successor website) not later than 
                                the date on which the requirement under 
                                subsection (b)(8)(C) is implemented.
            ``(2) Review and modification of website.--
                    ``(A) In general.--The Secretary shall establish a 
                process--
                            ``(i) to review the accuracy, clarity of 
                        presentation, timeliness, and comprehensiveness 
                        of information reported on such website as of 
                        the day before the date of enactment of this 
                        subsection; and
                            ``(ii) not later than 1 year after the date 
                        of enactment of this subsection, to modify or 
                        revamp such website in accordance with the 
                        review conducted under clause (i).
                    ``(B) Consultation.--In conducting the review under 
                subparagraph (A)(i), the Secretary shall consult with--
                            ``(i) State long-term care ombudsman 
                        programs;
                            ``(ii) consumer advocacy groups;
                            ``(iii) provider stakeholder groups;
                            ``(iv) skilled nursing facility employees 
                        and their representatives; and
                            ``(v) any other representatives of programs 
                        or groups the Secretary determines 
                        appropriate.''.
            (2) Timeliness of submission of survey and certification 
        information.--
                    (A) In general.--Section 1819(g)(5) of the Social 
                Security Act (42 U.S.C. 1395i-3(g)(5)) is amended by 
                adding at the end the following new subparagraph:
                    ``(E) Submission of survey and certification 
                information to the secretary.--In order to improve the 
                timeliness of information made available to the public 
                under subparagraph (A) and provided on the Nursing Home 
                Compare Medicare website under subsection (i), each 
                State shall submit information respecting any survey or 
                certification made respecting a skilled nursing 
                facility (including any enforcement actions taken by 
                the State) to the Secretary not later than the date on 
                which the State sends such information to the facility. 
                Any necessary subsequent corrections to prior 
                information submitted by the State shall be submitted 
                to the Secretary in a timely fashion. The Secretary 
                shall use the information submitted under the preceding 
                sentence to update the information provided on the 
                Nursing Home Compare Medicare website as expeditiously 
                as practicable, but not less frequently than 
                quarterly.''.
                    (B) Effective date.--The amendment made by this 
                paragraph shall take effect 1 year after the date of 
                enactment of this Act.
            (3) Special focus facility program.--Section 1819(f) of 
        such Act is amended by adding at the end the following new 
        paragraph:
            ``(8) Special focus facility program.--
                    ``(A) In general.--The Secretary shall conduct a 
                special focus facility program for enforcement of 
                requirements for skilled nursing facilities that the 
                Secretary has identified as having substantially failed 
                to meet applicable requirements of this Act.
                    ``(B) Periodic surveys.--Under such program the 
                Secretary shall conduct surveys of each facility in the 
                program not less often than once very 6 months.''.
    (b) Nursing Facilities.--
            (1) In general.--Section 1919 of the Social Security Act 
        (42 U.S.C. 1396r) is amended--
                    (A) by redesignating subsection (i) as subsection 
                (j); and
                    (B) by inserting after subsection (h) the following 
                new subsection:
    ``(i) Nursing Home Compare Website.--
            ``(1) Inclusion of additional information.--
                    ``(A) In general.--The Secretary shall ensure that 
                the Department of Health and Human Services includes, 
                as part of the information provided for comparison of 
                nursing homes on the official Internet website of the 
                Federal Government for Medicare beneficiaries (commonly 
                referred to as the `Nursing Home Compare' Medicare 
                website) (or a successor website), the following 
                information in a manner that is prominent, easily 
                accessible, readily understandable to consumers of 
                long-term care services, and searchable:
                            ``(i) Information that is reported to the 
                        Secretary under section 1124(c)(3).
                            ``(ii) Information on the `Special Focus 
                        Facility program' (or a successor program) 
                        established by the Centers for Medicare & 
                        Medicaid Services, according to procedures 
                        established by the Secretary. Such procedures 
                        shall provide for the inclusion of information 
                        with respect to, and the names and locations 
                        of, those facilities that, since the previous 
                        quarter--
                                    ``(I) were newly enrolled in the 
                                program;
                                    ``(II) are enrolled in the program 
                                and have failed to significantly 
                                improve;
                                    ``(III) are enrolled in the program 
                                and have significantly improved;
                                    ``(IV) have graduated from the 
                                program; and
                                    ``(V) have closed voluntarily or or 
                                no longer participate under this title.
                            ``(iii) Staffing data for each facility 
                        (including resident census data and data on the 
                        hours of care provided per resident per day) 
                        based on data submitted under subsection 
                        (b)(8)(C), including information on staffing 
                        turnover and tenure, in a format that is 
                        clearly understandable to consumers of long-
                        term care services and allows such consumers to 
                        compare differences in staffing between 
                        facilities and State and national averages for 
                        the facilities. Such format shall include--
                                    ``(I) concise explanations of how 
                                to interpret the data (such as a plain 
                                English explanation of data reflecting 
                                ``nursing home staff hours per resident 
                                day'');
                                    ``(II) differences in types of 
                                staff (such as training associated with 
                                different categories of staff);
                                    ``(III) the relationship between 
                                nurse staffing levels and quality of 
                                care; and
                                    ``(IV) an explanation that 
                                appropriate staffing levels vary based 
                                on patient case mix.
                            ``(iv) Links to State internet websites 
                        where information about State survey and 
                        certification programs, Form 2567 inspection 
                        reports (or a successor form), and facility 
                        plans of corrections may be found, along with 
                        information to guide consumers in interpreting 
                        and understanding such reports.
                            ``(v) The standardized complaint form 
                        developed under subsection (f)(8), including 
                        explanatory material on what complaint forms 
                        are, how they are used, and how to file a 
                        complaint with the State survey and 
                        certification program and the State long-term 
                        care ombudsman program.
                            ``(vi) The number of adjudicated instances 
                        of criminal violations by a nursing facility or 
                        crimes committed by an employee of a nursing 
                        facility--
                                    ``(I) that were committed inside of 
                                the facility; and
                                    ``(II) with respect to such 
                                instances of violations or crimes 
                                committed outside of the facility, that 
                                were the violations or crimes of elder 
                                abuse, neglect, and exploitation, 
                                criminal sexual abuse of an elder, or 
                                other violations or crimes that 
                                resulted in the serious bodily injury 
                                of an elder.
                    ``(B) Deadline for provision of information.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), the Secretary shall ensure that 
                        the information described in subparagraph (A) 
                        is included on such website (or a successor 
                        website) not later than 1 year after the date 
                        of enactment of this subsection.
                            ``(ii) Exceptions.--
                                    ``(I) Ownership and affiliated 
                                parties and accountability requirements 
                                information.--The Secretary shall 
                                ensure that the information described 
                                in subparagraph (A)(i) is included on 
                                such website (or a successor website) 
                                not later than the date on which the 
                                requirements under section 1124(c)(3) 
                                are implemented.
                                    ``(II) Staffing data.--The 
                                Secretary shall ensure that the 
                                information described in subparagraph 
                                (A)(iii) is included on such website 
                                (or a successor website) not later than 
                                the date on which the requirement under 
                                subsection (b)(8)(C) is implemented.
            ``(2) Review and modification of website.--
                    ``(A) In general.--The Secretary shall establish a 
                process--
                            ``(i) to review the accuracy, clarity of 
                        presentation, timeliness, and comprehensiveness 
                        of information reported on such website as of 
                        the day before the date of enactment of this 
                        subsection; and
                            ``(ii) not later than 1 year after the date 
                        of enactment of this subsection, to modify or 
                        revamp such website in accordance with the 
                        review conducted under clause (i).
                    ``(B) Consultation.--In conducting the review under 
                subparagraph (A)(i), the Secretary shall consult with--
                            ``(i) State long-term care ombudsman 
                        programs;
                            ``(ii) consumer advocacy groups;
                            ``(iii) provider stakeholder groups;
                            ``(iv) skilled nursing facility employees 
                        and their representatives; and
                            ``(v) any other representatives of programs 
                        or groups the Secretary determines 
                        appropriate.''.
            (2) Timeliness of submission of survey and certification 
        information.--
                    (A) In general.--Section 1919(g)(5) of the Social 
                Security Act (42 U.S.C. 1396r(g)(5)) is amended by 
                adding at the end the following new subparagraph:
                    ``(E) Submission of survey and certification 
                information to the secretary.--In order to improve the 
                timeliness of information made available to the public 
                under subparagraph (A) and provided on the Nursing Home 
                Compare Medicare website under subsection (i), each 
                State shall submit information respecting any survey or 
                certification made respecting a nursing facility 
                (including any enforcement actions taken by the State) 
                to the Secretary not later than the date on which the 
                State sends such information to the facility. Any 
                necessary subsequent corrections to prior information 
                submitted by the State shall be submitted to the 
                Secretary in a timely fashion. The Secretary shall use 
                the information submitted under the preceding sentence 
                to update the information provided on the Nursing Home 
                Compare Medicare website as expeditiously as 
                practicable, but not less frequently than quarterly.''.
                    (B) Effective date.--The amendment made by this 
                paragraph shall take effect 1 year after the date of 
                enactment of this Act.
            (3) Special focus facility program.--Section 1919(f) of 
        such Act is amended by adding at the end the following new 
        paragraph:
            ``(8) Special focus facility program.--
                    ``(A) In general.--The Secretary shall conduct a 
                special focus facility program for enforcement of 
                requirements for nursing facilities that the Secretary 
                has identified as having substantially failed to meet 
                applicable requirements of this Act.
                    ``(B) Periodic surveys.--Under such program the 
                Secretary shall conduct surveys of each facility in the 
                program not less often than once very 6 months.''.
    (c) Availability of Reports on Surveys, Certifications, and 
Substantiated Complaint Investigations.--
            (1) Skilled nursing facilities.--Section 1819(d)(1) of the 
        Social Security Act (42 U.S.C. 1395i-3(d)(1)), as amended by 
        section 102, is amended by adding at the end the following new 
        subparagraph:
                    ``(G) Availability of survey, certification, and 
                substantiated complaint investigation reports.--A 
                skilled nursing facility must--
                            ``(i) have reports with respect to any 
                        surveys, certifications, and substantiated 
                        complaint investigations made respecting the 
                        facility during the 3 preceding years available 
                        for any individual to review upon request, 
                        along with the plan of corrective action; and
                            ``(ii) post notice of the availability of 
                        such reports in areas of the facility that are 
                        prominent and accessible to the public.
                The facility shall not make available under clause (i) 
                identifying information about complainants or 
                residents.''.
            (2) Nursing facilities.--Section 1919(d)(1) of the Social 
        Security Act (42 U.S.C. 1396r(d)(1)), as amended by section 
        102, is amended by adding at the end the following new 
        subparagraph:
                    ``(G) Availability of survey, certification, and 
                substantiated complaint investigation reports.--A 
                nursing facility must--
                            ``(i) have reports with respect to any 
                        surveys, certifications, and substantiated 
                        complaint investigations made respecting the 
                        facility during the 3 preceding years available 
                        for any individual to review upon request, 
                        along with the plan of corrective action; and
                            ``(ii) post notice of the availability of 
                        such reports in areas of the facility that are 
                        prominent and accessible to the public.
                The facility shall not make available under clause (i) 
                identifying information about complainants or 
                residents.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect 1 year after the date of enactment of this 
        Act.
    (d) Guidance to States on Form 2567 State Inspection Reports and 
Substantiated Complaint Investigation Reports.--
            (1) Guidance.--The Secretary shall provide guidance to 
        States on how States can establish electronic links to Form 
        2567 State inspection reports (or a successor form), 
        substantiated complaint investigation reports, and a facility's 
        plan of correction or other response to such Form 2567 State 
        inspection reports (or a successor form) on the Internet 
        website of the State that provides information on skilled 
        nursing facilities and nursing facilities in a manner that does 
        not disclose identifying information about complainants or 
        residents.
            (2) Requirement.--As a condition of a contract with a State 
        under section 1864(d) of the Social Security Act, effective not 
        later than 2 years after the date of the enactment of this Act, 
        the Secretary of Health and Human Services shall require that a 
        State have, on the State's Internet website referred to in 
        paragraph (1), the electronic links referred to in such 
        paragraph.
            (3) Definitions.--In this subsection:
                    (A) 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)).
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
                    (C) Skilled nursing facility.--The term ``skilled 
                nursing facility'' has the meaning given such term in 
                section 1819(a) of the Social Security Act (42 U.S.C. 
                1395i-3(a)).

SEC. 104. REPORTING OF EXPENDITURES.

    Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is 
amended by adding at the end the following new subsection:
    ``(f) Reporting of Direct Care Expenditures.--
            ``(1) In general.--For cost reports submitted under this 
        title for cost reporting periods beginning on or after the date 
        that is 2 years after the date of enactment of this subsection, 
        skilled nursing facilities shall separately report expenditures 
        for wages and benefits for direct care staff (breaking out (at 
        a minimum) registered nurses, licensed professional nurses, 
        certified nurse assistants, and other medical and therapy 
        staff).
            ``(2) Modification of form.--The Secretary, in consultation 
        with private sector accountants experienced with medicare and 
        medicaid nursing facility home cost reports, shall redesign 
        such reports to meet the requirement of paragraph (1) not later 
        than 1 year after the date of the enactment of this subsection.
            ``(3) Categorization by functional accounts.--Not later 
        than 30 months after the date of the enactment of this 
        subsection, the Secretary, working in consultation with the 
        Medicare Payment Advisory Commission, the Inspector General of 
        the Department of Health and Human Services, and other expert 
        parties the Secretary determines appropriate, shall take the 
        expenditures listed on cost reports, as modified under 
        paragraph (1), submitted by skilled nursing facilities and 
        categorize such expenditures, regardless of any source of 
        payment for such expenditures, for each skilled nursing 
        facility into the following functional accounts on an annual 
        basis:
                    ``(A) Spending on direct care services (including 
                nursing, therapy, and medical services).
                    ``(B) Spending on indirect care (including 
                housekeeping and dietary services).
                    ``(C) Capital assets (including building and land 
                costs).
                    ``(D) Administrative services costs.
            ``(4) Availability of information submitted.--The Secretary 
        shall establish procedures to make information on expenditures 
        submitted under this subsection readily available to interested 
        parties upon request, subject to such requirements as the 
        Secretary may specify under the procedures established under 
        this paragraph.''.

SEC. 105. STANDARDIZED COMPLAINT FORM.

    (a) Skilled Nursing Facilities.--
            (1) Development by the secretary.--Section 1819(f) of the 
        Social Security Act (42 U.S.C. 1395i-3(f)) is amended by adding 
        at the end the following new paragraph:
            ``(8) Standardized complaint form.--The Secretary shall 
        develop a standardized complaint form for use in filing, in 
        good faith, a complaint with a State survey and certification 
        agency and a State long-term care ombudsman program with 
        respect to a skilled nursing facility.''.
            (2) State requirements.--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) Complaint process and whistleblower protection.--
                    ``(A) Complaint forms.--The State must make the 
                standardized complaint form developed under subsection 
                (f)(8) available upon request to--
                            ``(i) a resident of a skilled nursing 
                        facility;
                            ``(ii) any person acting on the resident's 
                        behalf; and
                            ``(iii) any person who works at a skilled 
                        nursing facility or is a representative of such 
                        a worker.
                    ``(B) Complaint resolution process.--The State must 
                establish a complaint resolution process in order to 
                ensure that a resident is not retaliated against if the 
                resident has complained, in good faith, about the 
                quality of care or other issues relating to the skilled 
                nursing facility, that the legal representative of a 
                resident of a skilled nursing facility or other 
                responsible party is not denied access to such resident 
                or otherwise retaliated against if such representative 
                or party has complained, in good faith, about the 
                quality of care provided by the facility or other 
                issues relating to the facility, and that a person who 
                works at a skilled nursing facility is not retaliated 
                against if the worker has complained, in good faith, 
                about quality of care or services or an issue relating 
                to the quality of care or services provided at the 
                facility, whether the resident, legal representative, 
                other responsible party, or worker used the form 
                developed under subsection (f)(8) or some other method 
                for submitting the complaint. Such complaint resolution 
                process shall include--
                            ``(i) procedures to assure accurate 
                        tracking of complaints received, including 
                        notification to the complainant that a 
                        complaint has been received;
                            ``(ii) procedures to determine the likely 
                        severity of a complaint and for the 
                        investigation of the complaint;
                            ``(iii) deadlines for responding to a 
                        compliant and procedures in order to enable the 
                        complainant to track the status of the 
                        complaint and investigation; and
                            ``(iv) procedures to ensure that the 
                        identity of the complainant will be kept 
                        confidential.
                    ``(C) Whistleblower protection.--
                            ``(i) Prohibition against retaliation.--No 
                        person who works at a skilled nursing facility 
                        may be penalized, discriminated, or retaliated, 
                        against with respect to any aspect of 
                        employment, including discharge, promotion, 
                        compensation, terms, conditions, or privileges 
                        of employment, or have a contract for services 
                        terminated, because the person (or anyone 
                        acting at the person's request) complained, in 
                        good faith, about the quality of care or 
                        services provided by a nursing facility or 
                        about other issues relating to quality of care 
                        or services, whether using the form developed 
                        under subsection (f)(8) or some other method 
                        for submitting the complaint.
                            ``(ii) Retaliatory reporting.--A skilled 
                        nursing facility may not file a complaint or a 
                        report against a person who works (or has 
                        worked) at the facility with the appropriate 
                        State professional disciplinary agency because 
                        the person (or anyone acting at the person's 
                        request) filed, in good faith, a complaint 
                        described in clause (i).
                            ``(iii) Commencement of action.--Any person 
                        who believes the person has been penalized, 
                        discriminated, or retaliated against, or had a 
                        contract for services terminated in violation 
                        of clause (i) or against whom a complaint has 
                        been filed in violation of clause (ii) may 
                        bring an action at law or equity in the 
                        appropriate district court of the United 
                        States, which shall have jurisdiction over such 
                        action without regard to the amount in 
                        controversy or the citizenship of the parties, 
                        and which shall have jurisdiction to grant 
                        complete relief, including, but not limited to, 
                        injunctive relief (such as reinstatement), 
                        compensatory damages (which may include 
                        reimbursement of lost wages, compensation, and 
                        benefits), costs of litigation (including 
                        reasonable attorney and expert witness fees), 
                        exemplary damages where appropriate, and such 
                        other relief as the court deems just and 
                        proper.
                            ``(iv) Rights not waivable.--The rights 
                        protected by this paragraph may not be 
                        diminished by contract or other agreement, and 
                        nothing in this paragraph shall be construed to 
                        diminish any greater or additional protection 
                        provided by Federal or State law or by contract 
                        or other agreement.
                            ``(v) Rule of construction.--Nothing in 
                        this section shall be construed as preventing a 
                        resident of a skilled nursing facility, a 
                        person acting on the resident's behalf, or a 
                        person who works at a skilled nursing facility 
                        from submitting a complaint in a manner or 
                        format other than by using the standardized 
                        complaint form developed under subsection 
                        (f)(8) (including submitting a complaint 
                        orally).
                            ``(vi) Requirement to post notice of 
                        employee rights.--Each skilled nursing facility 
                        shall post conspicuously in an appropriate 
                        location a sign (in a form specified by the 
                        Secretary) specifying the rights of persons 
                        under this paragraph and including a statement 
                        that an employee may file a complaint with the 
                        Secretary against the a skilled nursing 
                        facility that violates the provisions of this 
                        paragraph and information with respect to the 
                        manner of filing such a complaint.
                    ``(D) Good faith defined.--For purposes of this 
                paragraph, an individual shall be deemed to be acting 
                in good faith with respect to the filing of a complaint 
                if the individual reasonably believes--
                            ``(i) the information reported or disclosed 
                        in the complaint is true; and
                            ``(ii) a violation of this title has 
                        occurred or may occur in relation to such 
                        information.''.
    (b) Nursing Facilities.--
            (1) Development by the secretary.--Section 1919(f) of the 
        Social Security Act (42 U.S.C. 1395i-3(f)) is amended by adding 
        at the end the following new paragraph:
            ``(10) Standardized complaint form.--The Secretary shall 
        develop a standardized complaint form for use in filing, in 
        good faith, a complaint with a State survey and certification 
        agency and a State long-term care ombudsman program with 
        respect to a nursing facility.''.
            (2) State requirements.--Section 1919(e) of the Social 
        Security Act (42 U.S.C. 1395i-3(e)) is amended by adding at the 
        end the following new paragraph:
            ``(8) Complaint process and whistleblower protection.--
                    ``(A) Complaint forms.--The State must make the 
                standardized complaint form developed under subsection 
                (f)(10) available upon request to--
                            ``(i) a resident of a nursing facility;
                            ``(ii) any person acting on the resident's 
                        behalf; and
                            ``(iii) any person who works at a nursing 
                        facility or a representative of such a worker.
                    ``(B) Complaint resolution process.--The State must 
                establish a complaint resolution process in order to 
                ensure that a resident is not retaliated against if the 
                resident has complained, in good faith, about the 
                quality of care or other issues relating to the nursing 
                facility, that the legal representative of a resident 
                of a nursing facility or other responsible party is not 
                denied access to such resident or otherwise retaliated 
                against if such representative or party has complained, 
                in good faith, about the quality of care provided by 
                the facility or other issues relating to the facility, 
                and that a person who works at a nursing facility is 
                not retaliated against if the worker has complained, in 
                good faith, about quality of care or services or an 
                issue relating to the quality of care or services 
                provided at the facility, whether the resident, legal 
                representative, other responsible party, or worker used 
                the form developed under subsection (f)(10) or some 
                other method for submitting the complaint. Such 
                complaint resolution process shall include--
                            ``(i) procedures to assure accurate 
                        tracking of complaints received, including 
                        notification to the complainant that a 
                        complaint has been received;
                            ``(ii) procedures to determine the likely 
                        severity of a complaint and for the 
                        investigation of the complaint;
                            ``(iii) deadlines for responding to a 
                        compliant and procedures in order to enable the 
                        complainant to track the status of the 
                        complaint and investigation; and
                            ``(iv) procedures to ensure that the 
                        identity of the complainant will be kept 
                        confidential.
                    ``(C) Whistleblower protection.--
                            ``(i) Prohibition against retaliation.--No 
                        person who works at a skilled nursing facility 
                        may be penalized, discriminated, or retaliated, 
                        against with respect to any aspect of 
                        employment, including discharge, promotion, 
                        compensation, terms, conditions, or privileges 
                        of employment, or have a contract for services 
                        terminated, because the person (or anyone 
                        acting at the person's request) complained, in 
                        good faith, about the quality of care or 
                        services provided by a nursing facility or 
                        about other issues relating to quality of care 
                        or services, whether using the form developed 
                        under subsection (f)(10) or some other method 
                        for submitting the complaint.
                            ``(ii) Retaliatory reporting.--A nursing 
                        facility may not file a complaint or a report 
                        against a person who works (or has worked) at 
                        the facility with the appropriate State 
                        professional disciplinary agency because the 
                        person (or anyone acting at the person's 
                        request) filed, in good faith, a complaint 
                        described in clause (i).
                            ``(iii) Commencement of action.--Any person 
                        has been penalized, discriminated, or 
                        retaliated against, or had a contract for 
                        services terminated in violation of clause (i) 
                        or against whom a complaint has been filed in 
                        violation of clause (ii) may bring an action at 
                        law or equity in the appropriate district court 
                        of the United States, which shall have 
                        jurisdiction over such action without regard to 
                        the amount in controversy or the citizenship of 
                        the parties, and which shall have jurisdiction 
                        to grant complete relief, including, but not 
                        limited to, injunctive relief (such as 
                        reinstatement), compensatory damages (which may 
                        include reimbursement of lost wages, 
                        compensation, and benefits), costs of 
                        litigation (including reasonable attorney and 
                        expert witness fees), exemplary damages where 
                        appropriate, and such other relief as the court 
                        deems just and proper.
                            ``(iv) Rights not waivable.--The rights 
                        protected by this paragraph may not be 
                        diminished by contract or other agreement, and 
                        nothing in this paragraph shall be construed to 
                        diminish any greater or additional protection 
                        provided by Federal or State law or by contract 
                        or other agreement.
                            ``(v) Rule of construction.--Nothing in 
                        this section shall be construed as preventing a 
                        resident of a nursing facility, a person acting 
                        on the resident's behalf, or a person who works 
                        at a nursing facility from submitting a 
                        complaint in a manner or format other than by 
                        using the standardized complaint form developed 
                        under subsection (f)(10) (including submitting 
                        a complaint orally).
                            ``(vi) Requirement to post notice of 
                        employee rights.--Each nursing facility shall 
                        post conspicuously in an appropriate location a 
                        sign (in a form specified by the Secretary) 
                        specifying the rights of persons under this 
                        paragraph and including a statement that an 
                        employee may file a complaint with the 
                        Secretary against the a skilled nursing 
                        facility that violates the provisions of this 
                        paragraph and information with respect to the 
                        manner of filing such a complaint.
                    ``(D) Good faith defined.--For purposes of this 
                paragraph, an individual shall be deemed to be acting 
                in good faith with respect to the filing of a complaint 
                if the individual reasonably believes--
                            ``(i) the information reported or disclosed 
                        in the complaint is true; and
                            ``(ii) a violation of this title has 
                        occurred or may occur in relation to such 
                        information.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect 1 year after the date of enactment of this Act.

SEC. 106. ENSURING STAFFING ACCOUNTABILITY.

    (a) Skilled Nursing Facilities.--Section 1819(b)(8) of the Social 
Security Act (42 U.S.C. 1395i-3(b)(8)) is amended by adding at the end 
the following new subparagraph:
                    ``(C) Submission of staffing information based on 
                payroll data in a uniform format.--Beginning not later 
                than 2 years after the date of the enactment of this 
                subparagraph, and after consulting with State long-term 
                care omubdsman programs, consumer advocacy groups, 
                provider stakeholder groups, employees and their 
                representatives, and other parties the Secretary deems 
                appropriate, the Secretary shall require a skilled 
                nursing facility to electronically submit to the 
                Secretary direct care staffing information (including 
                information with respect to agency and contract staff) 
                based on payroll and other verifiable and auditable 
                data in a uniform format (according to specifications 
                established by the Secretary in consultation with such 
                programs, groups, and parties). Such specifications 
                shall require that the information submitted under the 
                preceding sentence--
                            ``(i) specify the category of work a 
                        certified employee performs (such as whether 
                        the employee is a registered nurse, licensed 
                        practical nurse, licensed vocational nurse, 
                        certified nursing assistant, therapist, or 
                        other medical personnel);
                            ``(ii) include resident census data and 
                        information on resident case mix;
                            ``(iii) include a regular reporting 
                        schedule; and
                            ``(iv) include information on employee 
                        turnover and tenure and on the hours of care 
                        provided by each category of certified 
                        employees referenced in clause (i) per resident 
                        per day.
                Nothing in this subparagraph shall be construed as 
                preventing the Secretary from requiring submission of 
                such information with respect to specific categories, 
                such as nursing staff, before other categories of 
                certified employees. Information under this 
                subparagraph with respect to agency and contract staff 
                shall be kept separate from information on employee 
                staffing.''
    (b) Nursing Facilities.--Section 1919(b)(8) of the Social Security 
Act (42 U.S.C. 1396r(b)(8)) is amended by adding at the end the 
following new subparagraph:
                    ``(C) Submission of staffing information based on 
                payroll data in a uniform format.--Beginning not later 
                than 2 years after the date of the enactment of this 
                subparagraph, and after consulting with State long-term 
                care omubdsman programs, consumer advocacy groups, 
                provider stakeholder groups, employees and their 
                representatives, and other parties the Secretary deems 
                appropriate, the Secretary shall require a nursing 
                facility to electronically submit to the Secretary 
                direct care staffing information (including information 
                with respect to agency and contract staff) based on 
                payroll and other verifiable and auditable data in a 
                uniform format (according to specifications established 
                by the Secretary in consultation with such programs, 
                groups, and parties). Such specifications shall require 
                that the information submitted under the preceding 
                sentence--
                            ``(i) specify the category of work a 
                        certified employee performs (such as whether 
                        the employee is a registered nurse, licensed 
                        practical nurse, licensed vocational nurse, 
                        certified nursing assistant, therapist, or 
                        other medical personnel);
                            ``(ii) include resident census data and 
                        information on resident case mix;
                            ``(iii) include a regular reporting 
                        schedule; and
                            ``(iv) include information on employee 
                        turnover and tenure and on the hours of care 
                        provided by each category of certified 
                        employees referenced in clause (i) per resident 
                        per day.
                Nothing in this subparagraph shall be construed as 
                preventing the Secretary from requiring submission of 
                such information with respect to specific categories, 
                such as nursing staff, before other categories of 
                certified employees. Information under this 
                subparagraph with respect to agency and contract staff 
                shall be kept separate from information on employee 
                staffing.''

                    TITLE II--TARGETING ENFORCEMENT

SEC. 201. CIVIL MONEY PENALTIES.

    (a) Skilled Nursing Facilities.--
            (1) In general.--Section 1819(h)(2)(B)(ii) of the Social 
        Security Act (42 U.S.C. 1395i-3(h)(2)(B)(ii)) is amended to 
        read as follows:
                            ``(ii) Authority with respect to civil 
                        money penalties.--
                                    ``(I) Amount.--Subject to subclause 
                                (IV), the Secretary may impose a civil 
                                money penalty in the applicable per 
                                instance or per day amount (as defined 
                                in subclause (II) and (III)) for each 
                                day or each instance, respectively, of 
                                noncompliance (as determined 
                                appropriate by the Secretary).
                                    ``(II) Applicable per instance 
                                amount.--In this clause, the term 
                                `applicable per instance amount' 
                                means--
                                            ``(aa) in the case where 
                                        the deficiency is found to be a 
                                        direct proximate cause of death 
                                        of a resident of the facility, 
                                        an amount not to exceed 
                                        $100,000;
                                            ``(bb) in each case of a 
                                        deficiency where the facility 
                                        is cited for actual harm or 
                                        immediate jeopardy, an amount 
                                        not less than $3,050 and not 
                                        more than $25,000; and
                                            ``(cc) in each case of any 
                                        other deficiency, an amount not 
                                        less than $250 and not to 
                                        exceed $3,050.
                                    ``(III) Applicable per day 
                                amount.--In this clause, the term 
                                `applicable per day amount' means--
                                            ``(aa) in each case of a 
                                        deficiency where the facility 
                                        is cited for actual harm or 
                                        immediate jeopardy, an amount 
                                        not less than $3,050 and not 
                                        more than $25,000; and
                                            ``(bb) in each case of any 
                                        other deficiency, an amount not 
                                        less than $250 and not to 
                                        exceed $3,050.
                                    ``(IV) Reduction of civil money 
                                penalties in certain circumstances.--
                                Subject to subclauses (V) and (VI), in 
                                the case where a facility self-reports 
                                and promptly corrects a deficiency for 
                                which a penalty was imposed under this 
                                clause not later than 10 calendar days 
                                after the date of such imposition, the 
                                Secretary may reduce the amount of the 
                                penalty imposed.
                                    ``(V) Prohibitions on reduction for 
                                certain deficiencies.--
                                            ``(aa) Repeat 
                                        deficiencies.--The Secretary 
                                        may not reduce the amount of a 
                                        penalty under subclause (IV) if 
                                        the Secretary had reduced a 
                                        penalty imposed on the facility 
                                        in the preceding year under 
                                        such subclause with respect to 
                                        a repeat deficiency.
                                            ``(bb) Certain other 
                                        deficiencies.--The Secretary 
                                        may not reduce the amount of a 
                                        penalty under subclause (IV) if 
                                        the penalty is imposed for a 
                                        deficiency described in 
                                        subclause (II)(bb) or (III)(aa) 
                                        and the actual harm is found to 
                                        result in a pattern of harm or 
                                        widespread harm that 
                                        immediately jeopardizes the 
                                        health or safety of a resident 
                                        or residents of the facility, 
                                        or if the penalty is imposed 
                                        for a deficiency described in 
                                        subclause (II)(aa).
                                    ``(VI) Limitation on aggregate 
                                reductions.--The aggregate reduction in 
                                a penalty under subclause (IV) may not 
                                exceed 35 percent on the basis of self-
                                reporting, on the basis of a waiver of 
                                an appeal (as provided for under 
                                regulations under section 488.436 of 
                                title 42, Code of Federal Regulations), 
                                or on the basis of both.
                                    ``(VII) Collection of civil money 
                                penalties.--In the case of a civil 
                                money penalty imposed under this clause 
                                for a deficiency described in item (aa) 
                                or (bb) of subclause (II) or subclause 
                                (III)(aa), the Secretary--
                                            ``(aa) subject to item 
                                        (bb), shall provide the 
                                        opportunity for the facility to 
                                        participate in an informal 
                                        dispute resolution process 
                                        prior to the collection of such 
                                        penalty;
                                            ``(bb) may provide for the 
                                        collection of such civil money 
                                        penalty and the placement of 
                                        such amounts collected in an 
                                        escrow account on the earlier 
                                        of the date on which the 
                                        informal dispute resolution 
                                        process under item (aa) is 
                                        completed or the date that is 
                                        90 days after the date of the 
                                        imposition of the penalty;
                                            ``(cc) may provide that 
                                        such amounts collected are kept 
                                        in such account pending the 
                                        resolution of any appeals;
                                            ``(dd) in the case where 
                                        the facility successfully 
                                        appeals the penalty, shall 
                                        provide for the return of such 
                                        amounts collected (plus 
                                        interest) to the facility; and
                                            ``(ee) in the case where 
                                        all such appeals are 
                                        unsuccessful, may provide that 
                                        some portion of such amounts 
                                        collected may be used to 
                                        support activities of the State 
                                        long term care ombudsman or 
                                        that benefit residents, 
                                        including assistance to support 
                                        and protect residents who 
                                        reside in a facility that 
                                        closes (voluntarily or 
                                        involuntarily) or is 
                                        decertified (including 
                                        offsetting costs of relocating 
                                        residents to home and 
                                        community-based settings or 
                                        another facility), and projects 
                                        that support resident and 
                                        family councils and other 
                                        consumer involvement in 
                                        assuring quality care in 
                                        facilities.
                                    ``(VIII) Procedure.--The provisions 
                                of section 1128A (other than 
                                subsections (a) and (b) and except to 
                                the extent that such provisions require 
                                a hearing prior to the imposition of a 
                                civil money penalty in the case 
                                described in subclause (VII)) shall 
                                apply to a civil money penalty under 
                                this clause in the same manner as such 
                                provisions apply to a penalty or 
                                proceeding under section 1128A(a).
                                    ``(IX) Indexing amounts.--For years 
                                beginning after 2010, each of the 
                                amounts specified in subclauses (II) 
                                and (III) shall be subject to periodic 
                                increase in accordance with the 
                                provisions of section 5 of the Federal 
                                Civil Penalties Inflation Adjustment 
                                Act of 1990 (Public Law 101-410; 28 
                                U.S.C. 2461 note).''.
            (2) Conforming amendment.--The second sentence of section 
        1819(h)(5) of the Social Security Act (42 U.S.C. 1395i-3(h)(5)) 
        is amended by inserting ``(ii)(V),'' after ``(i),''.
    (b) Nursing Facilities.--
            (1) Penalties imposed by the state.--
                    (A) In general.--Section 1919(h)(2) of the Social 
                Security Act (42 U.S.C. 1396r(h)(2)) is amended--
                            (i) in subparagraph (A)(ii), by striking 
                        the first sentence and inserting the following: 
                        ``A civil money penalty in accordance with 
                        subparagraph (G).''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(G) Civil money penalties.--
                            ``(i) In general.--Subject to clause (iii), 
                        the State may impose a civil money penalty 
                        under subparagraph (A)(ii) in the applicable 
                        per instance or per day amount (as defined in 
                        clause (ii) and (iii)) for each day or each 
                        instance, respectively, of noncompliance (as 
                        determined appropriate by the State).
                            ``(ii) Applicable per instance amount.--In 
                        this subparagraph, the term `applicable per 
                        instance amount' means--
                                    ``(I) in the case where the 
                                deficiency is found to be a direct 
                                proximate cause of death of a resident 
                                of the facility, an amount not to 
                                exceed $100,000;
                                    ``(II) in each case of a deficiency 
                                where the facility is cited for actual 
                                harm or immediate jeopardy, an amount 
                                not less than $3,050 and not more than 
                                $25,000; and
                                    ``(III) in each case of any other 
                                deficiency, an amount not less than 
                                $250 and not to exceed $3,050.
                            ``(iii) Applicable per day amount.--In this 
                        subparagraph, the term `applicable per day 
                        amount' means--
                                    ``(I) in each case of a deficiency 
                                where the facility is cited for actual 
                                harm or immediate jeopardy, an amount 
                                not less than $3,050 and not more than 
                                $25,000; and
                                    ``(II) in each case of any other 
                                deficiency, an amount not less than 
                                $250 and not to exceed $3,050.
                            ``(iv) Reduction of civil money penalties 
                        in certain circumstances.--Subject to clauses 
                        (v) and (vi), in the case where a facility 
                        self-reports and promptly corrects a deficiency 
                        for which a penalty was imposed under 
                        subparagraph (A)(ii) not later than 10 calendar 
                        days after the date of such imposition, the 
                        State may reduce the amount of the penalty 
                        imposed.
                            ``(v) Prohibition on reduction for certain 
                        deficiencies.--
                                    ``(I) Repeat deficiencies.--The 
                                State may not reduce the amount of a 
                                penalty under clause (iv) if the State 
                                had reduced a penalty imposed on the 
                                facility in the preceding year under 
                                such clause with respect to a repeat 
                                deficiency.
                                    ``(II) Certain other 
                                deficiencies.--The State may not reduce 
                                the amount of a penalty under clause 
                                (iv) if the penalty is imposed for a 
                                deficiency described in clause (ii)(II) 
                                or (iii)(I) and the actual harm is 
                                found to result in a pattern of harm or 
                                widespread harm that immediately 
                                jeopardizes the health or safety of a 
                                resident or residents of the facility, 
                                or if the penalty is imposed for a 
                                deficiency described in clause (ii)(I).
                            ``(vi) Limitation on aggregate 
                        reductions.--The aggregate reduction in a 
                        penalty under clause (iv) may not exceed 35 
                        percent on the basis of self-reporting, on the 
                        basis of a waiver of an appeal (as provided for 
                        under regulations under section 488.436 of 
                        title 42, Code of Federal Regulations), or on 
                        the basis of both.
                            ``(vii) Collection of civil money 
                        penalties.--In the case of a civil money 
                        penalty imposed under subparagraph (A)(ii) for 
                        a deficiency described in subclause (I) or (II) 
                        of clause (ii) or clause (iii)(I), the State--
                                    ``(I) subject to subclause (II), 
                                shall provide the opportunity for the 
                                facility to participate in an informal 
                                dispute resolution process prior to the 
                                collection of such penalty;
                                    ``(II) may provide for the 
                                collection of such civil money penalty 
                                and the placement of such amounts 
                                collected in an escrow account on the 
                                earlier of the date on which the 
                                informal dispute resolution process 
                                under subclause (I) is completed or the 
                                date that is 90 days after the date of 
                                the imposition of the penalty;
                                    ``(III) may provide that such 
                                amounts collected are kept in such 
                                account pending the resolution of any 
                                appeals;
                                    ``(IV) in the case where the 
                                facility successfully appeals the 
                                penalty, shall provide for the return 
                                of such amounts collected (plus 
                                interest) to the facility; and
                                    ``(V) in the case where all such 
                                appeals are unsuccessful, may provide 
                                that such funds collected shall be used 
                                for the purposes described in the 
                                second sentence of subparagraph 
                                (A)(ii).
                            ``(viii) Indexing amounts.--For years 
                        beginning after 2010, each of the amounts 
                        specified in clauses (ii) and (iii) shall be 
                        subject to periodic increase in accordance with 
                        the provisions of section 5 of the Federal 
                        Civil Penalties Inflation Adjustment Act of 
                        1990 (Public Law 101-410; 28 U.S.C. 2461 
                        note).''.
                    (B) Conforming amendment.--The second sentence of 
                section 1919(h)(2)(A)(ii) is amended by inserting ``, 
                and some portion of such funds may be used to support 
                activities of the State long-term care ombudsman that 
                benefit residents, including assistance to support and 
                protect residents who reside in a facility that closes 
                (voluntarily or involuntarily) or is decertified 
                (including offsetting costs of relocating residents to 
                home and community-based settings or another facility), 
                and projects that support resident and family councils 
                and other consumer involvement in assuring quality care 
                in facilities'' before the period at the end.
            (2) Penalties imposed by the secretary.--
                    (A) In general.--Section 1919(h)(3)(C)(ii) of the 
                Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is 
                amended to read as follows:
                            ``(ii) Authority with respect to civil 
                        money penalties.--
                                    ``(I) In general.--Subject to 
                                subclause (III), the Secretary may 
                                impose a civil money penalty in the 
                                applicable per instance or per day 
                                amount (as defined in subclause (II) 
                                and (III)) for each day or each 
                                instance, respectively, of 
                                noncompliance (as determined 
                                appropriate by the Secretary).
                                    ``(II) Applicable per instance 
                                amount.--In this clause, the term 
                                `applicable per instance amount' 
                                means--
                                            ``(aa) in the case where 
                                        the deficiency is found to be a 
                                        direct proximate cause of death 
                                        of a resident of the facility, 
                                        an amount not to exceed 
                                        $100,000;
                                            ``(bb) in each case of a 
                                        deficiency where the facility 
                                        is cited for actual harm or 
                                        immediate jeopardy, an amount 
                                        not less than $3,050 and not 
                                        more than $25,000; and
                                            ``(cc) in each case of any 
                                        other deficiency, an amount not 
                                        less than $250 and not to 
                                        exceed $3,050.
                                    ``(III) Applicable per day 
                                amount.--In this subparagraph, the term 
                                `applicable per day amount' means--
                                            ``(aa) in each case of a 
                                        deficiency where the facility 
                                        is cited for actual harm or 
                                        immediate jeopardy, an amount 
                                        not less than $3,050 and not 
                                        more than $25,000; and
                                            ``(bb) in each case of any 
                                        other deficiency, an amount not 
                                        less than $250 and not to 
                                        exceed $3,050.
                                    ``(IV) Reduction of civil money 
                                penalties in certain circumstances.--
                                Subject to subclauses (V) and (VI), in 
                                the case where a facility self-reports 
                                and promptly corrects a deficiency for 
                                which a penalty was imposed under this 
                                clause not later than 10 calendar days 
                                after the date of such imposition, the 
                                State may reduce the amount of the 
                                penalty imposed.
                                    ``(V) Prohibition on reduction for 
                                certain deficiencies.--
                                            ``(aa) Repeat 
                                        deficiencies.--The Secretary 
                                        may not reduce the amount of a 
                                        penalty under subclause (IV) if 
                                        the Secretary had reduced a 
                                        penalty imposed on the facility 
                                        in the preceding year under 
                                        such subclause with respect to 
                                        a repeat deficiency.
                                            ``(bb) Certain other 
                                        deficiencies.--The Secretary 
                                        may not reduce the amount of a 
                                        penalty under subclause (IV) if 
                                        the penalty is imposed for a 
                                        deficiency described in 
                                        subclause (II)(aa) or (III)(a) 
                                        and the actual harm is found to 
                                        result in a pattern of harm or 
                                        widespread harm that 
                                        immediately jeopardizes the 
                                        health or safety of a resident 
                                        or residents of the facility, 
                                        or if the penalty is imposed 
                                        for a deficiency described in 
                                        subclause (II)(a).
                                    ``(VI) Limitation on aggregate 
                                reductions.--The aggregate reduction in 
                                a penalty under subclause (IV) may not 
                                exceed 35 percent on the basis of self-
                                reporting, on the basis of a waiver of 
                                an appeal (as provided for under 
                                regulations under section 488.436 of 
                                title 42, Code of Federal Regulations), 
                                or on the basis of both.
                                    ``(VII) Collection of civil money 
                                penalties.--In the case of a civil 
                                money penalty imposed under 
                                subparagraph (A)(ii) for a deficiency 
                                described in subclause (I) or (II) of 
                                clause (ii) or clause (iii)(I), the 
                                State--
                                            ``(aa) subject to subclause 
                                        (II), shall provide the 
                                        opportunity for the facility to 
                                        participate in an informal 
                                        dispute resolution process 
                                        prior to the collection of such 
                                        penalty;
                                            ``(bb) may provide for the 
                                        collection of such civil money 
                                        penalty and the placement of 
                                        such amounts collected in an 
                                        escrow account on the earlier 
                                        of the date on which the 
                                        informal dispute resolution 
                                        process under subclause (I) is 
                                        completed or the date that is 
                                        90 days after the date of the 
                                        imposition of the penalty;
                                            ``(cc) may provide that 
                                        such amounts collected are kept 
                                        in such account pending the 
                                        resolution of any appeals;
                                            ``(dd) in the case where 
                                        the facility successfully 
                                        appeals the penalty, shall 
                                        provide for the return of such 
                                        amounts collected (plus 
                                        interest) to the facility; and
                                            ``(ee) in the case where 
                                        all such appeals are 
                                        unsuccessful, may provide that 
                                        such funds collected shall be 
                                        used for the purposes described 
                                        in the second sentence of 
                                        paragraph (2)(A)(ii).
                                    ``(VIII) Indexing amounts.--For 
                                years beginning after 2010, each of the 
                                amounts specified in subclauses (II) 
                                and (III) shall be subject to periodic 
                                increase in accordance with the 
                                provisions of section 5 of the Federal 
                                Civil Penalties Inflation Adjustment 
                                Act of 1990 (Public Law 101-410; 28 
                                U.S.C. 2461 note).
                                    ``(IX) Procedure.--The provisions 
                                of section 1128A (other than 
                                subsections (a) and (b) and except to 
                                the extent that such provisions require 
                                a hearing prior to the imposition of a 
                                civil money penalty in the case 
                                described in subclause (VII)) shall 
                                apply to a civil money penalty under 
                                this clause in the same manner as such 
                                provisions apply to a penalty or 
                                proceeding under section 1128A(a).''.
                    (B) Conforming amendment.--Section 1919(h)(5)(8) of 
                the Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is 
                amended by inserting ``(ii)(V),'' after ``(i),''.
    (c) Effective Date.--The amendments made by this section shall take 
effect 1 year after the date of enactment of this Act.

SEC. 202. NATIONAL INDEPENDENT MONITORING REQUIREMENTS.

    (a) Skilled Nursing Facilities.--Section 1819(h) of the Social 
Security Act (42 U.S.C. 1395i-3(h)(2)) is amended--
            (1) by redesignating paragraphs (5) and (6) as paragraphs 
        (6) and (7), respectively; and
            (2) by inserting after paragraph (4) the following new 
        paragraph:
            ``(5) National independent monitoring requirements.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this paragraph, the Secretary 
                shall, in consultation with the Inspector General of 
                the Department of Health and Human Services, evaluate 
                the potential benefit and feasibility of applying 
                independent monitoring requirements to interstate and 
                large intrastate chains of skilled nursing facilities.
                    ``(B) Considerations.--The feasibility evaluation 
                under subparagraph (A) shall consider the following:
                            ``(i) The need for independent monitoring 
                        requirements to address and remedy patterns of 
                        chronic poor performance, based on quality 
                        deficiencies, high staff turnover rates, or 
                        poor performance on other metrics of quality of 
                        care.
                            ``(ii) Criteria for selecting interstate 
                        and large intrastate chains subject to 
                        independent monitoring requirements, 
                        including--
                                    ``(I) chains that have had a number 
                                of the facilities of such chain 
                                enrolled in the `Special Focus Facility 
                                program' (or a successor program) 
                                established by the Centers for Medicare 
                                & Medicaid Services during the 
                                preceding 3 years that exceeds a 
                                threshold number specified by the 
                                Secretary;
                                    ``(II) chains experiencing 
                                financial problems that may be linked 
                                to serious quality deficiencies;
                                    ``(III) chains experiencing low 
                                staffing levels in relation to the 
                                number and case mix of patients or 
                                turnover rates linked to serious 
                                quality deficiencies; and
                                    ``(IV) chains that have a record of 
                                chronic poor performance;
                and including other appropriate criteria.
                            ``(iii) Responsibilities of independent 
                        monitors, including--
                                    ``(I) conducting periodic reviews 
                                and preparing root-cause quality and 
                                deficiency analyses of a chain 
                                described in such subparagraph to 
                                assess compliance by the chain with 
                                State and Federal laws and regulations;
                                    ``(II) conducting oversight of 
                                efforts by such a chain, whether 
                                publicly or privately held, to achieve 
                                compliance with State and Federal laws 
                                and regulations;
                                    ``(III) analyzing the management 
                                structure, distribution of 
                                expenditures, and direct care staffing 
                                levels of facilities of such a chain in 
                                relation to resident census, staff 
                                turnover rates, and tenure;
                                    ``(IV) reporting findings and 
                                recommendations with respect to such 
                                reviews, analyses, and oversight to the 
                                chain and facilities of the chain, to 
                                the Secretary, and to relevant States; 
                                and
                                    ``(V) other responsibilities of 
                                independent monitors;
                            ``(iv) Other implementation issues, 
                        including timelines, processes, and enforcement 
                        mechanisms for implementation of independent 
                        monitor recommendations and corrective action 
                        plans.''.
    (b) Nursing Facilities.--Section 1919(h) of the Social Security Act 
(42 U.S.C. 1396r(h)) is amended--
            (1) by redesignating paragraphs (8) and (9) as paragraphs 
        (9) and (10), respectively; and
            (2) by inserting after paragraph (7) the following new 
        paragraph:
            ``(7) National independent monitoring requirements.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this paragraph, the Secretary 
                shall, in consultation with the Inspector General of 
                the Department of Health and Human Services, evaluate 
                the potential benefit and feasibility of applying 
                independent monitoring requirements to interstate and 
                large intrastate chains of nursing facilities.
                    ``(B) Considerations.--The feasibility evaluation 
                under subparagraph (A) shall consider the following:
                            ``(i) The need for independent monitoring 
                        requirements to address and remedy patterns of 
                        chronic poor performance, based on quality 
                        deficiencies, high staff turnover rates, or 
                        poor performance on other metrics of quality of 
                        care.
                            ``(ii) Criteria for selecting interstate 
                        and large intrastate chains subject to 
                        independent monitoring requirements, 
                        including--
                                    ``(I) chains that have had a number 
                                of the facilities of such chain 
                                enrolled in the `Special Focus Facility 
                                program' (or a successor program) 
                                established by the Centers for Medicare 
                                & Medicaid Services during the 
                                preceding 3 years that exceeds a 
                                threshold number specified by the 
                                Secretary;
                                    ``(II) chains experiencing 
                                financial problems that may be linked 
                                to serious quality deficiencies;
                                    ``(III) chains experiencing low 
                                staffing levels in relation to the 
                                number and case mix of patients or 
                                turnover rates linked to serious 
                                quality deficiencies; and
                                    ``(IV) chains that have a record of 
                                chronic poor performance;
                and including other appropriate criteria.
                            ``(iii) Responsibilities of independent 
                        monitors, including--
                                    ``(I) conducting periodic reviews 
                                and preparing root-cause quality and 
                                deficiency analyses of a chain 
                                described in such subparagraph to 
                                assess compliance by the chain with 
                                State and Federal laws and regulations;
                                    ``(II) conducting oversight of 
                                efforts by such a chain, whether 
                                publicly or privately held, to achieve 
                                compliance with State and Federal laws 
                                and regulations;
                                    ``(III) analyzing the management 
                                structure, distribution of 
                                expenditures, and direct care staffing 
                                levels of facilities of such a chain in 
                                relation to resident census, staff 
                                turnover rates, and tenure;
                                    ``(IV) reporting findings and 
                                recommendations with respect to such 
                                reviews, analyses, and oversight to the 
                                chain and facilities of the chain, to 
                                the Secretary, and to relevant States; 
                                and
                                    ``(V) other responsibilities of 
                                independent monitors;
                            ``(iv) Other implementation issues, 
                        including timelines, processes, and enforcement 
                        mechanisms for implementation of independent 
                        monitor recommendations and corrective action 
                        plans.''.

SEC. 203. GAO STUDIES AND REPORTS ON TEMPORARY MANAGEMENT.

    (a) In General.--The Comptroller General of the United States (in 
this section referred to as the ``Comptroller General'') shall conduct 
a study on--
            (1) best practices for the appointment of temporary 
        management under sections 1819(h)(2)(B)(iii), 
        1919(h)(2)(A)(iii), and 1919(h)(3)(C)(iii) of the Social 
        Security Act (42 U.S.C. 1395i-3(h)(2)(B)(iii); 
        1396r(h)(2)(A)(iii); 1396r(h)(3)(C)(iii)); and
            (2) barriers to the appointment of such temporary 
        management.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General shall submit a report to Congress 
containing the results of the study conducted under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.
    (c) Guidance to States.--The Secretary of Health and Human Services 
shall issue guidance to States based on the recommendations contained 
in the report submitted under subsection (b).

SEC. 204. NOTIFICATION OF FACILITY CLOSURE.

    (a) Skilled Nursing Facilities.--
            (1) In general.--Section 1819(c) of the Social Security Act 
        (42 U.S.C. 1395i-3(c)) is amended by adding at the end the 
        following new paragraph:
            ``(7) Notification of facility closure.--
                    ``(A) In general.--Any individual who is the 
                license holder of a skilled nursing facility must--
                            ``(i) submit to the Secretary, the State 
                        long-term care ombudsman, residents of the 
                        facility, and the legal representatives of such 
                        residents or other responsible parties, written 
                        notification of an impending closure--
                                    ``(I) subject to subclause (II), 
                                not later than the date that is 60 days 
                                prior to the date of such closure; and
                                    ``(II) in the case of a facility 
                                where the Secretary terminates the 
                                facility's participation under this 
                                title, not later than the date that the 
                                Secretary determines appropriate;
                            ``(ii) ensure that the facility does not 
                        admit any new residents on or after the date on 
                        which such written notification is submitted; 
                        and
                            ``(iii) include in the notice a plan for 
                        the transfer and adequate relocation of the 
                        residents of the facility by a specified date 
                        prior to closure that has been approved by the 
                        State, including assurances that the residents 
                        will be transferred to the most appropriate 
                        facility or other setting in terms of quality, 
                        services, and location, taking into 
                        consideration the needs, best interests, and 
                        preferences of each resident.
                    ``(B) Relocation.--
                            ``(i) In general.--The State shall ensure 
                        that, before a facility closes, all residents 
                        of the facility have been successfully 
                        relocated to another facility or an alternative 
                        home and community-based setting.
                            ``(ii) Continuation of payments until 
                        residents relocated.--The Secretary may, as the 
                        Secretary determines appropriate, continue to 
                        make payments under this title with respect to 
                        residents of a facility that has submitted a 
                        notification under subparagraph (A) during the 
                        period beginning on the date such notification 
                        is submitted and ending on the date on which 
                        the resident is successfully relocated.''.
            (2) Conforming amendments.--Section 1819(h)(4) of the 
        Social Security Act (42 U.S.C. 1395i-3(h)(4)) is amended--
                    (A) in the first sentence, by striking ``the 
                Secretary shall terminate'' and inserting ``the 
                Secretary, subject to subsection (c)(7), shall 
                terminate''; and
                    (B) in the second sentence, by striking 
                ``subsection (c)(2)'' and inserting ``paragraphs (2) 
                and (7) of subsection (c)''.
    (b) Nursing Facilities.--
            (1) In general.--Section 1919(c) of the Social Security Act 
        (42 U.S.C. 1396r(c)) is amended by adding at the end the 
        following new paragraph:
            ``(9) Notification of facility closure.--
                    ``(A) In general.--Any individual who is the 
                license holder of a nursing facility must--
                            ``(i) submit to the Secretary, the State 
                        long-term care ombudsman, residents of the 
                        facility, and the legal representatives of such 
                        residents or other responsible parties, written 
                        notification of an impending closure--
                                    ``(I) subject to subclause (II), 
                                not later than the date that is 60 days 
                                prior to the date of such closure; and
                                    ``(II) in the case of a facility 
                                where the Secretary terminates the 
                                facility's participation under this 
                                title, not later than the date that the 
                                Secretary determines appropriate;
                            ``(ii) ensure that the facility does not 
                        admit any new residents on or after the date on 
                        which such written notification is submitted; 
                        and
                            ``(iii) include in the notice a plan for 
                        the transfer and adequate relocation of the 
                        residents of the facility by a specified date 
                        prior to closure that has been approved by the 
                        State, including assurances that the residents 
                        will be transferred to the most appropriate 
                        facility or other setting in terms of quality, 
                        services, and location, taking into 
                        consideration the needs, best interests, and 
                        preferences of each resident.
                    ``(B) Relocation.--
                            ``(i) In general.--The State shall ensure 
                        that, before a facility closes, all residents 
                        of the facility have been successfully 
                        relocated to another facility or an alternative 
                        home and community-based setting.
                            ``(ii) Continuation of payments until 
                        residents relocated.--The Secretary may, as the 
                        Secretary determines appropriate, continue to 
                        make payments under this title with respect to 
                        residents of a facility that has submitted a 
                        notification under subparagraph (A) during the 
                        period beginning on the date such notification 
                        is submitted and ending on the date on which 
                        the resident is successfully relocated.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect 1 year after the date of enactment of this Act.

SEC. 205. NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE AND USE OF 
              INFORMATION TECHNOLOGY IN NURSING HOMES.

    (a) In General.--The Secretary shall conduct 2 demonstration 
projects, 1 for the development of best practices in skilled nursing 
facilities and nursing facilities that are involved in the culture 
change movement (including the development of resources for facilities 
to find and access funding in order to undertake culture change) and 1 
for the development of best practices in skilled nursing facilities and 
nursing facilities for the use of information technology to improve 
resident care.
    (b) Conduct of Demonstration Projects.--
            (1) Grant award.--Under each demonstration project 
        conducted under this section, the Secretary shall award 1 or 
        more grants to facility-based settings for the development of 
        best practices described in subsection (a) with respect to the 
        demonstration project involved. Such award shall be made on a 
        competitive basis and may be allocated in 1 lump-sum payment.
            (2) Consideration of special needs of residents.--Each 
        demonstration project conducted under this section shall take 
        into consideration the special needs of residents of skilled 
        nursing facilities and nursing facilities who have cognitive 
        impairment, including dementia.
    (c) Implementation and Duration.--
            (1) Implementation.--The demonstration projects shall each 
        be implemented not later than 1 year after the date of 
        enactment of this Act.
            (2) In general.--The demonstration projects shall each be 
        conducted for a period not to exceed 3 years.
    (d) Definitions.--In this section:
            (1) 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)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) Skilled nursing facility.--The term ``skilled nursing 
        facility'' has the meaning given such term in section 1819(a) 
        of the Social Security Act (42 U.S.C. 1395(a)).
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.
    (f) Report.--Not later than 9 months after the completion of the 
demonstration project, the Secretary shall submit a report to Congress 
on such project, together with recommendations for such legislation and 
administrative action as the Secretary determines appropriate.

                  TITLE III--IMPROVING STAFF TRAINING

SEC. 301. DEMENTIA AND ABUSE PREVENTION TRAINING.

    (a) Skilled Nursing Facilities.--Section 1819(f)(2)(A)(i)(I) of the 
Social Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(I)) is amended by 
inserting ``(including, in the case of initial training and, if the 
Secretary determines appropriate, in the case of ongoing training, 
dementia management training, and patient abuse prevention training'' 
before ``, (II)''.
    (b) Nursing Facilities.--Section 1919(f)(2)(A)(i)(I) of the Social 
Security Act (42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by inserting 
``(including, in the case of initial training and, if the Secretary 
determines appropriate, in the case of ongoing training, dementia 
management training, and patient abuse prevention'' before ``, (II)''.
    (c) Effective Date.--The amendments made by this section shall take 
effect 1 year after the date of enactment of this Act.

SEC. 302. STUDY AND REPORT ON TRAINING REQUIRED FOR CERTIFIED NURSE 
              AIDES AND SUPERVISORY STAFF.

    (a) Study.--
            (1) In general.--The Secretary shall conduct a study on the 
        content of training for certified nurse aides and supervisory 
        staff of skilled nursing facilities and nursing facilities. The 
        study shall include an analysis of the following:
                    (A) Whether the number of initial training hours 
                for certified nurse aides required under sections 
                1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the 
                Social Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(II); 
                1396r(f)(2)(A)(i)(II)) should be increased from 75 and, 
                if so, what the required number of initial training 
                hours should be, including any recommendations for the 
                content of such training (including training related to 
                dementia).
                    (B) Whether requirements for ongoing training under 
                such sections 1819(f)(2)(A)(i)(II) and 
                1919(f)(2)(A)(i)(II) should be increased from 12 hours 
                per year, including any recommendations for the content 
                of such training.
            (2) Consultation.--In conducting the analysis under 
        paragraph (1)(A), the Secretary shall consult with States that 
        currently (as of the date of enactment of this Act) require 
        more than 75 hours of training for certified nurse aides.
            (3) Definitions.--In this section:
                    (A) 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)).
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services, acting through 
                the Assistant Secretary for Planning and Evaluation.
                    (C) Skilled nursing facility.--The term ``skilled 
                nursing facility'' has the meaning given such term in 
                section 1819(a) of the Social Security Act (42 U.S.C. 
                1395(a)).
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Secretary shall submit a report to Congress containing 
the results of the study conducted under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate.
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