110 HR 7128 IH: Nursing Home Transparency and
U.S. House of Representatives
2008-09-26
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Nursing Home Transparency and
Quality of Care Improvement Act of 2008
.
(b)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.
<enum>I</enum><header>Improving
transparency of information on skilled nursing facilities and nursing
facilities</header>
<section display-inline="no-display-inline" id="HC94707591010497E8339B27F15E89098" section-type="subsequent-section"><enum>101.</enum><header>Required disclosure
of ownership and additional disclosable parties information</header>
<subsection id="H6E65B08911734DBAA7F6141D646303AD"><enum>(a)</enum><header>In
general</header><text>Section 1124 of the Social Security Act (42 U.S.C.
1320a–3) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HDB071C2BAC2E4FF29D6B36EFB65FC31E" style="OLC">
<subsection id="H5C74D816CC52417E9755A7EF36469932"><enum>(c)</enum><header>Required
disclosure of ownership and additional disclosable parties information</header>
<paragraph id="HE4E919051477450DA85FC90996A60046"><enum>(1)</enum><header>Disclosure</header>
<subparagraph id="H104458593285460EB9A73C16B04B013B"><enum>(A)</enum><header>In
general</header><text>A facility shall have the information described in
paragraph (2) available—</text>
<clause id="H0E913B9CDA1541FFAE31F05DC1633E86"><enum>(i)</enum><text display-inline="yes-display-inline">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</text>
</clause><clause id="H060ED8C8495944B69B0975D9384EB2C"><enum>(ii)</enum><text>beginning on the
effective date of the final regulations promulgated under paragraph (3)(A), for
reporting such information in accordance with such final regulations.</text>
</clause><continuation-text continuation-text-level="subparagraph">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).</continuation-text></subparagraph><subparagraph id="H962B1B10E6134CDDA0E8E4A6E0501394"><enum>(B)</enum><header>Public
availability of information</header><text>During the period described in
subparagraph (A)(i), a facility shall—</text>
<clause id="HC6D3AD6DD52E432BB9D502D8C260D09E"><enum>(i)</enum><text>make the
information described in paragraph (2) available to the public upon request;
and</text>
</clause><clause id="HCFB4DB6E51A74F0AACDDCE9C004318EC"><enum>(ii)</enum><text>post a notice of
the availability of such information in the lobby of the facility in a
prominent manner.</text>
</clause></subparagraph></paragraph><paragraph id="H4A57ED78B6324E099ED8E7C328178D2F"><enum>(2)</enum><header>Information
described</header>
<subparagraph id="HBD3DC888EE554C7498002D047900D89F"><enum>(A)</enum><header>In
general</header><text>The following information is described in this
paragraph:</text>
<clause id="HC4C7751760314B43B3C729DCB79100A6"><enum>(i)</enum><text>The information
described in subsections (a) and (b), subject to subparagraph (C).</text>
</clause><clause id="H791D0E3106BE49FAAF18A3279BF2722"><enum>(ii)</enum><text>The identity of
and information on—</text>
<subclause id="H5F9385843F7B41D4B2A18CD0E0CC659E"><enum>(I)</enum><text>each member of the
governing body of the facility, including the name, title, and period of
service of each such member;</text>
</subclause><subclause id="HB1191DAFBB214CD2A0D304A0CAD55710"><enum>(II)</enum><text>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</text>
</subclause><subclause id="H4D29E60FB8DD4A14B03EEC0300C2C600"><enum>(III)</enum><text>each person or
entity who is an additional disclosable party of the facility.</text>
</subclause></clause><clause id="H76F711008C404C26893BEE4CF823972B"><enum>(iii)</enum><text>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.</text>
</clause></subparagraph><subparagraph id="HC943982A116B488CB7FE4F0182DDC0C0"><enum>(B)</enum><header>Special rule
where information is already reported or submitted</header><text>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).</text>
</subparagraph><subparagraph id="HA8C4567D6AE9413E8C6037535C030994"><enum>(C)</enum><header>Special
rule</header><text>In applying subparagraph (A)(i)—</text>
<clause id="HE575A92ACA9F46FB97BA00DA81E90275"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to subsections (a) and (b),
<quote>ownership or control interest</quote> shall include direct or indirect
interests through any number of intermediate entities; and</text>
</clause><clause id="H001ED964BFA449AB95DF6BB7A028036E"><enum>(ii)</enum><text>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.</text>
</clause></subparagraph></paragraph><paragraph id="HBEBF04C52AEE4FFD8BAA5FE00B939C9"><enum>(3)</enum><header>Reporting</header>
<subparagraph id="HC4089CF4CC474CB1BD4833E0C900E145"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="H57036E3FB1504CF299689D6C9F3BAA57"><enum>(B)</enum><header>Guidance</header><text>The
Secretary shall provide guidance and technical assistance to States on how to
adopt the standardized format under subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="H17DB32E8FA564A95B6C8EF62CC4439DA"><enum>(4)</enum><header>No effect on
existing reporting requirements</header><text>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.</text>
</paragraph><paragraph id="H56296579BEEF407BBA7D769C95CFAF0"><enum>(5)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="H212F3AD308394DFB8EFAEE89F8B19B4C"><enum>(A)</enum><header>Additional
disclosable party</header><text>The term <term>additional disclosable
party</term> means, with respect to a facility, any person or entity
who—</text>
<clause id="H8CCE317CDE2E481C81CF4B1DD5826497"><enum>(i)</enum><text display-inline="yes-display-inline">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;</text>
</clause><clause id="H3DB246341E9F43D4B4FE00180427A5BB"><enum>(ii)</enum><text display-inline="yes-display-inline">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;</text>
</clause><clause id="H1F12E5514AC747089D817F9F74DFB791"><enum>(iii)</enum><text>lends funds or
provides a financial guarantee to the facility in an amount which is equal to
or exceeds $50,000;</text>
</clause><clause id="HC6EF3C064E594B3985BB211F9BD66814"><enum>(iv)</enum><text>provides
management or administrative services, management or clinical consulting
services, or accounting or financial services to the facility;</text>
</clause><clause id="H5706EF4C84714373AD7C72AF039ED59E"><enum>(v)</enum><text>provides therapy,
pharmacy, or hospice services to residents of the facility; or</text>
</clause><clause id="HF2C41D99C0ED4351B0DC6890514E8FB1"><enum>(vi)</enum><text>leases employees
to or employs staff on behalf of the facility.</text>
</clause></subparagraph><subparagraph id="H9548B38C35DA41AD8BFCFD8D5519327D"><enum>(B)</enum><header>Facility</header><text>The
term <term>facility</term> means a disclosing entity which is—</text>
<clause id="H022585BAA43D4599875E1DF4F44F7620"><enum>(i)</enum><text>a
skilled nursing facility (as defined in section 1819(a)); or</text>
</clause><clause id="HCBB0EB08C8914DA98592C88E30BB3199"><enum>(ii)</enum><text>a
nursing facility (as defined in section 1919(a)).</text>
</clause></subparagraph><subparagraph id="HF2233F5A2C7E450B0000DF77DCE7065C"><enum>(C)</enum><header>Managing
employee</header><text>The term <term>managing employee</term> 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.</text>
</subparagraph><subparagraph id="HE42918F5F6C74AF9BF1B5290DF736600"><enum>(D)</enum><header>Organizational
structure</header><text>The term <term>organizational structure</term> means,
in the case of—</text>
<clause id="HAE1E261090284531867E6CF0D650EF22"><enum>(i)</enum><text>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;</text>
</clause><clause id="H477FFCC0EDC44C4091DBE77052D206B9"><enum>(ii)</enum><text>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);</text>
</clause><clause id="H61F29ABFD4D1493DAC065331253156AE"><enum>(iii)</enum><text>a general
partnership, the partners of the general partnership;</text>
</clause><clause id="H9AADA5568D044BEF8374261B6F3F4B77"><enum>(iv)</enum><text>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;</text>
</clause><clause id="HFF2D56B496814ADD82C2E527D51744E"><enum>(v)</enum><text>a
trust, the trustees of the trust;</text>
</clause><clause id="H9293AEF9633549EF9C09A82392858908"><enum>(vi)</enum><text>an individual,
contact information for the individual; and</text>
</clause><clause id="H5DD4FC47A6924DBF99AE00532CC666DA"><enum>(vii)</enum><text>any other person
or entity, such information as the Secretary determines
appropriate.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF4C90724BBD444D59EB0E1A298EFED37"><enum>(b)</enum><header>Public
availability of information</header>
<paragraph id="HCA70F7E0B9F74961ADF5E500E01E2D81"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="HE11686731C97428EA80091FADEF70040"><enum>(2)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="H1E570C2255DE4829A1D1E63002F3C23"><enum>(A)</enum><header>Nursing
facility</header><text>The term <term>nursing facility</term> has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).</text>
</subparagraph><subparagraph id="H30966D3A6310401693F135FA8F94F146"><enum>(B)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</subparagraph><subparagraph id="HCC7A7DC26B504DB7B0C9147079E6BFB5"><enum>(C)</enum><header>Skilled nursing
facility</header><text>The term <term>skilled nursing facility</term> has the
meaning given such term in section 1819(a) of the Social Security Act (42
U.S.C. 1395i–3(a)).</text>
</subparagraph></paragraph></subsection><subsection id="H915663BFFC31461582C3581B2CC9F9F0"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph id="HEA7DF9440EFF4856909294CD42695934"><enum>(1)</enum><header>Skilled nursing
facilities</header><text>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).</text>
</paragraph><paragraph id="H76BD72C462C34451934D2FFF971C16C4"><enum>(2)</enum><header>Nursing
facilities</header><text>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).</text>
</paragraph></subsection></section><section id="HA1B339EF583245CF86DDAD30722F9E5C" section-type="subsequent-section"><enum>102.</enum><header>Accountability
requirements</header>
<subsection id="H071744F4551A49BC8B44B5021D45FB6E"><enum>(a)</enum><header>Effective
compliance and ethics programs</header>
<paragraph id="H0EDA43DB599C4317933B20C9D42E3F5E"><enum>(1)</enum><header>Skilled nursing
facilities</header><text display-inline="yes-display-inline">Section 1819(d)(1)
of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3">42 U.S.C. 1395i–3(d)(1)</external-xref>) is amended by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H7ADEC3AD3DED4A30A3E7F3039221C8CD" style="OLC">
<subparagraph id="HBB4E215F190149DAA9A83BC3DEBD08C"><enum>(D)</enum><header>Compliance and
ethics programs</header>
<clause display-inline="no-display-inline" id="HEDC3736C96C345DAA47BA9E722B5324"><enum>(i)</enum><header>Requirement</header><text display-inline="yes-display-inline">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 <quote>operating organization</quote> or
<quote>organization</quote>), 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).</text>
</clause><clause id="H7321FB1A7CA5474092A03430273D6B00"><enum>(ii)</enum><header>Development of
regulations</header>
<subclause id="HC3045884AA2241AD004C7890D4CFAA32"><enum>(I)</enum><header>In
general</header><text>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.</text>
</subclause><subclause id="H954EB7175B6E486BA63282DA5D2FF555"><enum>(II)</enum><header> Design of
regulations</header><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="HFB9232AE01274AE9AD40D4D5D6CA8BE6"><enum>(III)</enum><header>Evaluation</header><text>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.</text>
</subclause></clause><clause id="H46D98600186B4281BAD14227A94200E9"><enum>(iii)</enum><header>Requirements
for compliance and ethics programs</header><text display-inline="yes-display-inline">In this subparagraph, the term
<term>compliance and ethics program</term> means, with respect to a skilled
nursing facility, a program of the operating organization that—</text>
<subclause id="HA465CE1906CE476AB58CBA6121B380EE"><enum>(I)</enum><text>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</text>
</subclause><subclause id="HBAA8EF5D13394DAA8912E62C1318A108"><enum>(II)</enum><text>includes at least
the required components specified in clause (iv).</text>
</subclause></clause><clause id="HCE08F8077E4A4DD4B71796E5B8EAC7E"><enum>(iv)</enum><header>Required
components of program</header><text>The required components of a compliance and
ethics program of an organization are the following:</text>
<subclause id="HD88FB231C596411A8648CF00CC92180"><enum>(I)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H171159BE0AFB4AD386E760BF753409E"><enum>(II)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H3B558F5A3C6B4CB1ABA9564C9585C158"><enum>(III)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H0859E13165D54D2AAFCCE8815C5957E"><enum>(IV)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H76B82EDEF97941E1A72407A2791BAE19"><enum>(V)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H127C8C2B455C4170906EACAAED6ED500"><enum>(VI)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H0829ADC3100D404DAB87809D9C65A965"><enum>(VII)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H18C56787C4774C50BECCCBC1C01F1BF8"><enum>(VIII)</enum><text display-inline="yes-display-inline">The organization must periodically
undertake reassessment of its compliance program to identify changes necessary
to reflect changes within the organization and its
facilities.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H36A17F171E5B4A16A442400089474E60"><enum>(2)</enum><header>Nursing
facilities</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H98868F1091594916872CBA655383006C" style="OLC">
<subparagraph id="HBE8C7BA4C172478A00E79CC333B0BE00"><enum>(D)</enum><header>Compliance and
ethics program</header>
<clause display-inline="no-display-inline" id="HC979EAE2AE304B91A18F8EB48DB98C00"><enum>(i)</enum><header>Requirement</header><text>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 <quote>operating
organization</quote> or <quote>organization</quote>), 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).</text>
</clause><clause id="HA1F6AD43314044B58BE5007328AED9FB"><enum>(ii)</enum><header>Development of
regulations</header>
<subclause id="H5DA569570DA748F98D7107B5CA6F5EB1"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="HF27818A06F0D4F6C9C3409B02E009383"><enum>(II)</enum><header> Design of
regulations</header><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H90FD99247E7845A9A535D929D93B7E43"><enum>(III)</enum><header>Evaluation</header><text display-inline="yes-display-inline">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.</text>
</subclause></clause><clause id="H396FE65397664268BB22896DBDC8CBFA"><enum>(iii)</enum><header>Requirements
for compliance and ethics programs</header><text display-inline="yes-display-inline">In this subparagraph, the term
<term>compliance and ethics program</term> means, with respect to a nursing
facility, a program of the operating organization that—</text>
<subclause id="H3A1E5D96C856429F8E12D9BF564938E4"><enum>(I)</enum><text>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</text>
</subclause><subclause id="H6694B9F1D6C64D01AA912EDA7CA1ED5B"><enum>(II)</enum><text>includes at least
the required components specified in clause (iv).</text>
</subclause></clause><clause id="HD81ED47E18BF470AB295F8188053124B"><enum>(iv)</enum><header>Required
components of program</header><text>The required components of a compliance and
ethics program of an organization are the following:</text>
<subclause id="H1999B401C51E44F782C936F9DADE9155"><enum>(I)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H39BC607DB9E346B3B43886F8A261C8EF"><enum>(II)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="HBF9DCFE6DC7C4B07BD93BA00E952AAD0"><enum>(III)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H957DBE04A01A4C07BCCB16002F5B5372"><enum>(IV)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H0B1EA14A3B1A45B49C3D4FBAF9269724"><enum>(V)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H5614BC4EB2D2453A8DD891389761FB30"><enum>(VI)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H4171C91C698743C993AC85E26BF1088"><enum>(VII)</enum><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H918ADFD3363144FA849B67009E7467F2"><enum>(VIII)</enum><text display-inline="yes-display-inline">The organization must periodically
undertake reassessment of its compliance program to identify changes necessary
to reflect changes within the organization and its
facilities.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF00D8105341F42FBBC82C930E5973F00"><enum>(b)</enum><header>Quality
assurance and performance improvement (QAPI) demonstration program</header>
<paragraph id="HA6C20B479DF04AB39DF8DBD7F0892B11"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services (in this subsection referred to as the
<quote>Secretary</quote>) shall establish a demonstration program (in this
subsection referred to as the <quote>program</quote>) 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.</text>
</paragraph><paragraph id="HE28D65B14DB64162AED5C7B698846891"><enum>(2)</enum><header>Facilities to be
included</header><text>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.</text>
</paragraph><paragraph id="H0ED919EF07B0404C88C8E3E894823462"><enum>(3)</enum><header>Activities</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H513E4D9A83604F56AA11CD2366844084"><enum>(4)</enum><header>Evaluation</header>
<subparagraph id="H29622B038D6046C496A6E6973F13D13"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph id="H8E62A621348E40B4AADA16092F777008"><enum>(B)</enum><header>Best practices
manual</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph id="H97CAAEB157284F8FB1AEFCFFB53999"><enum>(C)</enum><header>Proposal to revise
quality assurance and performance improvement programs</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(5)(A)</external-xref>) 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.</text>
</subparagraph></paragraph><paragraph id="H65422C900F82496D92DC2310A51B3020"><enum>(5)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated such sums
as may be necessary to carry out this subsection.</text>
</paragraph></subsection><subsection id="H63ABC766C42044AD81ECDA9B514869C3"><enum>(c)</enum><header>GAO study on
nursing facility undercapitalization</header>
<paragraph id="H3D5F2D3C5CCB465BBEE562231416B0B9"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Comptroller
General of the United States shall conduct a study that examines the
following:</text>
<subparagraph id="H59544A11CBBC45C18E30009E8FC548FA"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph id="H49ED9367906148F6B27C09DCE99C3E22"><enum>(B)</enum><text>The effects of
such undercapitalization on quality of care, including staffing and food costs,
at such facilities.</text>
</subparagraph><subparagraph id="H046DF008CCA342859FB89F19068D1F89"><enum>(C)</enum><text>Options to address
such undercapitalization, such as requirements relating to surety bonds,
liability insurance, or minimum capitalization.</text>
</subparagraph></paragraph><paragraph id="HDC0502F67AB640D59843D104CDF68CB4"><enum>(2)</enum><header>Report</header><text>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).</text>
</paragraph><paragraph id="HB04ADF009C104A8C9BA7D0204BA000CE"><enum>(3)</enum><header>Nursing
facility</header><text>In this subsection, the term <term>nursing
facility</term> includes a skilled nursing facility.</text>
</paragraph></subsection></section><section id="HFF0FDCCBC5D24B15A0AE0010C2D054C5"><enum>103.</enum><header>Nursing home
compare Medicare website</header>
<subsection id="HAD4E2B1E6B894E49ABD181B3FC163600"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="H0FE00B1AB1F347D9BD90BAD93865766"><enum>(1)</enum><header>In
general</header><text>Section 1819 of the Social Security Act (42 U.S.C.
1395i–3) is amended—</text>
<subparagraph id="H2CFEA20CB8CB4011B004E08D7831008D"><enum>(A)</enum><text>by redesignating
subsection (i) as subsection (j); and</text>
</subparagraph><subparagraph id="HA72AC1D06715480BB22BD84F00415D88"><enum>(B)</enum><text>by inserting after
subsection (h) the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HC51B8C0DF72D425182F85477ACD4D0F2" style="OLC">
<subsection id="H31BAC1072E5446FB9CECBB54C730E268"><enum>(i)</enum><header>Nursing home
compare website</header>
<paragraph id="H2077B9A757A143F38B3FDD670096D9AE"><enum>(1)</enum><header>Inclusion of
additional information</header>
<subparagraph id="H34FFD0C786284DCF8EF6134865C9A540"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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 <quote>Nursing Home Compare</quote> 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:</text>
<clause id="H60FB314A9211492E8454ABEFFCCFA536"><enum>(i)</enum><text>Information that
is reported to the Secretary under section 1124(c)(3).</text>
</clause><clause commented="no" id="H10DFA233CF024EA78E205EDDF8AA9D9"><enum>(ii)</enum><text>Information on the
<quote>Special Focus Facility program</quote> (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—</text>
<subclause commented="no" id="HEA8E9E264F5B4ECEB3CBD2392F59E492"><enum>(I)</enum><text display-inline="yes-display-inline">were newly enrolled in the program;</text>
</subclause><subclause id="HF3159EF6A3AD4BA188AC46B6E732334"><enum>(II)</enum><text>are enrolled in
the program and have failed to significantly improve;</text>
</subclause><subclause id="H5A89B367C11C450380077426A5BEAB3D"><enum>(III)</enum><text>are enrolled in
the program and have significantly improved;</text>
</subclause><subclause id="HBBFF30E658384DBDB67888E50470953D"><enum>(IV)</enum><text>have graduated
from the program; and</text>
</subclause><subclause id="HD46243CB936443F091CF26992D71A575"><enum>(V)</enum><text>have closed
voluntarily or no longer participate under this title.</text>
</subclause></clause><clause id="H17AF5B3B78B947EDBADD092EB0C8C213"><enum>(iii)</enum><text display-inline="yes-display-inline">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—</text>
<subclause id="HFD743A7A2C2D45948F98C07415BCDBC"><enum>(I)</enum><text>concise
explanations of how to interpret the data (such as a plain English explanation
of data reflecting “nursing home staff hours per resident day”);</text>
</subclause><subclause id="HB74BB092B68D4E539D93DBEEAE6320E"><enum>(II)</enum><text>differences in
types of staff (such as training associated with different categories of
staff);</text>
</subclause><subclause id="HCA12525FCD3E4B4BB1FC456C0278304F"><enum>(III)</enum><text>the relationship
between nurse staffing levels and quality of care; and</text>
</subclause><subclause id="H2DB4D03D53424ABCBACF44F42CD93694"><enum>(IV)</enum><text>an explanation
that appropriate staffing levels vary based on patient case mix.</text>
</subclause></clause><clause id="HE8BE628E1E154320AC60AA43051000E4"><enum>(iv)</enum><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H465045D88A2D46728833BD8100F550DD"><enum>(v)</enum><text>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.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H18C364778AB64897A51FE980CA3822F7"><enum>(vi)</enum><text display-inline="yes-display-inline">The number of adjudicated instances of
criminal violations by a nursing facility or crimes committed by an employee of
a nursing facility—</text>
<subclause id="H2A530D2A550F43AD8139AAFDFC0458D"><enum>(I)</enum><text>that were committed
inside of the facility; and</text>
</subclause><subclause id="HF5599CDBF0F04C4B9B7BB746F396DFB"><enum>(II)</enum><text>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.</text>
</subclause></clause></subparagraph><subparagraph id="H4F2F89C45CEB41F1BDC663BD54A4F379"><enum>(B)</enum><header>Deadline for
provision of information</header>
<clause id="H858CBF4EB3424F63931C6B58B3493800"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause id="H07D1648ABA2743CBAEF9C57258006327"><enum>(ii)</enum><header>Exceptions</header>
<subclause id="H7A38EA4C33BD4BEA9FA296FD3156E15"><enum>(I)</enum><header>Ownership and
affiliated parties and accountability requirements information</header><text display-inline="yes-display-inline">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.</text>
</subclause><subclause id="H5FB21CBE34194502BA5FD174FE970190"><enum>(II)</enum><header>Staffing
data</header><text>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.</text>
</subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD324AD0FB85B4E00AFEB7F2B7BD363EC"><enum>(2)</enum><header>Review and
modification of website</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H776355CB8B694784A0DAC68B1DD7D5B2"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a process—</text>
<clause commented="no" display-inline="no-display-inline" id="H5F57A4E7148349059283CF1669F6A043"><enum>(i)</enum><text>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</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H7039C4E6FBF84BFB9CECBDB2FD64634"><enum>(ii)</enum><text>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).</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H698E664B429D49C599249800B8FCD4DC"><enum>(B)</enum><header>Consultation</header><text>In
conducting the review under subparagraph (A)(i), the Secretary shall consult
with—</text>
<clause commented="no" display-inline="no-display-inline" id="H72B71EBE7D214F94B2287465B406AFCC"><enum>(i)</enum><text>State long-term
care ombudsman programs;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HEBBAC085E08F42D4A383A0CEDEB7842D"><enum>(ii)</enum><text>consumer advocacy
groups;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HFCB992EA5B2041889F4927DFA5D64802"><enum>(iii)</enum><text>provider
stakeholder groups;</text>
</clause><clause display-inline="no-display-inline" id="HA800063D135849229E89CBB7497676EB"><enum>(iv)</enum><text>skilled nursing
facility employees and their representatives; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H57E9FC55E14B4FFF87C06BFD353775B"><enum>(v)</enum><text>any other
representatives of programs or groups the Secretary determines
appropriate.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H4C4C97AB731645649EAAC5C69E6B3F2F"><enum>(2)</enum><header>Timeliness of
submission of survey and certification information</header>
<subparagraph id="HFC63F164BBA84B9DB511BC2E0594A969"><enum>(A)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H2ED459E25E114BEDB3EBEDEB00A30082" style="OLC">
<subparagraph id="HB86D0FB5D979425E003FB62334138C60"><enum>(E)</enum><header>Submission of
survey and certification information to the secretary</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H64DD7DCC2EED4EA6AA34F5B2CAD0D458"><enum>(B)</enum><header>Effective
date</header><text>The amendment made by this paragraph shall take effect 1
year after the date of enactment of this Act.</text>
</subparagraph></paragraph><paragraph id="H8DEE727F04FB4895A33D88B2B879CFA8"><enum>(3)</enum><header>Special focus
facility program</header><text>Section 1819(f) of such Act is amended by adding
at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HE11CF9B7EC7F48FF80008179D1D2185E" style="OLC">
<paragraph id="H24346AE1455F43FAB2E2DABDCE4C8C8E"><enum>(8)</enum><header>Special focus
facility program</header>
<subparagraph id="HF8FFE7A283864C1C86F59472DA877CFC"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph id="H7C6D21563FEE4A89B31412A6F0C55FB6"><enum>(B)</enum><header>Periodic
surveys</header><text>Under such program the Secretary shall conduct surveys of
each facility in the program not less often than once very 6
months.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H7B26ABA6E3F3460800006DB7BA573262"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="H337573F79E634375ABFBA82F692970B0"><enum>(1)</enum><header>In
general</header><text>Section 1919 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r">42 U.S.C. 1396r</external-xref>)
is amended—</text>
<subparagraph id="H100B53A802404BE79648C45D771F66AD"><enum>(A)</enum><text>by redesignating
subsection (i) as subsection (j); and</text>
</subparagraph><subparagraph id="H8EEF555C89DC44B00000F1C8E51204D5"><enum>(B)</enum><text>by inserting after
subsection (h) the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H59E2F61B426D4E1587F6DBA62F9903B4" style="OLC">
<subsection id="HA48D33F6223F4F3885F8CF86992944FA"><enum>(i)</enum><header>Nursing home
compare website</header>
<paragraph id="H9E459EBA21264E27B126ABD40059774C"><enum>(1)</enum><header>Inclusion of
additional information</header>
<subparagraph id="H29E90C644E034906A6DF3008EBA1724"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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 <quote>Nursing Home Compare</quote> 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:</text>
<clause id="H6D9F7E16F6C34F2ABBEAEBD55644975F"><enum>(i)</enum><text display-inline="yes-display-inline">Information that is reported to the
Secretary under section 1124(c)(3).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H58DC1ED1156C4BD9A62D4F9CC53796A5"><enum>(ii)</enum><text>Information on
the <quote>Special Focus Facility program</quote> (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—</text>
<subclause commented="no" id="H6A3DF84BB76F45C582B0C8A005699580"><enum>(I)</enum><text display-inline="yes-display-inline">were newly enrolled in the program;</text>
</subclause><subclause id="H88FB43E8F4564CB0AA73AE9113CE268F"><enum>(II)</enum><text>are enrolled in
the program and have failed to significantly improve;</text>
</subclause><subclause id="H77D6D292404C43148C20E6D984F2A765"><enum>(III)</enum><text display-inline="yes-display-inline">are enrolled in the program and have
significantly improved;</text>
</subclause><subclause id="HCC2A2BDAF01B4C1090D0B25F00416E07"><enum>(IV)</enum><text>have graduated
from the program; and</text>
</subclause><subclause id="HD8075F17AD744A12B96C546B7B9E47D2"><enum>(V)</enum><text display-inline="yes-display-inline">have closed voluntarily or or no longer
participate under this title.</text>
</subclause></clause><clause id="H2743F423C7684D4EA2702B9F863B048B"><enum>(iii)</enum><text display-inline="yes-display-inline">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—</text>
<subclause id="H864E2E325189489594DFD88172B02723"><enum>(I)</enum><text>concise
explanations of how to interpret the data (such as a plain English explanation
of data reflecting “nursing home staff hours per resident day”);</text>
</subclause><subclause id="H06BCCC4837654C4784C79542A84D0944"><enum>(II)</enum><text>differences in
types of staff (such as training associated with different categories of
staff);</text>
</subclause><subclause id="HC8BFB47ACFCE49F2A37C4300BF2BCB79"><enum>(III)</enum><text>the relationship
between nurse staffing levels and quality of care; and</text>
</subclause><subclause id="H7FB945D412864D319BD049F30719ABEB"><enum>(IV)</enum><text display-inline="yes-display-inline">an explanation that appropriate staffing
levels vary based on patient case mix.</text>
</subclause></clause><clause id="H721AB3FC03F54748A9D0CC287000E613"><enum>(iv)</enum><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H1541408497D240B096C08DEAB9013E8F"><enum>(v)</enum><text>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.</text>
</clause><clause commented="no" id="HB91E4F58E5204B538BE77D535426FD79"><enum>(vi)</enum><text display-inline="yes-display-inline">The number of adjudicated instances of
criminal violations by a nursing facility or crimes committed by an employee of
a nursing facility—</text>
<subclause id="H03541ED0BF7645378BFE7054D0A82EFB"><enum>(I)</enum><text>that were
committed inside of the facility; and</text>
</subclause><subclause id="H7FDAE9A618D3476E9BC424FC5385E658"><enum>(II)</enum><text>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.</text>
</subclause></clause></subparagraph><subparagraph id="HBAC693B4281042C49D8791CBD55E126D"><enum>(B)</enum><header>Deadline for
provision of information</header>
<clause id="H002DAAAE65924EB0BE53628C51E741DE"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause id="H76E3BE6F1CF14A9F86CD7F96F1A7DA15"><enum>(ii)</enum><header>Exceptions</header>
<subclause id="H613297E6672844E398C597BF421BE915"><enum>(I)</enum><header>Ownership and
affiliated parties and accountability requirements
information</header><text>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.</text>
</subclause><subclause id="HD1E55BF6CBC64C1B9E4F2214CB4CF006"><enum>(II)</enum><header>Staffing
data</header><text>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.</text>
</subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA1582A253FD4475A001285DE23CFE8DD"><enum>(2)</enum><header>Review and
modification of website</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H82867A08FE49415C9FA5C32D002FD0E8"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a process—</text>
<clause commented="no" display-inline="no-display-inline" id="H87C0F12CF92F4AC1AF3B33E885183BD6"><enum>(i)</enum><text>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</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HCE1AE1E5B1F5424D83B7FE08206F1100"><enum>(ii)</enum><text>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).</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HDB9231E20A8446EE9FB0AEDA79DF16C"><enum>(B)</enum><header>Consultation</header><text>In
conducting the review under subparagraph (A)(i), the Secretary shall consult
with—</text>
<clause commented="no" display-inline="no-display-inline" id="H58A651ED25154E5B00F909DCA4F6AF60"><enum>(i)</enum><text>State long-term
care ombudsman programs;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HB5711A7C060A478896E844EA852F4C59"><enum>(ii)</enum><text>consumer advocacy
groups;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H45A60822008343479BD7FA4FC7ABF750"><enum>(iii)</enum><text>provider
stakeholder groups;</text>
</clause><clause id="HA88794B9DD18499CA401F48DD19687E6"><enum>(iv)</enum><text>skilled nursing
facility employees and their representatives; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H97DACAA4C95646598999FD083FE4C500"><enum>(v)</enum><text>any other
representatives of programs or groups the Secretary determines
appropriate.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H42F12E4A34BE48DFAB118C9D8F003E72"><enum>(2)</enum><header>Timeliness of
submission of survey and certification information</header>
<subparagraph id="H78910FD1C9C940D2006700ABD9663F26"><enum>(A)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H06E3493B2A2E4FFCAB05D62D04EFD63" style="OLC">
<subparagraph id="H3D935A742A2E4D2C862608BD8F2B7DE9"><enum>(E)</enum><header>Submission of
survey and certification information to the secretary</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1F9E3E833EFE4D71AE1018FB932C2B3D"><enum>(B)</enum><header>Effective
date</header><text>The amendment made by this paragraph shall take effect 1
year after the date of enactment of this Act.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H67FB4A2C27B844D2B359107F59120330"><enum>(3)</enum><header>Special focus
facility program</header><text>Section 1919(f) of such Act is amended by adding
at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD9E7EB190C664C849337A9D3CFFB3F" style="OLC">
<paragraph commented="no" id="H229668A30DA146E5961590376780272F"><enum>(8)</enum><header>Special focus
facility program</header>
<subparagraph commented="no" id="H8ED5AA64166D460EB8308CA0352459A8"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph commented="no" id="H66568F3D538643BE8B14D65B1C619D9B"><enum>(B)</enum><header>Periodic
surveys</header><text>Under such program the Secretary shall conduct surveys of
each facility in the program not less often than once very 6
months.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HC187BD0447974CB1932BC737005BDDFC"><enum>(c)</enum><header>Availability of
reports on surveys, certifications, and substantiated complaint
investigations</header>
<paragraph id="H9F80929A50B84F409F4FD1805494F8DE"><enum>(1)</enum><header>Skilled nursing
facilities</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H477ACFF6811743AA913DDB8CD47D37A1" style="OLC">
<subparagraph id="H74674F9476194BB5A2481262DC3D2523"><enum>(G)</enum><header>Availability of
survey, certification, and substantiated complaint investigation
reports</header><text>A skilled nursing facility must—</text>
<clause id="H0A43DA0DC7354C0D94ED279500F5AD38"><enum>(i)</enum><text display-inline="yes-display-inline">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</text>
</clause><clause id="H175FF1BDFF754E6DA587C8424E7F7DE6"><enum>(ii)</enum><text>post notice of
the availability of such reports in areas of the facility that are prominent
and accessible to the public.</text>
</clause><continuation-text continuation-text-level="subparagraph">The
facility shall not make available under clause (i) identifying information
about complainants or
residents.</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H1CDC21791C534C1EBD1543F094A213E8"><enum>(2)</enum><header>Nursing
facilities</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H78D607AF8C78490EA38E2760766111FF" style="OLC">
<subparagraph id="H50E9E879A2DF46C8911D2800E06075D9"><enum>(G)</enum><header>Availability of
survey, certification, and substantiated complaint investigation
reports</header><text>A nursing facility must—</text>
<clause id="H9E73D8A1B1AA47A40000ABCE00883428"><enum>(i)</enum><text display-inline="yes-display-inline">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</text>
</clause><clause id="HF8928CE0E67345E0ADD1781267F86EA0"><enum>(ii)</enum><text>post notice of
the availability of such reports in areas of the facility that are prominent
and accessible to the public.</text>
</clause><continuation-text continuation-text-level="subparagraph">The
facility shall not make available under clause (i) identifying information
about complainants or
residents.</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H7484EAA7CDC646E4BDC6A4E9904F2484"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect 1
year after the date of enactment of this Act.</text>
</paragraph></subsection><subsection id="HA39F5297A1224FDBAF64BF2D8974DFE6"><enum>(d)</enum><header>Guidance to
states on form <enum-in-header>2567 </enum-in-header>State inspection reports
and substantiated complaint investigation reports</header>
<paragraph id="H73BE37E621674334BA12BA9DA9C94DD7"><enum>(1)</enum><header>Guidance</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph commented="no" id="HF9E6DC6568FA4A8399B7B3B3B2D6C565"><enum>(2)</enum><header>Requirement</header><text>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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H86CF9EAD68A04E9000A6EF264BAF36E"><enum>(3)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HCA825FCFE91E427081848274DDC5C038"><enum>(A)</enum><header>Nursing
facility</header><text>The term <term>nursing facility</term> has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2EDD5BAF54F74B48A8FF04E8B9000CF"><enum>(B)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HA85445DC018D4A1FA1CCB6A65519FDEE"><enum>(C)</enum><header>Skilled nursing
facility</header><text>The term <term>skilled nursing facility</term> has the
meaning given such term in section 1819(a) of the Social Security Act (42
U.S.C. 1395i–3(a)).</text>
</subparagraph></paragraph></subsection></section><section commented="no" id="H4D4969212E834D65AC47ACA731F48"><enum>104.</enum><header>Reporting of
expenditures</header><text display-inline="no-display-inline">Section 1888 of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy</external-xref>) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HC5275DB17B6445C500AF9926CEC74CD" style="OLC">
<subsection commented="no" id="H8808E009680B4CAB885C2EDC0000B2D9"><enum>(f)</enum><header>Reporting of
direct care expenditures</header>
<paragraph id="HA3C0BF5A1EA24CD4B22CF8378E11D45D"><enum>(1)</enum><header>In
general</header><text>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).</text>
</paragraph><paragraph id="H386AEB7341E344C3A2D400205700FD64"><enum>(2)</enum><header>Modification of
form</header><text>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.</text>
</paragraph><paragraph id="H17B1B90C2C3F44D88419FEFA9D069650"><enum>(3)</enum><header>Categorization
by functional accounts</header><text>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:</text>
<subparagraph commented="no" id="HCDDC9E1126C14F1F89CC02A2077C8E14"><enum>(A)</enum><text>Spending on direct
care services (including nursing, therapy, and medical services).</text>
</subparagraph><subparagraph commented="no" id="HEFE6BBEA53774561B66FF2D6B81EEA23"><enum>(B)</enum><text>Spending on
indirect care (including housekeeping and dietary services).</text>
</subparagraph><subparagraph commented="no" id="H84003DD6DEFE4F0AA8CC3244F09E6853"><enum>(C)</enum><text>Capital assets
(including building and land costs).</text>
</subparagraph><subparagraph commented="no" id="H7094D7B8F1784C60898FDDE8D95C3EDB"><enum>(D)</enum><text>Administrative
services costs.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFA94F23CCD084C80A6F69948960230D7"><enum>(4)</enum><header>Availability of
information submitted</header><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HED514532F124479DB76765FCE831DA86"><enum>105.</enum><header>Standardized
complaint form</header>
<subsection id="H7CED6BCB7E0844C3B0A372C0312F93B"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="HB19EEE4DE7704F879040204ED7610093"><enum>(1)</enum><header>Development by
the Secretary</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H639533DA31434C7CB27647246E2B26CE" style="OLC">
<paragraph id="H8143E1A976B2487700E0EF16695BA800"><enum>(8)</enum><header>Standardized
complaint form</header><text display-inline="yes-display-inline">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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB44FB6D3F1E24639949BA148882462A8"><enum>(2)</enum><header>State
requirements</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H5A21A019EF8A4F739D00BEAE4C28831" style="OLC">
<paragraph id="HF3C1F45AF5B345C1A24DFB5EB773B49E"><enum>(6)</enum><header>Complaint
process and whistleblower protection</header>
<subparagraph id="H5D4A7100CD284DF9BFFF7D62A07FEEE4"><enum>(A)</enum><header>Complaint
forms</header><text display-inline="yes-display-inline">The State must make the
standardized complaint form developed under subsection (f)(8) available upon
request to—</text>
<clause id="H289B4926E99D48CE001E8DD912C938AA"><enum>(i)</enum><text>a
resident of a skilled nursing facility;</text>
</clause><clause id="HC84BEDFE2C70464D98F37D88F150B9F9"><enum>(ii)</enum><text>any person acting
on the resident’s behalf; and</text>
</clause><clause id="H29DFD2972754435899F69278C48977C0"><enum>(iii)</enum><text>any person who
works at a skilled nursing facility or is a representative of such a
worker.</text>
</clause></subparagraph><subparagraph id="H1910EABBA88841C1AECDE13600BA79E2"><enum>(B)</enum><header>Complaint
resolution process</header><text display-inline="yes-display-inline">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—</text>
<clause id="H01C7B650AC1548C284B95F61E1DA8D67"><enum>(i)</enum><text>procedures to
assure accurate tracking of complaints received, including notification to the
complainant that a complaint has been received;</text>
</clause><clause id="H9856CFD7740E4C4386BCCDA38E91F7B2"><enum>(ii)</enum><text>procedures to
determine the likely severity of a complaint and for the investigation of the
complaint;</text>
</clause><clause id="HB773E6F968144C6880A82764BF737148"><enum>(iii)</enum><text>deadlines for
responding to a compliant and procedures in order to enable the complainant to
track the status of the complaint and investigation; and</text>
</clause><clause id="H93D69C6C302A437096D6682FD413FE9E"><enum>(iv)</enum><text>procedures to
ensure that the identity of the complainant will be kept confidential.</text>
</clause></subparagraph><subparagraph id="H6235642F3F7A489BA44B7F5880968730"><enum>(C)</enum><header>Whistleblower
protection</header>
<clause id="H9F0DAAB213BE4EF0008161BB7E117D4C"><enum>(i)</enum><header>Prohibition
against retaliation</header><text display-inline="yes-display-inline">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.</text>
</clause><clause id="HF2C388305D294286A67845A5E8EFD863"><enum>(ii)</enum><header>Retaliatory
reporting</header><text>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).</text>
</clause><clause id="H2739BCA8BBAE4D73BBA595B034F8BAE0"><enum>(iii)</enum><header>Commencement
of action</header><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H3B958CC4FA1646529100A3856DC58E3"><enum>(iv)</enum><header>Rights not
waivable</header><text>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.</text>
</clause><clause id="HD0961D996D774B42B037BD8DB66E3384"><enum>(v)</enum><header>Rule of
construction</header><text>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).</text>
</clause><clause id="HF3C268D1F1704E2991C2442E20A751C"><enum>(vi)</enum><header>Requirement to
post notice of employee rights</header><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph commented="no" id="HBAB89BBA2C4F48969D93BC870074157C"><enum>(D)</enum><header>Good faith
defined</header><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="H62A9D1F104534402ABBCD769FF812C88"><enum>(i)</enum><text>the information
reported or disclosed in the complaint is true; and</text>
</clause><clause commented="no" id="H7F072CB32620403B8E6E4BA796CC9CE"><enum>(ii)</enum><text>a violation of
this title has occurred or may occur in relation to such
information.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H107450C0699D46DE000001B964A4EB1F"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="H47BE399230854E19B9A55DDB74A050C1"><enum>(1)</enum><header>Development by
the Secretary</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H2200B87C34384F82B1EB647BB77E0067" style="OLC">
<paragraph id="HD58B812CE6AB4AF794603200E5F2E053"><enum>(10)</enum><header>Standardized
complaint form</header><text display-inline="yes-display-inline">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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HDA87DA1F770A41309FF800BA1531C0A4"><enum>(2)</enum><header>State
requirements</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H8ED03D31542F4BD1ABDB1F21ED2593E0" style="OLC">
<paragraph id="H9FFF4C5A81824E439891F8F7182CB655"><enum>(8)</enum><header>Complaint
process and whistleblower protection</header>
<subparagraph id="H8B89584173C543AB8D101FBEC5D0C027"><enum>(A)</enum><header>Complaint
forms</header><text display-inline="yes-display-inline">The State must make the
standardized complaint form developed under subsection (f)(10) available upon
request to—</text>
<clause id="H1F1C8C85EBEF41EEB9767BDFBAD00162"><enum>(i)</enum><text>a
resident of a nursing facility;</text>
</clause><clause id="H2DBFB19363B648F088695500BEA9CDAF"><enum>(ii)</enum><text>any person acting
on the resident’s behalf; and</text>
</clause><clause id="HB1F94921691A48D987DA80DCCE83A923"><enum>(iii)</enum><text>any person who
works at a nursing facility or a representative of such a worker.</text>
</clause></subparagraph><subparagraph id="HD8D7D069BCB74DDBB2C11872D2AFB7DE"><enum>(B)</enum><header>Complaint
resolution process</header><text display-inline="yes-display-inline">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—</text>
<clause id="H086A52144F974A82ABD63DC21E9BC74"><enum>(i)</enum><text>procedures to
assure accurate tracking of complaints received, including notification to the
complainant that a complaint has been received;</text>
</clause><clause id="H04E26B40B576444BB770222347D7E81C"><enum>(ii)</enum><text>procedures to
determine the likely severity of a complaint and for the investigation of the
complaint;</text>
</clause><clause id="H1537ECD9C1D24134AA6B801FF1880009"><enum>(iii)</enum><text>deadlines for
responding to a compliant and procedures in order to enable the complainant to
track the status of the complaint and investigation; and</text>
</clause><clause id="H095E7B8D14D545A197883CBD5973A159"><enum>(iv)</enum><text>procedures to
ensure that the identity of the complainant will be kept confidential.</text>
</clause></subparagraph><subparagraph id="HE81A9A510A584745B31FF83455AF9752"><enum>(C)</enum><header>Whistleblower
protection</header>
<clause id="HE9DB4BA01DA444DA9C21CF00AEC13855"><enum>(i)</enum><header>Prohibition
against retaliation</header><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H14B8F1700C554AE8A8CBD8BF7FB6666E"><enum>(ii)</enum><header>Retaliatory
reporting</header><text>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).</text>
</clause><clause id="H545015B5EF164BFEAFD6DEF4C4171060"><enum>(iii)</enum><header>Commencement
of action</header><text display-inline="yes-display-inline">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.</text>
</clause><clause id="HFAB71A1AF52C4EA0A0B7EA177336DAC4"><enum>(iv)</enum><header>Rights not
waivable</header><text>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.</text>
</clause><clause id="H328C5FDF834C43FBA4C838D1A50037A2"><enum>(v)</enum><header>Rule of
construction</header><text>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).</text>
</clause><clause id="HF3D8BD884C2B4EFF90964EFAAAD565B"><enum>(vi)</enum><header>Requirement to
post notice of employee rights</header><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph commented="no" id="HEE52EF7D5A9C40D6900993A64B63B1D6"><enum>(D)</enum><header>Good faith
defined</header><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="H8560F37EA0B04B26B9C1A5539CC8A8F1"><enum>(i)</enum><text>the information
reported or disclosed in the complaint is true; and</text>
</clause><clause commented="no" id="H676A0FED2EC74EA983751B8F5CC32FE5"><enum>(ii)</enum><text>a violation of
this title has occurred or may occur in relation to such
information.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HA113DC88DD6F4751904FE1F95F96CAF"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect 1 year
after the date of enactment of this Act.</text>
</subsection></section><section id="HEAB5CC15623F457483348FBCF186AE07"><enum>106.</enum><header>Ensuring
staffing accountability</header>
<subsection id="HC5244FB7F66142788E4E5D9D2E75A97D"><enum>(a)</enum><header>Skilled nursing
facilities</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H4A52BC95197C4F1D93CB2EDE057E374D" style="OLC">
<subparagraph id="H884D602043DD407691CE2BB50430010"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header><text display-inline="yes-display-inline">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—</text>
<clause id="H41D6934A9A45419EA7CDC13E55736688"><enum>(i)</enum><text display-inline="yes-display-inline">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);</text>
</clause><clause id="HC2FAA0C741374CB3BDF22300B81C0946"><enum>(ii)</enum><text>include resident
census data and information on resident case mix;</text>
</clause><clause id="HAA4766600385450397B7E307BC9D921F"><enum>(iii)</enum><text>include a
regular reporting schedule; and</text>
</clause><clause id="H07FAE88EC6EB411200D44098584788C6"><enum>(iv)</enum><text>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.</text>
</clause><continuation-text continuation-text-level="subparagraph">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.</continuation-text></subparagraph><after-quoted-block></after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H74677E639C7F4F3A85CFFED406BA7F01"><enum>(b)</enum><header>Nursing
facilities</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H0CD586B67F4E46F9BAA983E08054D400" style="OLC">
<subparagraph commented="no" id="H6515EA4AC9E74A4DB9D474EA74AAC000"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="HC3532A48EC534D39853723D72978979F"><enum>(i)</enum><text>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);</text>
</clause><clause commented="no" id="H60B57A7E80ED4636A83337FEFDDE6ED"><enum>(ii)</enum><text display-inline="yes-display-inline">include resident census data and
information on resident case mix;</text>
</clause><clause commented="no" id="HEDAFFEECCD4A470B8BFB165800174C73"><enum>(iii)</enum><text>include a
regular reporting schedule; and</text>
</clause><clause commented="no" id="H75DF49DD057D4C86B0A6ED53C047D702"><enum>(iv)</enum><text>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.</text>
</clause><continuation-text continuation-text-level="subparagraph">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.</continuation-text></subparagraph><after-quoted-block></after-quoted-block></quoted-block>
</subsection></section><enum>II</enum><header>Targeting
Enforcement</header>
<section id="H13F8890470FD4D31B20038F7229E879E"><enum>201.</enum><header>Civil money
penalties</header>
<subsection id="H846DDE2A6161422BB6524CA609FEFE5B"><enum>(a)</enum><header>Skilled nursing
facilities</header><text display-inline="yes-display-inline"></text>
<paragraph id="H9D794AF2F0754A71BA8ED4C0CA5193B8"><enum>(1)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H3A2F8D16E7B94158AAE11F0196698227" style="OLC">
<clause id="H7E5CABBD079E4376A580F2B5F1B08DD"><enum>(ii)</enum><header>Authority with
respect to civil money penalties</header>
<subclause id="HD9084287C72141CFB21B35FA79114BC5"><enum>(I)</enum><header>Amount</header><text>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).</text>
</subclause><subclause id="H88162716FFE14406A4CEEC4FF5D3E7A0"><enum>(II)</enum><header>Applicable per
instance amount</header><text>In this clause, the term <term>applicable per
instance amount</term> means—</text>
<item id="H0940258E154D4974A3BF5318F8C899DD"><enum>(aa)</enum><text>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;</text>
</item><item id="H1B12522ABCB4479491E5BD7F9ED353E"><enum>(bb)</enum><text>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</text>
</item><item id="HF76B59C596E04ABA83633FCA23D2F12F"><enum>(cc)</enum><text>in
each case of any other deficiency, an amount not less than $250 and not to
exceed $3,050.</text>
</item></subclause><subclause id="HE8D0CCD609D84B1EB2FC1824EAA28BE0"><enum>(III)</enum><header>Applicable per
day amount</header><text>In this clause, the term <term>applicable per day
amount</term> means—</text>
<item id="HC184D96D91734F47BCBDE823817CC57"><enum>(aa)</enum><text>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</text>
</item><item id="HCE48BD6A28974A85BEA2FEE9086079F8"><enum>(bb)</enum><text>in
each case of any other deficiency, an amount not less than $250 and not to
exceed $3,050.</text>
</item></subclause><subclause commented="no" id="H6FF587750855467988DEC7627263B055"><enum>(IV)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>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.</text>
</subclause><subclause commented="no" id="H8431856CA09E41D69177FC00E5CFAABC"><enum>(V)</enum><header>Prohibitions on
reduction for certain deficiencies</header>
<item commented="no" id="HC717F951ED16495495CE7FDDA31DBCC6"><enum>(aa)</enum><header>Repeat
deficiencies</header><text>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.</text>
</item><item commented="no" id="H2B04A57F9A1845D6B0851E9DF9F04F17"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>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).</text>
</item></subclause><subclause id="HCADFCA9E65104ADABBC9FAA69F6DA291"><enum>(VI)</enum><header>Limitation on
aggregate reductions</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/42/488">section 488.436</external-xref> of title 42, Code of
Federal Regulations), or on the basis of both.</text>
</subclause><subclause id="HC7DB00FD92144E0C8BFE897300952DB5"><enum>(VII)</enum><header>Collection of
civil money penalties</header><text>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—</text>
<item id="HBA1A1875E44048EE8800FBAB13553C6E"><enum>(aa)</enum><text>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;</text>
</item><item id="HEBE8D58501A14D439B42A6A83E06592E"><enum>(bb)</enum><text>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;</text>
</item><item id="HCC410AE4F3FF42E7AC239F00B2BD9C58"><enum>(cc)</enum><text>may
provide that such amounts collected are kept in such account pending the
resolution of any appeals;</text>
</item><item id="H26D625DDA67546609CF5077FBD8454E"><enum>(dd)</enum><text>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</text>
</item><item commented="no" id="H97C16167F56A4835BEB516A78B502FBA"><enum>(ee)</enum><text display-inline="yes-display-inline">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.</text>
</item></subclause><subclause id="H2E1C1994C44A4DAB96F1E012B2137511"><enum>(VIII)</enum><header>Procedure</header><text>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).</text>
</subclause><subclause id="HE312F5178DAD4DFE8D08B43CA773C4B7"><enum>(IX)</enum><header>Indexing
amounts</header><text display-inline="yes-display-inline">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).</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB4BCE2F9A781435EBC75D200798BA06F"><enum>(2)</enum><header>Conforming
amendment</header><text>The second sentence of section 1819(h)(5) of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3">42 U.S.C. 1395i–3(h)(5)</external-xref>) is amended by inserting
<quote>(ii)(V),</quote> after <quote>(i),</quote>.</text>
</paragraph></subsection><subsection id="H7490E782096C4B9EBC28E0AB2F426C8"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="H7CF894F6F9524992B972A5EFA08135A"><enum>(1)</enum><header>Penalties imposed
by the State</header>
<subparagraph id="H10878D6681234BE681BEEDC5F433BF6B"><enum>(A)</enum><header>In
general</header><text>Section 1919(h)(2) of the Social Security Act (42 U.S.C.
1396r(h)(2)) is amended—</text>
<clause id="H0DFF08AFA88A44F7B08BDD0939AA3BD0"><enum>(i)</enum><text>in
subparagraph (A)(ii), by striking the first sentence and inserting the
following: <quote>A civil money penalty in accordance with subparagraph
(G).</quote>; and</text>
</clause><clause id="HBB7C34B9F93147788811AB80E70700C3"><enum>(ii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8A7978CEC87547629FFC2968BAAFE7CF" style="OLC">
<subparagraph id="H700812D7168A4166B20863807F21E206"><enum>(G)</enum><header>Civil money
penalties</header>
<clause id="HCD80E794091241DCAF766BA636D9144"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">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).</text>
</clause><clause id="H2F8AEEF9F0B844238EEB27C116AB104E"><enum>(ii)</enum><header>Applicable per
instance amount</header><text>In this subparagraph, the term <term>applicable
per instance amount</term> means—</text>
<subclause id="H60A8A0D0E471474A8F2E7D7F001C2CF0"><enum>(I)</enum><text display-inline="yes-display-inline">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;</text>
</subclause><subclause id="HA0F83DFF745E4608B07184C173B6DC10"><enum>(II)</enum><text>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</text>
</subclause><subclause id="H4B3F293F867547458C63B15320D2E605"><enum>(III)</enum><text>in each case of
any other deficiency, an amount not less than $250 and not to exceed
$3,050.</text>
</subclause></clause><clause id="HE41BBC4C9AE046F5BD26E1B59BF2902F"><enum>(iii)</enum><header>Applicable per
day amount</header><text>In this subparagraph, the term <term>applicable per
day amount</term> means—</text>
<subclause id="H5A1B251F48784DA78750063C24001836"><enum>(I)</enum><text>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</text>
</subclause><subclause id="HE93117DA96EA4E71890801CAAC83071"><enum>(II)</enum><text>in each case of
any other deficiency, an amount not less than $250 and not to exceed
$3,050.</text>
</subclause></clause><clause commented="no" id="H6780DF71CDB345A98D17E2E88AB1806"><enum>(iv)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>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.</text>
</clause><clause commented="no" id="H4B2F2A084256491FB94900ABFFCB08B6"><enum>(v)</enum><header>Prohibition on
reduction for certain deficiencies</header>
<subclause commented="no" id="H309208BE2F404EF39BF600B800D5E32C"><enum>(I)</enum><header>Repeat
deficiencies</header><text>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.</text>
</subclause><subclause commented="no" id="HF0637C986F694D6588875C587581F4D0"><enum>(II)</enum><header>Certain other
deficiencies</header><text>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).</text>
</subclause></clause><clause id="HCA3ECE461D1046A9B493CEDF068B3B19"><enum>(vi)</enum><header>Limitation on
aggregate reductions</header><text>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.</text>
</clause><clause id="HA3812310578046FE8B7529FF34391CDA"><enum>(vii)</enum><header>Collection of
civil money penalties</header><text>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—</text>
<subclause id="H559E859996B04A81A5005D53A7B6923"><enum>(I)</enum><text>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;</text>
</subclause><subclause id="HF47411CA21ED491F88B7AA2860CDD7A"><enum>(II)</enum><text>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;</text>
</subclause><subclause id="HC9E6E05958E84011A000FBDA1697C534"><enum>(III)</enum><text>may provide that
such amounts collected are kept in such account pending the resolution of any
appeals;</text>
</subclause><subclause id="H8CB0498943E845DDB1CAF673292B04C"><enum>(IV)</enum><text display-inline="yes-display-inline">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</text>
</subclause><subclause commented="no" id="H6FB23F213C034A37A9003393C4C0A764"><enum>(V)</enum><text>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).</text>
</subclause></clause><clause id="H33D02D05842746039400C22D38001F16"><enum>(viii)</enum><header>Indexing
amounts</header><text>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 (<external-xref legal-doc="public-law" parsable-cite="pl/101/410">Public Law 101–410</external-xref>; 28 U.S.C. 2461
note).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" id="H0200C66B1BF24C56B21E40368C88B1D3"><enum>(B)</enum><header>Conforming
amendment</header><text>The second sentence of section 1919(h)(2)(A)(ii) is
amended by inserting <quote>, 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</quote> before the period at the end.</text>
</subparagraph></paragraph><paragraph id="H54D56AA37ECE44B8A700001B8E00A818"><enum>(2)</enum><header>Penalties
imposed by the Secretary</header>
<subparagraph id="HCA943D645B63436E9E4BB51002F8103"><enum>(A)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H36EB11788388465B9DC3000458B838C" style="OLC">
<clause id="HEEE0FD52FF714CF08E4CA8F2B225BF28"><enum>(ii)</enum><header>Authority with
respect to civil money penalties</header>
<subclause display-inline="no-display-inline" id="HA545A6B849144B529D00C0B251922C75"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">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).</text>
</subclause><subclause id="H80E1879A40CB4764AF0029C0857417E2"><enum>(II)</enum><header>Applicable per
instance amount</header><text>In this clause, the term <term>applicable per
instance amount</term> means—</text>
<item id="H32CAE441A11643088300BE37E65763E1"><enum>(aa)</enum><text display-inline="yes-display-inline">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;</text>
</item><item id="HDE9C2E6C1FB04DE48D873C00B5EA20C1"><enum>(bb)</enum><text>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</text>
</item><item id="HB0734CD002CC467A86C1F9D754DBCC2"><enum>(cc)</enum><text>in
each case of any other deficiency, an amount not less than $250 and not to
exceed $3,050.</text>
</item></subclause><subclause id="HD7BC23C3C35D40B1B33242ED7CED4443"><enum>(III)</enum><header>Applicable per
day amount</header><text>In this subparagraph, the term <term>applicable per
day amount</term> means—</text>
<item id="H8F67F1937CD2483D9D2600B6E9C3611"><enum>(aa)</enum><text>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</text>
</item><item id="HA1A5B47E35E24A2F99536CC39BC7F869"><enum>(bb)</enum><text>in
each case of any other deficiency, an amount not less than $250 and not to
exceed $3,050.</text>
</item></subclause><subclause commented="no" display-inline="no-display-inline" id="HC669BD881BB943C2A6000500A0703F58"><enum>(IV)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>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.</text>
</subclause><subclause commented="no" id="H00D185DD32CC49279FD2EC2B5DD6454"><enum>(V)</enum><header>Prohibition on
reduction for certain deficiencies</header>
<item commented="no" id="HF5A16BC95EB54FE09306CDFC872F1356"><enum>(aa)</enum><header>Repeat
deficiencies</header><text>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.</text>
</item><item commented="no" id="H8DB5B7E46C1D44B9B47530AA02BB8996"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>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).</text>
</item></subclause><subclause id="H772D23F9577E497C8E9675688C878149"><enum>(VI)</enum><header>Limitation on
aggregate reductions</header><text>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.</text>
</subclause><subclause id="HA8D14EA07E0140A5AFF8F061A01834A4"><enum>(VII)</enum><header>Collection of
civil money penalties</header><text>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—</text>
<item id="HFB752BE6FB214875894C0929CD3EC365"><enum>(aa)</enum><text>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;</text>
</item><item id="HC4272DE6720944FDA5B5FF9D47BC2384"><enum>(bb)</enum><text>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;</text>
</item><item id="H52066F085E6A424F8B56A38629BEF1E"><enum>(cc)</enum><text>may
provide that such amounts collected are kept in such account pending the
resolution of any appeals;</text>
</item><item id="H9CD9CE86149C4164AD862CE33295D4F"><enum>(dd)</enum><text display-inline="yes-display-inline">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</text>
</item><item commented="no" id="H1F82698EB777466900A58DDC2361C5B2"><enum>(ee)</enum><text>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).</text>
</item></subclause><subclause id="HBE4AE43DAB79492FA827DE8DF85ECD"><enum>(VIII)</enum><header>Indexing
amounts</header><text>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 (<external-xref legal-doc="public-law" parsable-cite="pl/101/410">Public Law 101–410</external-xref>; 28 U.S.C. 2461
note).</text>
</subclause><subclause id="HDE4E126D033B4CBAB44CADACF9923700"><enum>(IX)</enum><header>Procedure</header><text>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).</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H5CB87046B11C4F388389DC6FCD27A472"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 1919(h)(5)(8) of the Social Security Act (42
U.S.C. 1396r(h)(5)(8)) is amended by inserting <quote>(ii)(V),</quote> after
<quote>(i),</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HA3F3E373765941A1A5BBA7FAB21D8B43"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect 1 year
after the date of enactment of this Act.</text>
</subsection></section><section commented="no" id="H5E1CFA608A70438F933634A7B5EB008B"><enum>202.</enum><header>National
independent monitoring requirements</header>
<subsection commented="no" id="HA8D8D3299B0243339B8F8F3DE46D3BAA"><enum>(a)</enum><header>Skilled nursing
facilities</header><text>Section 1819(h) of the Social Security Act (42 U.S.C.
1395i–3(h)(2)) is amended—</text>
<paragraph commented="no" id="HD747B99BBBC84D28B5014F441D42FF00"><enum>(1)</enum><text>by redesignating
paragraphs (5) and (6) as paragraphs (6) and (7), respectively; and</text>
</paragraph><paragraph commented="no" id="H9C67A4656F9F47C59DF1331350388498"><enum>(2)</enum><text>by inserting after
paragraph (4) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HA1BF56C38008460ABE7EED64EDFB185C" style="OLC">
<paragraph commented="no" id="HD4C831D1F91D4059AF37336365FF2700"><enum>(5)</enum><header>National
independent monitoring requirements</header>
<subparagraph commented="no" id="HF1D73D21153449229998D7AC2098D179"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph id="H8AC2B40AC3BF4116A744236E5EE6EC6C"><enum>(B)</enum><header>Considerations</header><text>The feasibility evaluation under subparagraph (A) shall consider the
following:</text>
<clause id="HFECB15110DB1424EA69FC27035839937"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H166A6D5318874F97B29EB2194F00429E"><enum>(ii)</enum><text>Criteria for
selecting interstate and large intrastate chains subject to independent
monitoring requirements, including—</text>
<subclause id="HD328267EDEDD46F0A579E0152174E790"><enum>(I)</enum><text display-inline="yes-display-inline">chains that have had a number of the
facilities of such chain enrolled in the <quote>Special Focus Facility
program</quote> (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;</text>
</subclause><subclause commented="no" id="H991F0377812E45A3B3AE3775586FB006"><enum>(II)</enum><text>chains
experiencing financial problems that may be linked to serious quality
deficiencies;</text>
</subclause><subclause id="HBC469AA75FA6458393CDC5FDBAE72932"><enum>(III)</enum><text display-inline="yes-display-inline">chains experiencing low staffing levels in
relation to the number and case mix of patients or turnover rates linked to
serious quality deficiencies; and</text>
</subclause><subclause commented="no" id="H83C62CC4F1534FC3B42C64DED05DAA8E"><enum>(IV)</enum><text>chains that have
a record of chronic poor performance;</text>
</subclause></clause><continuation-text continuation-text-level="subparagraph">and
including other appropriate criteria.</continuation-text><clause commented="no" id="H5608D2B2019A459F87AA46F44DE223C5"><enum>(iii)</enum><text display-inline="yes-display-inline">Responsibilities of independent monitors,
including—</text>
<subclause commented="no" id="H7EC2026727AE446F9345F9238113EC02"><enum>(I)</enum><text>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;</text>
</subclause><subclause commented="no" id="H6E2850DFFF9D46848C81BDF792ECD5"><enum>(II)</enum><text>conducting
oversight of efforts by such a chain, whether publicly or privately held, to
achieve compliance with State and Federal laws and regulations;</text>
</subclause><subclause commented="no" id="H303A2566D68D4D14A2A6BFA5176201D8"><enum>(III)</enum><text>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;</text>
</subclause><subclause commented="no" id="H3ADDB8927A544A40B065DA6C7484F33D"><enum>(IV)</enum><text>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</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H3D1894E7E1674E4EA14121C0849B2DFE"><enum>(V)</enum><text display-inline="yes-display-inline">other responsibilities of independent
monitors;</text>
</subclause></clause><clause id="HB979D3FA52344BDA9BBB74FFD74B3F00"><enum>(iv)</enum><text display-inline="yes-display-inline">Other implementation issues, including
timelines, processes, and enforcement mechanisms for implementation of
independent monitor recommendations and corrective action
plans.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="HB833926E57D34E62002572107E5E9465"><enum>(b)</enum><header>Nursing
facilities</header><text>Section 1919(h) of the Social Security Act (42 U.S.C.
1396r(h)) is amended—</text>
<paragraph commented="no" id="HF448820200FE41B7898D85B06BFFF24C"><enum>(1)</enum><text>by redesignating
paragraphs (8) and (9) as paragraphs (9) and (10), respectively; and</text>
</paragraph><paragraph commented="no" id="HC56CF5EA743C4CC7997D00099F313E5F"><enum>(2)</enum><text>by inserting after
paragraph (7) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HC82D69C672914B40B2D2E14C7B6BF9E2" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HDA972D662CFE4172AB6744CC941862F8"><enum>(7)</enum><header>National
independent monitoring requirements</header>
<subparagraph commented="no" id="H9B182BD0D37C4EFFB49C79F4B07DAEB3"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><subparagraph id="H5775F009CC634D4A9FBF2892EDE6CE41"><enum>(B)</enum><header>Considerations</header><text>The feasibility evaluation under subparagraph (A) shall consider the
following:</text>
<clause id="HF2E34FE7B3044C3D0023C803D4C88449"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text>
</clause><clause id="H4E8FF594B12146DB9DA71DCE82A819B0"><enum>(ii)</enum><text>Criteria for
selecting interstate and large intrastate chains subject to independent
monitoring requirements, including—</text>
<subclause id="H9EEED0E0F7444526850001C2DAFEB0F4"><enum>(I)</enum><text display-inline="yes-display-inline">chains that have had a number of the
facilities of such chain enrolled in the <quote>Special Focus Facility
program</quote> (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;</text>
</subclause><subclause commented="no" id="HF5EA46E60CC844CB91AA57A77878F299"><enum>(II)</enum><text>chains
experiencing financial problems that may be linked to serious quality
deficiencies;</text>
</subclause><subclause id="HE2D0DF44A3014DEB00AEC779E38BC836"><enum>(III)</enum><text display-inline="yes-display-inline">chains experiencing low staffing levels in
relation to the number and case mix of patients or turnover rates linked to
serious quality deficiencies; and</text>
</subclause><subclause commented="no" id="H837424BD49BE4C60BCA5AEC2EACB038"><enum>(IV)</enum><text>chains that have a
record of chronic poor performance;</text>
</subclause></clause><continuation-text continuation-text-level="subparagraph">and
including other appropriate criteria.</continuation-text><clause commented="no" id="H7CBC310F3E9841A6945536C1D96CB6D4"><enum>(iii)</enum><text display-inline="yes-display-inline">Responsibilities of independent monitors,
including—</text>
<subclause commented="no" id="H387CED9B782143ABBDE6C973D629D8E9"><enum>(I)</enum><text>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;</text>
</subclause><subclause commented="no" id="H1DBA936958E14DDB9581545CFD82DC00"><enum>(II)</enum><text>conducting
oversight of efforts by such a chain, whether publicly or privately held, to
achieve compliance with State and Federal laws and regulations;</text>
</subclause><subclause commented="no" id="H29195EF64C9346AB82ABD903CCA5E44F"><enum>(III)</enum><text>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;</text>
</subclause><subclause commented="no" id="H1B54CCC497EF4DF2A315DF73819B1DFE"><enum>(IV)</enum><text>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</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H66343CA6431A43778E8074CAEE56975"><enum>(V)</enum><text display-inline="yes-display-inline">other responsibilities of independent
monitors;</text>
</subclause></clause><clause id="H5C88C7F10E51421189DA624DA64562A2"><enum>(iv)</enum><text display-inline="yes-display-inline">Other implementation issues, including
timelines, processes, and enforcement mechanisms for implementation of
independent monitor recommendations and corrective action
plans.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="H5F64765271C14048A993CA9931C5CF7D"><enum>203.</enum><header>GAO studies and
reports on temporary management</header>
<subsection display-inline="no-display-inline" id="H48D0C979E6804409BFC19CFF7E88F6C3"><enum>(a)</enum><header>In
general</header><text>The Comptroller General of the United States (in this
section referred to as the <quote>Comptroller General</quote>) shall conduct a
study on—</text>
<paragraph id="H8D5482E1761F4E78B014B2FB4EE874A5"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="HED1A433812AE4D7EB8C3CBD58D09BE4"><enum>(2)</enum><text>barriers to the
appointment of such temporary management.</text>
</paragraph></subsection><subsection id="H0DA7B415A1274FE1A9F5664E19F590B3"><enum>(b)</enum><header>Report</header><text>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.</text>
</subsection><subsection id="H76A74B16D0434DB8A4FBFEB386E0D09E"><enum>(c)</enum><header>Guidance to
states</header><text>The Secretary of Health and Human Services shall issue
guidance to States based on the recommendations contained in the report
submitted under subsection (b).</text>
</subsection></section><section id="H7BF03A0AF6884BA2A02B41F9ACB0D241"><enum>204.</enum><header>Notification of
facility closure</header>
<subsection id="H32E2675BAB9A4A83A4B6177998A29CA6"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="HE0C0AE81C0544933AB331C8EF931C15E"><enum>(1)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H1B35AD36F9DB4AA6A1FFEF24FF3CF12D" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HABE0A9E4286949199E4BAB76813B129"><enum>(7)</enum><header display-inline="yes-display-inline">Notification of Facility Closure</header>
<subparagraph commented="no" display-inline="no-display-inline" id="HD08A37C99B5941F282F7FED300F19BB4"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any individual who is the license holder of
a skilled nursing facility must—</text>
<clause commented="no" display-inline="no-display-inline" id="HC57C25E3AF704DD2BC2709475F17DBFB"><enum>(i)</enum><text display-inline="yes-display-inline">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—</text>
<subclause commented="no" display-inline="no-display-inline" id="HC4A011145B11442CA8BF7590BE31ECA5"><enum>(I)</enum><text display-inline="yes-display-inline">subject to subclause (II), not later than
the date that is 60 days prior to the date of such closure; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="HE6462A765F2741F782CE7DE54DAFEC"><enum>(II)</enum><text>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;</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="H55260019BBD84970B2F7E1B37E0000EB"><enum>(ii)</enum><text>ensure that the
facility does not admit any new residents on or after the date on which such
written notification is submitted; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HD816F8E8FAF942618612D9FF801413B3"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H048A27615FCE436B846E53AD70CC2FB0"><enum>(B)</enum><header>Relocation</header>
<clause commented="no" display-inline="no-display-inline" id="HEF4CF61A8788401595B300AF38C08C15"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H259F99979E4247D7AE807BB4F7FED82"><enum>(ii)</enum><header>Continuation of
payments until residents relocated</header><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H18D2168404B047989280C4E600F69CA8"><enum>(2)</enum><header>Conforming
amendments</header><text>Section 1819(h)(4) of the Social Security Act (42
U.S.C. 1395i–3(h)(4)) is amended—</text>
<subparagraph id="HF36E1772316542A0857F9742735732A3"><enum>(A)</enum><text>in the first
sentence, by striking <quote>the Secretary shall terminate</quote> and
inserting <quote>the Secretary, subject to subsection (c)(7), shall
terminate</quote>; and</text>
</subparagraph><subparagraph id="H2795EB6A7D9946808878D7D2AB885302"><enum>(B)</enum><text>in the second
sentence, by striking <quote>subsection (c)(2)</quote> and inserting
<quote>paragraphs (2) and (7) of subsection (c)</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H60E7F2EB657D4C94A8A9270774905EB6"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="H42D3107F181D4E939B24E491125088A4"><enum>(1)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H79D6A4B8E9C84BC58513A8B9ED659BD0" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H267D2469E2BB43C5AE724E80345000AC"><enum>(9)</enum><header display-inline="yes-display-inline">Notification of Facility Closure</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H31A4BF9D40E04332002655BCFC6B8FB1"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any individual who is the license holder of
a nursing facility must—</text>
<clause commented="no" display-inline="no-display-inline" id="H6CDA7601AF454357A32781CC9484B148"><enum>(i)</enum><text display-inline="yes-display-inline">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—</text>
<subclause commented="no" display-inline="no-display-inline" id="H5C8E7F7EB77E4871974472AAFA74C2C1"><enum>(I)</enum><text display-inline="yes-display-inline">subject to subclause (II), not later than
the date that is 60 days prior to the date of such closure; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="H748921558EED4AF793724690DB009F04"><enum>(II)</enum><text>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;</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="HF50FE7A83FC949EE84DA2CBEB601438E"><enum>(ii)</enum><text>ensure that the
facility does not admit any new residents on or after the date on which such
written notification is submitted; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H5EDA2A7F87BF449CA20070112FAB2F98"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H75C51972AD47489E83EB9DF3774E1618"><enum>(B)</enum><header>Relocation</header>
<clause commented="no" display-inline="no-display-inline" id="HEE16DC6846664316934E8200EC321F65"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H0F1CA04DD1884FC5BB8F35FC1C8DDD00"><enum>(ii)</enum><header>Continuation of
payments until residents relocated</header><text display-inline="yes-display-inline">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.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H64769974DD714CF2AE33502700DEF455"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect 1 year
after the date of enactment of this Act.</text>
</subsection></section><section id="H8C8082DEB3794E4681A1E0795BF4A631"><enum>205.</enum><header>National
demonstration projects on culture change and use of information technology in
nursing homes</header>
<subsection id="H85AF3FF263BD414585DF5200FDD9E768"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="H2014102DC8F74131BADB5CE309CF34CA"><enum>(b)</enum><header>Conduct of
demonstration projects</header>
<paragraph id="H0707947F71914284924DD7B04C38102C"><enum>(1)</enum><header>Grant
award</header><text>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.</text>
</paragraph><paragraph id="H2147B54FD99343EBAD7E39CC0175358D"><enum>(2)</enum><header>Consideration of
special needs of residents</header><text>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.</text>
</paragraph></subsection><subsection id="HEB8F44740C174F8C801D82C31CBF4849"><enum>(c)</enum><header>Implementation
and duration</header>
<paragraph id="HDF403A94DC354FF4B9DF7DCE2C09E16"><enum>(1)</enum><header>Implementation</header><text>The
demonstration projects shall each be implemented not later than 1 year after
the date of enactment of this Act.</text>
</paragraph><paragraph id="H6948114650244100AF0096A7A8D423B8"><enum>(2)</enum><header>In
general</header><text>The demonstration projects shall each be conducted for a
period not to exceed 3 years.</text>
</paragraph></subsection><subsection id="H816F319B14D74410B279646600AA7BF4"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H648A00DB9B944FC7A8AFAC4496ADD2A6"><enum>(1)</enum><header>Nursing
facility</header><text>The term <term>nursing facility</term> has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).</text>
</paragraph><paragraph id="HF8EB8DEB99BD49BCA1DC19003DB49875"><enum>(2)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="HE28410DECD45403B94CB09E6DB85B386"><enum>(3)</enum><header>Skilled nursing
facility</header><text>The term <term>skilled nursing facility</term> has the
meaning given such term in section 1819(a) of the Social Security Act (42
U.S.C. 1395(a)).</text>
</paragraph></subsection><subsection id="H04D0AF1408AB4FB1BD7875A9370053A2"><enum>(e)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated such sums
as are necessary to carry out this section.</text>
</subsection><subsection id="HEFDE1D82CA6A4CB8812F10611CF8AE47"><enum>(f)</enum><header>Report</header><text>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.</text>
</subsection></section><enum>III</enum><header>Improving staff
training</header>
<section id="H7805E35FC35D4634A4E4A0C531EDAEAD"><enum>301.</enum><header>Dementia and
abuse prevention training</header>
<subsection id="HED75C1070E724624854F23F1656BC5F9"><enum>(a)</enum><header>Skilled nursing
facilities</header><text>Section 1819(f)(2)(A)(i)(I) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3">42 U.S.C. 1395i–3(f)(2)(A)(i)(I)</external-xref>) is amended by inserting <quote>(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</quote> before <quote>, (II)</quote>.</text>
</subsection><subsection id="H202F4B089B0B411EAFF4F6629F8E26D1"><enum>(b)</enum><header>Nursing
facilities</header><text>Section 1919(f)(2)(A)(i)(I) of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1396r">42 U.S.C. 1396r(f)(2)(A)(i)(I)</external-xref>) is amended by inserting <quote>(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</quote> before <quote>, (II)</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H917A8FEEEF584C268F32C26D945E5B78"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect 1 year
after the date of enactment of this Act.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="H3E57B846BB6C406A882F49CED0005930"><enum>302.</enum><header>Study and
report on training required for certified nurse aides and supervisory
staff</header>
<subsection commented="no" display-inline="no-display-inline" id="H23E3918B9DBE4D07A750261DD4F2EF18"><enum>(a)</enum><header>Study</header>
<paragraph commented="no" display-inline="no-display-inline" id="H926A8F1AE25A46D394A4825FF9FD31B4"><enum>(1)</enum><header>In
general</header><text>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:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H083DD69D354847CD95FFB49616A94580"><enum>(A)</enum><text>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).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H213E5837495C459185660660A931317E"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H4A05F0FE7C6546C19CE8A1D0045BFB0"><enum>(2)</enum><header>Consultation</header><text>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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7A9E44E2006944D299E29B217B1EBEBB"><enum>(3)</enum><header>Definitions</header><text>In
this section:</text>
<subparagraph id="HC47143E123234DD3006D11A2CDA93F4E"><enum>(A)</enum><header>Nursing
facility</header><text>The term <term>nursing facility</term> has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).</text>
</subparagraph><subparagraph id="H76A962BF1ABE4D04A8426016E3AADE30"><enum>(B)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human Services,
acting through the Assistant Secretary for Planning and Evaluation.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H445C47B480B64AD488CC4300D470FE68"><enum>(C)</enum><header>Skilled nursing
facility</header><text>The term <term>skilled nursing facility</term> has the
meaning given such term in section 1819(a) of the Social Security Act (42
U.S.C. 1395(a)).</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H0A8748CEC5804E33B5BE6C50C914E7E0"><enum>(b)</enum><header>Report</header><text>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.</text>
</subsection></section>