1.Short
title; table of contents
(a)This Act may be cited
as the Nursing Home Transparency and
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 affiliated
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. GAO study and report on the relative financial status
and performance of special focus facilities.
Sec. 203. National independent monitor program.
Sec. 204. GAO studies and reports on temporary management and
barriers to purchasing facilities with a record of poor care.
Sec. 205. Notification of facility closure.
Sec. 206. 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 commented="no" id="id25618953451F4378B3BE58BA44AD702B"><enum>101.</enum><header>Required
disclosure of ownership and affiliated parties information</header>
<subsection commented="no" id="idE1910F3F471040E689C27C3717C749EC"><enum>(a)</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 adding at the end the following new
subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="id10E83B4DED35472A9B074059172CD019" style="OLC">
<subparagraph commented="no" id="id6BC26AC596F7431A99388AEE90E39558"><enum>(D)</enum><header>Availability of
ownership and affiliated parties information</header>
<clause commented="no" id="id31973B5915E243F4AC743BF2AEFC41B3"><enum>(i)</enum><header>In
general</header><text>Beginning on the date of enactment of this subparagraph,
a skilled nursing facility must have the information described in clause (ii)
available for submission to the Secretary, the Inspector General of the
Department of Health and Human Services, the State, the State long-term care
ombudsman, a resident of a facility, and the legal representative of such a
resident or other responsible party in the case where the Secretary, the
Inspector General, the State, the State long-term care ombudsman, the resident,
or the legal representative or responsible party requests such information
(and, beginning on the effective date of the regulations promulgated under
subparagraph (E)(i), for reporting such information in accordance with such
regulations). The facility shall certify to the Secretary and the Inspector
General of the Department of Health and Human Services, as a condition of
participation and payment under the program under this title, that the
information submitted upon such request is accurate and current.</text>
</clause><clause commented="no" id="id7D087E3F65914940A7ACC2DE6A197585"><enum>(ii)</enum><header>Information
described</header><text>The following information is described in this
clause:</text>
<subclause commented="no" id="ID0d41fb815c154819ac7a7477c606d375"><enum>(I)</enum><text>The identity of
individuals with an ownership or control interest (as defined in section
1124(a)(3)) in the facility.</text>
</subclause><subclause commented="no" id="IDabf2aa710739450f969bba375c012bab"><enum>(II)</enum><text>Information on
the members of the governing body of the skilled nursing facility, including
the names, titles, and dates of service of such members.</text>
</subclause><subclause commented="no" id="IDd91271bb43d945b88ee701e6c2e90387"><enum>(III)</enum><text>Information
describing the organizational structure of any affiliated or related parties,
including principal officers and directors of affiliated or related companies,
or members in the case of a limited liability company.</text>
</subclause><continuation-text continuation-text-level="clause">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 contains the
information described in subclauses (I), (II), and (III), the facility may
provide such Form or such information submitted to meet the requirements of
clause (i) and subparagraph (E)(i).</continuation-text></clause><clause commented="no" id="ID0845171395b449f5b97f9691bab05d4d"><enum>(iii)</enum><header>Definition of
affiliated or related parties</header><text>In this subparagraph, the term
<term>affiliated or related parties</term> means companies or individuals that
serve as operators, landlords, management companies or advisors, real estate or
consulting companies, members of a limited liability company, administrative
services companies, lenders and companies providing financial guarantees,
captive or affiliated liability insurance companies, and such other entities as
the Secretary determines appropriate.</text>
</clause></subparagraph><subparagraph commented="no" id="idB24F32431C174DDEA3BE9A8A65485926"><enum>(E)</enum><header>Reporting</header>
<clause commented="no" id="id1BB800558C44431A81E7081EB256B649"><enum>(i)</enum><header>In
general</header><text>Not later than 2 years after the date of enactment of
this subparagraph, the Secretary shall promulgate regulations requiring skilled
nursing facilities to report the information described in clause (ii) of
subparagraph (D) to the Secretary in a standardized format, and such other
regulations as are necessary to carry out such subparagraph. Such regulations
shall ensure that the facility certifies, as a condition of participation and
payment under the program under this title, that the information reported is
accurate and current.</text>
</clause><clause commented="no" id="id5EDF5958B5BC47A899A7EF1E3778AD56"><enum>(ii)</enum><header>Guidance</header><text>The
Secretary shall provide guidance and technical assistance to States on how to
adopt the standardized format under clause
(i).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="idCB4727160D8F4666AACA52162DDA7FFF"><enum>(b)</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="idB5F96BC1FC2749BD82E672C9D8D68820" style="OLC">
<subparagraph commented="no" id="id8EF65F35A38C4671AB5248E99EBF65F7"><enum>(D)</enum><header>Availability of
ownership and affiliated parties information</header>
<clause commented="no" id="idF1620A1714174C168CFFF116596D4945"><enum>(i)</enum><header>In
general</header><text>Beginning on the date of enactment of this subparagraph,
a nursing facility must have the information described in clause (ii) available
for submission to the Secretary, the Inspector General of the Department of
Health and Human Services, the State, the State long-term care ombudsman, a
resident of a facility, and the legal representative of such a resident or
other responsible party in the case where the Secretary, the Inspector General,
the State, the State long-term care ombudsman, the resident, or the legal
representative or responsible party requests such information (and, beginning
on the effective date of the regulations promulgated under subparagraph (E)(i),
for reporting such information in accordance with such regulations). The
facility shall certify to the Secretary and the Inspector General of the
Department of Health and Human Services, as a condition of participation and
payment under the program under this title, that the information submitted upon
such request is accurate and current.</text>
</clause><clause commented="no" id="idD1E0A467943B4E9E9BE7FA11F4CA3F3A"><enum>(ii)</enum><header>Information
described</header><text>The following information is described in this
clause:</text>
<subclause commented="no" id="id063EE28837EE4FA9958A8427543E56F5"><enum>(I)</enum><text>The identity of
individuals with an ownership or control interest (as defined in section
1124(a)(3)) in the facility.</text>
</subclause><subclause commented="no" id="id6E5A8FBBDF8E4FE0AE41504C6BB5B060"><enum>(II)</enum><text>Information on
the members of the governing body of the nursing facility, including the names,
titles, and dates of service of such members.</text>
</subclause><subclause commented="no" id="id6B6A448A6772454B9D68A7E20A486852"><enum>(III)</enum><text>Information
describing the organizational structure of any affiliated or related parties,
including principal officers and directors of affiliated or related companies,
or members in the case of a limited liability company.</text>
</subclause><continuation-text continuation-text-level="clause">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 contains the
information described in subclauses (I), (II), and (III), the facility may
provide such Form or such information submitted to meet the requirements of
clause (i) and subparagraph (E)(i).</continuation-text></clause><clause commented="no" id="id4AABC35B589D4555B649294592C65141"><enum>(iii)</enum><header>Definition of
affiliated or related parties</header><text>In this subparagraph, the term
<term>affiliated or related parties</term> means companies or individuals that
serve as operators, landlords, management companies or advisors, real estate or
consulting companies, members of a limited liability company, administrative
services companies, lenders and companies providing financial guarantees,
captive or affiliated liability insurance companies, and such other entities as
the Secretary determines appropriate.</text>
</clause></subparagraph><subparagraph commented="no" id="idBFDE2CD5458A4A06A206F4856046541B"><enum>(E)</enum><header>Reporting</header>
<clause commented="no" id="idFAF15935FB244FBEB486BE29DEE20A57"><enum>(i)</enum><header>In
general</header><text>Not later than 2 years after the date of enactment of
this subparagraph, the Secretary shall promulgate regulations requiring nursing
facilities to report the information described in clause (ii) of subparagraph
(D) to the Secretary in a standardized format, and such other regulations as
are necessary to carry out such subparagraph. Such regulations shall ensure
that the facility certifies, as a condition of participation and payment under
the program under this title, that the information reported is accurate and
current.</text>
</clause><clause commented="no" id="id6643573CCD884696A7D4777A4EC23BDE"><enum>(ii)</enum><header>Guidance</header><text>The
Secretary shall provide guidance and technical assistance to States on how to
adopt the standardized format under clause
(i).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id1EEC83C69B5547F894C471E19F757E0D"><enum>102.</enum><header>Accountability
requirements</header>
<subsection id="idCD28C4AAF4D04AC489C97875B5AA420C"><enum>(a)</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 101, is amended by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idCE742B736C1E438E94D6BB87011D71BC" style="OLC">
<subparagraph id="idC433E14AFC9C4FA0B742664BE729C5F5"><enum>(F)</enum><header>Accountability
requirements</header>
<clause id="id9B542A1875D0424B99398ECC0E7253D8"><enum>(i)</enum><header>In
general</header><text>On or after the date that is 2 years after the date of
enactment of this subparagraph, any skilled nursing facility or chain of such
facilities must meet standards for being an accountable entity by complying
with the criteria developed under clause (ii).</text>
</clause><clause id="idE6A599DDA1964C22A208D8887CDDD0EB"><enum>(ii)</enum><header>Criteria</header><text>Not
later than the date that is 2 years after such date of enactment, the
Secretary, in consultation with the General Counsel of the Department of Health
and Human Services and the Inspector General of the Department of Health and
Human Services, shall develop criteria to define accountability requirements
applicable to facilities and chains of such facilities. Such criteria
shall—</text>
<subclause id="idF9337652460745679E75B47794F75244"><enum>(I)</enum><text>include standards
for submission of annual independent audits for facilities that are part of a
group under common ownership or control, whether publicly or privately held and
which have annual revenues of $50,000,000 or more in the aggregate as a group;
and</text>
</subclause><subclause id="id8D652D24C8334C3B8D285333EC4BD3DA"><enum>(II)</enum><text>require new
owners of a facility to provide proof of financial ability to operate the
facility, including documentation of projected revenue and expenses for the
first 12 months of operation of the facility.</text>
</subclause></clause><clause id="id4EB73620BFAB461B901FBBA1338C6C74"><enum>(iii)</enum><header>Rule of
construction</header><text>The criteria developed under clause (ii), and any
requirements to submit information under such criteria, shall be in addition to
any information the Secretary otherwise requires providers to submit on the
ownership and operation of skilled nursing facilities (including information
required to be submitted or reported under subparagraph (D) or
(E)).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id6BDEE253CF754D46B9A6E79B59E20856"><enum>(b)</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 101, is amended by adding at the end
the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idA3E786A0A448475683C5859965F2D87E" style="OLC">
<subparagraph id="id4DACC4E11DB845F3AB60404DCAB6DD56"><enum>(F)</enum><header>Accountability
requirements</header>
<clause id="idB9E3CD09BA854205A2C939E400B56694"><enum>(i)</enum><header>In
general</header><text>On or after the date that is 2 years after the date of
enactment of this subparagraph, any nursing facility or chain of such
facilities must meet standards for being an accountable entity by complying
with the criteria developed under clause (ii).</text>
</clause><clause id="id0881AA93496441EB9CCD8BB4E45DD774"><enum>(ii)</enum><header>Criteria</header><text>Not
later than the date that is 2 years after such date of enactment, the
Secretary, in consultation with the General Counsel of the Department of Health
and Human Services and the Inspector General of the Department of Health and
Human Services, shall develop criteria to define accountability requirements
applicable to facilities and chains of such facilities. Such criteria
shall—</text>
<subclause id="id995720416BF7487D86D14370FC0D13AA"><enum>(I)</enum><text>include standards
for submission of annual independent audits for facilities that are part of a
group under common ownership or control, whether publicly or privately held and
which have annual revenues of $50,000,000 or more in the aggregate as a group;
and</text>
</subclause><subclause id="idB6F5361139554BB78D93FA9A4AA821C3"><enum>(II)</enum><text>require new
owners of a facility to provide proof of financial ability to operate the
facility, including documentation of projected revenue and expenses for the
first 12 months of operation of the facility.</text>
</subclause></clause><clause id="id6F04E4D0002A4C6A94FC3CF5E965A753"><enum>(iii)</enum><header>Rule of
construction</header><text>The criteria developed under clause (ii), and any
requirements to submit information under such criteria, shall be in addition to
any information the Secretary otherwise requires providers to submit on the
ownership and operation of nursing facilities (including information required
to be submitted or reported under subparagraph (D) or
(E)).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idDBF0C10F0F9C49A395C5D7CA9E9EC6A9"><enum>103.</enum><header>Nursing home
compare Medicare website</header>
<subsection id="id968ED36CBB1149DBAC03A923B43DA68F"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="id20BD580098EA4AE2B82BA2F01C5FF3D1"><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="id94B467C572754A81A0BDF38769CF065F"><enum>(A)</enum><text>by redesignating
subsection (i) as subsection (j); and</text>
</subparagraph><subparagraph id="id8313F7C65C114A109E843432115E2047"><enum>(B)</enum><text>by inserting
after subsection (h) the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id5D265C86D35F43CC91A518EEBA885597" style="OLC">
<subsection id="id2AF73F49973F4C4AB8C20CC42A6133B0"><enum>(i)</enum><header>Nursing home
compare website</header>
<paragraph id="idF89A68A84C3E4EA4A169A003D372E06F"><enum>(1)</enum><header>Inclusion of
additional information</header>
<subparagraph id="id0B18F6690ECA45F48687E459B24E718F"><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="ID0d8a6de2ff9a4e809cef2ed2b35ebbcd"><enum>(i)</enum><text>Information that
is reported to the Secretary under subparagraph (E) of subsection (d)(1) and
information submitted with respect to accountability requirements applicable to
facilities and chains of facilities under subparagraph (F) of such
subsection.</text>
</clause><clause commented="no" id="id25D77603B4EE4F0186D34F92B2FA3328"><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—</text>
<subclause commented="no" id="idB8788A150BC44DF088B0A6DDF9748181"><enum>(I)</enum><text>have been
enrolled in the program;</text>
</subclause><subclause commented="no" id="id00E6B494172F4B9AB55238A834179E35"><enum>(II)</enum><text>are enrolled in
the program and have failed to make significant progress within 18 months after
such enrollment; and</text>
</subclause><subclause commented="no" id="idDFBF222558914DD897C10C496D47C794"><enum>(III)</enum><text>have closed
voluntarily or whose participation under this title has been terminated by the
Secretary.</text>
</subclause></clause><clause id="idC053576C1DBC43F2822AC9F9095702A7"><enum>(iii)</enum><text>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)(ii), 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.</text>
</clause><clause id="id5B3BFD0CA68D4C3D88FC2DA7C442AB1D"><enum>(iv)</enum><text>Links to State
Internet websites with information regarding State survey and certification
programs, links to Form 2567 State inspection reports (or a successor form) on
such websites, information to guide consumers in how to interpret and
understand such reports, and the facility plan of correction or other response
to such report.</text>
</clause><clause id="idDEDA554144A84DC3A9E63D3D959A9CFC"><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 id="id1D0215EF84E14CFDA783592F689BCCC6"><enum>(vi)</enum><text>A summary of
information on enforcement that includes remedies proposed and imposed by the
Secretary with respect to a skilled nursing facility during the preceding 3
years.</text>
</clause></subparagraph><subparagraph id="idD12E065AD32A418F804F95421EAEEF78"><enum>(B)</enum><header>Deadline for
provision of information</header>
<clause id="id8E309DC649914E56937A0960228A4DC4"><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="id266FED9674664E6585577B0327520D6B"><enum>(ii)</enum><header>Exceptions</header>
<subclause id="id7E1D0611C8C745E7BF47C370A59000E3"><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 subparagraph
(E) and (F), respectively, of subsection (d)(1) are implemented.</text>
</subclause><subclause id="idB6E99B20F3354549BBBED25D3013B291"><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)(ii) is
implemented.</text>
</subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID121a459a7e254e4fbced1a458606b8e3"><enum>(2)</enum><header>Review and
modification of website</header>
<subparagraph commented="no" display-inline="no-display-inline" id="id65EB6A1DB6724919A03AF93A4AA8842D"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a process—</text>
<clause commented="no" display-inline="no-display-inline" id="id0B18120FDBDD4BA4A05AB3A8AC5C007C"><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="id582B0F0F0A30473DAB9DF0D2AEDD5F6C"><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="idE4E622B5142248A7B0E28609701B188B"><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="id0AC7459078964E349556BB1E74A8D328"><enum>(i)</enum><text>State long-term
care ombudsman programs;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id81D140364E394BA7B63962D69ACB891D"><enum>(ii)</enum><text>consumer
advocacy groups;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idD5C4C8DD802F4EF093B3B492F38B30F8"><enum>(iii)</enum><text>provider
stakeholder groups; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id74003B9237D2456893468BF4749EAA6A"><enum>(iv)</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="idA83753351A6541C1BE64B0AD4982824B"><enum>(2)</enum><header>Timeliness of
submission of survey and certification information</header>
<subparagraph id="idF2CF5A53C28C4AAA973441FC6F06824C"><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="id2F6572CC43B34524A3654CFA5F6A3E0D" style="OLC">
<subparagraph id="idAF678EE2BDFD448D903FB642A4EBE2C2"><enum>(E)</enum><header>Submission of
survey and certification information to the secretary</header><text>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. 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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id2D621C500179454A969AC25B80D1ED25"><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></subsection><subsection id="idFA3D547DC7444162BF066CED736CCC2B"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="id6369E8CBF68D44B08FE9C0AF708B64D8"><enum>(1)</enum><header>In
general</header><text>Section 1919 of the Social Security Act (42 U.S.C. 1396r)
is amended—</text>
<subparagraph id="id66817B0D510F4DEAA15A636D87691B98"><enum>(A)</enum><text>by redesignating
subsection (i) as subsection (j); and</text>
</subparagraph><subparagraph id="idAA9DEF535DE74B15AB7945EAABDB25C1"><enum>(B)</enum><text>by inserting
after subsection (h) the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id2A12801D2A2B49A5BA283074767A58C9" style="OLC">
<subsection id="idBBB6D7529EF94AF592EF64182C0C0C23"><enum>(i)</enum><header>Nursing home
compare website</header>
<paragraph id="idF5551FD995FA4352BCFA802AC567CDCE"><enum>(1)</enum><header>Inclusion of
additional information</header>
<subparagraph id="idD815B395B50D4EEF9DCD96ACCDDBED2E"><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="idBA9D2518594E45AAB9798B7DB91C0C0B"><enum>(i)</enum><text>Information that
is reported to the Secretary under subparagraph (E) of subsection (d)(1) and
information submitted with respect to accountability requirements applicable to
facilities and chains of facilities under subparagraph (F) of such
subsection.</text>
</clause><clause commented="no" id="id1363224BD9194641BAEC64567A865E31"><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—</text>
<subclause commented="no" id="id1C01D807A529415A816A5397CFC466B8"><enum>(I)</enum><text>have been
enrolled in the program;</text>
</subclause><subclause commented="no" id="id29591D89C02E41E28E26EBC18A026EEA"><enum>(II)</enum><text>are enrolled in
the program and have failed to make significant progress within 18 months after
such enrollment; and</text>
</subclause><subclause commented="no" id="id58C6FDCCA5F34CD180D892780E25EC3C"><enum>(III)</enum><text>have closed
voluntarily or whose participation under this title has been terminated by the
Secretary.</text>
</subclause></clause><clause id="idED885648D3114BE59901ADDBD9222E39"><enum>(iii)</enum><text>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)(ii), 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.</text>
</clause><clause id="idB8959251A2744CA8A28EBD85A744D88E"><enum>(iv)</enum><text>Links to State
Internet websites with information regarding State survey and certification
programs, links to Form 2567 State inspection reports (or a successor form) on
such websites, information to guide consumers in how to interpret and
understand such reports, and the facility plan of correction or other response
to such report.</text>
</clause><clause id="idF0BF669A71E747C19824C79FEBA43DC4"><enum>(v)</enum><text>The standardized
complaint form developed under subsection (f)(10), 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 id="idED62C2A76AE54BD88808A46C876A7542"><enum>(vi)</enum><text>A summary of
information on enforcement that includes remedies proposed and imposed by the
Secretary or a State with respect to a nursing facility during the preceding 3
years.</text>
</clause></subparagraph><subparagraph id="idB047CFF0E5B2449DA235580AF6AE9E68"><enum>(B)</enum><header>Deadline for
provision of information</header>
<clause id="id05CECC9EEB754973B45815790C348E65"><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="idAD52591968F542628E33AF5E57CE8D7E"><enum>(ii)</enum><header>Exceptions</header>
<subclause id="id5206B7C6A5204A8F8FFF5874790A25CB"><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 subparagraph
(E) and (F), respectively, of subsection (d)(1) are implemented.</text>
</subclause><subclause id="idBC187F5F82B94204AE734004FB81A98E"><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)(ii) is
implemented.</text>
</subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA7AEBADE19AC4BC88C8AD0A6DB38C065"><enum>(2)</enum><header>Review and
modification of website</header>
<subparagraph commented="no" display-inline="no-display-inline" id="id3C440ED887E24846ABA2A063AB1BCFEB"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a process—</text>
<clause commented="no" display-inline="no-display-inline" id="idA30131B355014F869911F941D4C75839"><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="id08ADFAEA9A8449918ABA16E83C914FBA"><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="id2DCA2D619532433997DBAD46F981A912"><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="id8A0B663943A04251B041238307D71828"><enum>(i)</enum><text>State long-term
care ombudsman programs;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id274DFF88415F497CBFD2D3CB12FB0D32"><enum>(ii)</enum><text>consumer
advocacy groups;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id41F441EE6B1B4403AEC02A8BAABFDBEB"><enum>(iii)</enum><text>provider
stakeholder groups; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idD6E3132EF26043D08D8B279C3E9A083A"><enum>(iv)</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="id8B7033A53735434FA6C04BB9C1DB8426"><enum>(2)</enum><header>Timeliness of
submission of survey and certification information</header>
<subparagraph id="id3F78FC956CA94902B652918919F812C1"><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="id7E11BDCFEE8F48B3B0459AD8B9DDDA7E" style="OLC">
<subparagraph id="idD5FA9859A45441F2A364D6FBC71760A2"><enum>(E)</enum><header>Submission of
survey and certification information to the secretary</header><text>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. 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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4E5E28E062344FE3A852C22074E25F81"><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></subsection><subsection commented="no" display-inline="no-display-inline" id="idACBE8FE2F4074230BCEE09AACDF309A5"><enum>(c)</enum><header>Availability of
reports on surveys, certifications, and complaint investigations</header>
<paragraph id="id2EB5E60A032447C7AA981C5F50503B97"><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="id80EBF596B2204575976160F5B7F49634" style="OLC">
<subparagraph id="idC21C40DD82734B3EA01F950D63FD242B"><enum>(G)</enum><header>Availability of
survey, certification, and complaint investigation reports</header><text>A
skilled nursing facility must—</text>
<clause id="id628E545E49FD4D6989FC1868CD91505E"><enum>(i)</enum><text>have reports with
respect to any surveys, certifications, and complaint investigations made
respecting the facility during the 3 preceding years available for any
individual to review upon request; and</text>
</clause><clause id="idE1BF059C6BC74145A001A6E6478D206A"><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></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id1E68F4CA6483430FACA16B97BE3B93C3"><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="idCFCC05816C644C2387E9924DD26EB285" style="OLC">
<subparagraph id="id596F0F0EE78842D093175A3C8BACE5BE"><enum>(G)</enum><header>Availability of
survey, certification, and complaint investigation reports</header><text>A
nursing facility must—</text>
<clause id="id78CB832653F64806B5ABB60B07213D61"><enum>(i)</enum><text>have reports with
respect to any surveys, certifications, and complaint investigations made
respecting the facility during the 3 preceding years available for any
individual to review upon request; and</text>
</clause><clause id="id4394187546CD4A3FB6BB5A2F76E4E8E8"><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></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="idE44619D4D7CB41019D0B0C0287D036C1"><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="idAE9CC6323889498CB8FCCC36EE9BF079"><enum>(d)</enum><header>Guidance to
states on form <enum-in-header>2567 </enum-in-header>State inspection reports
and complaint investigation reports</header>
<paragraph id="id1AEF61BF7F4045139A249EDFD40C2953"><enum>(1)</enum><header>Guidance</header><text>The
Secretary shall provide guidance to States on how States can establish
electronic links to Form 2567 State inspection reports (or a successor form),
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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id48BEB3D4D5B6457E909471C0E69B6BB2"><enum>(2)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idF06A237FA26C4FC69A2CE0F063EB7783"><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="id2C95D801425E4A9A91D0E10BFAC38D96"><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="idF12669C7A38A4739938E511A296D7F6F"><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="HB5C196F0EA3842879B308B863276C021"><enum>104.</enum><header>Reporting of
expenditures</header><text display-inline="no-display-inline">Section 1888 of
the Social Security Act (42 U.S.C. 1395yy) is amended by
adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HEF944F2A7AE645AA995BBA09CB005F00" style="OLC">
<subsection commented="no" id="H97A6C5E639F14237A0D41B15F62E0273"><enum>(f)</enum><header>Reporting of
expenditures</header>
<paragraph id="id7E68DBBC21B748ADA81A8C48C9DBAAF9"><enum>(1)</enum><header>In
general</header><text>For cost reports submitted for cost reporting periods
beginning on or after the date that is 1 year after the date of enactment of
this subsection, skilled nursing facilities shall separately report
expenditures for wages and benefits for nursing staff (by staff level, breaking
out (at a minimum) registered nurses, licensed professional nurses, and
certified nurse assistants).</text>
</paragraph><paragraph id="idA3E15262F9954251862104383DBB1821"><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).</text>
</paragraph><paragraph id="id6513148A5F6848659BD14ABE2AE511D5"><enum>(3)</enum><header>Categorization</header><text>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 submitted by skilled nursing
facilities and categorize such expenditures into the following categories on an
annual basis:</text>
<subparagraph commented="no" id="id12E8ABA967AB4A16B5F3DBEB2F20F3EC"><enum>(A)</enum><text>Spending on
direct care services (including nursing, therapy, and non-ancillary therapy
services).</text>
</subparagraph><subparagraph commented="no" id="id891AB35B7A6F43C78116F2FEDE45511E"><enum>(B)</enum><text>Spending on
indirect care (including housekeeping, dietary, and other related
services).</text>
</subparagraph><subparagraph commented="no" id="id7B628194152247B8AF2808DF23A36C15"><enum>(C)</enum><text>Capital costs
(including building and land costs).</text>
</subparagraph><subparagraph commented="no" id="id5D9785B2DB7C4310ABBBE4DD40B3EBB7"><enum>(D)</enum><text>Administrative
costs.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id75E709D82FC549B9B76A4E4F312C5D95"><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="idC48A1F4BC95641A3814419D7BAA22276"><enum>105.</enum><header>Standardized
complaint form</header>
<subsection id="idE1E89B2E314C46098303145200BBEA7E"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="idFD9CF52DFEC44FF983390D3394959983"><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="id8B4A8792F47647C1BBCFD60C1874D09F" style="OLC">
<paragraph id="id193F949D14AA4059983A67F1AAB19E02"><enum>(8)</enum><header>Standardized
complaint form</header><text>The Secretary shall develop a standardized
complaint form for use by a resident (or a person acting on the resident’s
behalf) in filing 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="idD003E912931A4A789EF9A6D082567BD3"><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="id21117EB1E65B43A3A9624E01B305EE67" style="OLC">
<paragraph id="id8A17836BF35F44BDA64E8FDEDBC2F7F3"><enum>(6)</enum><header>Complaint forms
and resolution processes</header>
<subparagraph id="id962D62656F43412BA3AC807D36ACDE36"><enum>(A)</enum><header>Complaint
forms</header><text>The State must make the standardized complaint form
developed under subsection (f)(8) available upon request to—</text>
<clause id="id74E12522EB8E49B9BA5E401014D46811"><enum>(i)</enum><text>a
resident of a skilled nursing facility; and</text>
</clause><clause id="idFB27A0F85E9746B0BF67B7B85F736F44"><enum>(ii)</enum><text>any person
acting on the resident’s behalf.</text>
</clause></subparagraph><subparagraph id="id7DCD8686DC8C4864922B6171CD1679AF"><enum>(B)</enum><header>Complaint
resolution process</header><text>The State must establish a complaint
resolution process in order to ensure 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 they have complained
about the quality of care provided by the facility or other issues relating to
the facility. Such complaint resolution process shall include—</text>
<clause id="idEC7BA3645E474D409D4DD9CCC0D0981F"><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="id2CFBC4528DE744D99A1BB7C1D7A38461"><enum>(ii)</enum><text>procedures to
determine the likely severity of a complaint and for the investigation of the
complaint; and</text>
</clause><clause id="id31EC4BBF150E4DE281F5130DE791E5AF"><enum>(iii)</enum><text>deadlines for
responding to a complaint and for notifying the complainant of the outcome of
the investigation.</text>
</clause></subparagraph><subparagraph id="id3CAF31436FC24459BF5C3B9D928AB6DD"><enum>(C)</enum><header>Rule of
construction</header><text>Nothing in this paragraph shall be construed as
preventing a resident of a skilled nursing facility (or a person acting on the
resident’s behalf) 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>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id47095D0B1A494DF7A30FE1FA0FA792CA"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="id575F733AB6534CC69AD85D53C98CB91B"><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="idAEE0967C92E74092A16646DE4A9ACBFB" style="OLC">
<paragraph id="idA8B1BD0B02DE45F2A44EA3BA74EC450E"><enum>(10)</enum><header>Standardized
complaint form</header><text>The Secretary shall develop a standardized
complaint form for use by a resident (or a person acting on the resident’s
behalf) in filing 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="id2C139740C3304AD1BEB19FB67FDBC640"><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="idCE7831EC1818405C8690AAD6D01AD567" style="OLC">
<paragraph id="idB95E8DB69B02456FB38D97E3483420AD"><enum>(8)</enum><header>Complaint forms
and resolution processes</header>
<subparagraph id="id6E03259787DD429C8107705557A3C7FF"><enum>(A)</enum><header>Complaint
forms</header><text>The State must make the standardized complaint form
developed under subsection (f)(10) available upon request to—</text>
<clause id="id380AA2F227B9418FA286407B2B0B4006"><enum>(i)</enum><text>a
resident of a nursing facility; and</text>
</clause><clause id="id6B13CD8516F146D3BBBD6A949EA3B249"><enum>(ii)</enum><text>any person
acting on the resident’s behalf.</text>
</clause></subparagraph><subparagraph id="id03620B742F6648299FBDE619452F6C56"><enum>(B)</enum><header>Complaint
resolution process</header><text>The State must establish a complaint
resolution process in order to ensure 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 they have complained about
the quality of care provided by the facility or other issues relating to the
facility. Such complaint resolution process shall include—</text>
<clause id="idB7D35C3888F4461596E61AD2ECD4D493"><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="id6396ED25F38A442482BD27D3550CFE1E"><enum>(ii)</enum><text>procedures to
determine the likely severity of a complaint and for the investigation of the
complaint; and</text>
</clause><clause id="id4A06450ED6B048E08199D9F9D2E29227"><enum>(iii)</enum><text>deadlines for
responding to a complaint and for notifying the complainant of the outcome of
the investigation.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idEA3599005CA148D98755F7C357F288E3"><enum>(C)</enum><header display-inline="yes-display-inline">Rule of construction</header><text display-inline="yes-display-inline">Nothing in this paragraph shall be
construed as preventing a resident of a nursing facility (or a person acting on
the resident’s behalf) 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>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idA719090DB0F14456BCCF656FC4C61E23"><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="id223F30868BD34F839D1496DD026FAC8F"><enum>106.</enum><header>Ensuring
staffing accountability</header>
<subsection id="id0ED03FC375DC477F8BBC18D090106E18"><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="id76F3694B059343848050EA0CE9134EA2" style="OLC">
<subparagraph id="id966F7FD69C74494697F1280BF05B6832"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header>
<clause id="idBED91C90D9BF4B2E99F48CCA2A8F75A6"><enum>(i)</enum><header>Design
phase</header>
<subclause id="id65BC7A017A584EA3A484A35064EF4B0E"><enum>(I)</enum><header>In
general</header><text>The Secretary shall establish a program for skilled
nursing facilities to report staffing information (including information with
respect to agency and contract staff) based on payroll data. Such program shall
be conducted for a 1-year period beginning on the date of enactment of this
subparagraph.</text>
</subclause><subclause id="id0418C5B1C0EA4DD2B48EF6D5BBB97670"><enum>(II)</enum><header>Report</header><text>Not
later than 6 months after the completion of the program established under
subclause (I), the Secretary shall submit a report to Congress containing the
results of the program.</text>
</subclause></clause><clause id="idE832E55F206947C1945CB0BF9FA8D7EA"><enum>(ii)</enum><header>Submission of
staffing information</header><text>Beginning not later than 1 year after the
completion of the program established under clause (i)(I), the Secretary shall
require a skilled nursing facility to electronically submit to the Secretary
nurse staffing information (including information with respect to agency and
contract staff) based on payroll data in a uniform format (according to
specifications established by the Secretary). Such specifications shall require
that the information submitted under the preceding sentence—</text>
<subclause id="idF93C4706598F4BF38AA5933EB9D64735"><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, or
certified nursing assistant);</text>
</subclause><subclause id="id173AE8AE8E6C44A998BC724801C6892A"><enum>(II)</enum><text>include resident
census data;</text>
</subclause><subclause id="id03FE433BFA524B5FA554CAB3B4D11338"><enum>(III)</enum><text>include a
regular reporting schedule; and</text>
</subclause><subclause id="id4169D1EA5581478084BAAFC1D1CC3266"><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 subclause (I) per
resident per day.</text>
</subclause></clause></subparagraph><after-quoted-block></after-quoted-block></quoted-block>
</subsection><subsection id="idB7A5B68F97C94285ACF044500B98C827"><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="id5C4FDFD53573415B872C105AFB369D0A" style="OLC">
<subparagraph id="id3E16C6D9781E48D4B25C24F47475D12E"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header>
<clause id="id33970CF021354CAA94A75D7574272B29"><enum>(i)</enum><header>Design
phase</header>
<subclause id="id7C99CDFBF3FD4BB29769CD8529359F65"><enum>(I)</enum><header>In
general</header><text>The Secretary shall establish a program for nursing
facilities to report staffing information (including information with respect
to agency and contract staff) based on payroll data. Such program shall be
conducted for a 1-year period beginning on the date of enactment of this
subparagraph.</text>
</subclause><subclause id="idCF1B99144ED34102A1133FDB0D5A50C3"><enum>(II)</enum><header>Report</header><text>Not
later than 6 months after the completion of the program established under
subclause (I), the Secretary shall submit a report to Congress containing the
results of the program.</text>
</subclause></clause><clause id="idA0E97382A5234EB2BE01422F6C9984A2"><enum>(ii)</enum><header>Submission of
staffing information</header><text>Beginning not later than 1 year after the
completion of the program established under clause (i)(I), the Secretary shall
require a nursing facility to electronically submit to the Secretary nurse
staffing information (including information with respect to agency and contract
staff) based on payroll data in a uniform format (according to specifications
established by the Secretary). Such specifications shall require that the
information submitted under the preceding sentence—</text>
<subclause id="id2D7FB889EFCB482A8A5ACC2A2D6755D8"><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, or
certified nursing assistant);</text>
</subclause><subclause id="idE488566D649B446B9EB8AE5AB880C3BA"><enum>(II)</enum><text>include resident
census data;</text>
</subclause><subclause id="id4672F14E475B4F70A7DB36275BFEB6C9"><enum>(III)</enum><text>include a
regular reporting schedule; and</text>
</subclause><subclause id="id85AA45BCE476453EBD9B3B7FE3E5BEE6"><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 subclause (I) per
resident per day.</text>
</subclause></clause></subparagraph><after-quoted-block></after-quoted-block></quoted-block>
</subsection></section><enum>II</enum><header>Targeting
Enforcement</header>
<section id="idEC3F2A933E9A4D91B7959B9C1FCD48FC"><enum>201.</enum><header>Civil money
penalties</header>
<subsection id="idC583F7A3CD854C86AB29CD46845CBF5C"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="idD2FA2F64A6394AB8A0EE66D3731998BD"><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="idC1F219CC660D4DA5A351173A58D4C312" style="OLC">
<clause id="idDD48CDF431854C2FB13A4ECB187F0708"><enum>(ii)</enum><header>Authority with
respect to civil money penalties</header>
<subclause id="id7FA869D330B243AA9FC932F613E76407"><enum>(I)</enum><header>Amount</header><text>Subject
to subclause (III), the Secretary may impose a civil money penalty in the
applicable amount (as defined in subclause (II)) for each day or each instance
of noncompliance (as determined appropriate by the Secretary).</text>
</subclause><subclause id="id52D987F1DE584C9E8C5C1766270A5A03"><enum>(II)</enum><header>Applicable
amount</header><text>In this clause, the term <term>applicable amount</term>
means—</text>
<item id="idDA2352CA1F3C47BCBC41E916987C3A83"><enum>(aa)</enum><text>in
the case where the deficiency results in the death of a resident of the
facility, an amount not to exceed $100,000;</text>
</item><item id="id1B87C3E844994229A8A83A35573C1427"><enum>(bb)</enum><text>in
the case of a deficiency where the facility is cited for actual harm or
immediate jeopardy, an amount not less than $3,000 and not more than $25,000;
and</text>
</item><item id="id196914DC56844A9CB47E27DE6AC2098E"><enum>(cc)</enum><text>in
the case of any other deficiency, an amount not to exceed $3,000.</text>
</item></subclause><subclause commented="no" id="id384BFE18F6E542239586A0A5106912F5"><enum>(III)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>Subject to
subclause (IV), 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 by not more than 50 percent.</text>
</subclause><subclause commented="no" id="idC80A31101E4A4A00B1AF4AE8812B5B23"><enum>(IV)</enum><header>Prohibitions
on reduction for certain deficiencies</header>
<item commented="no" id="idABD0DBF7F318472987C40A7011731E78"><enum>(aa)</enum><header>Repeat
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (III) 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="idCCB915D29267404BB3B0A9967FBE980D"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (III) if the penalty is imposed for a deficiency described in
subclause (II)(bb) 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="id89ADBB66E0544744BA43AD15AC2A7F7E"><enum>(V)</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), the Secretary—</text>
<item id="id6D0C2757848649758D25C5E7DA323C4B"><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="id523CF0828F8645A4B423EF9F878B7738"><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="idBA51783396994E30AFF5267370EAB722"><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="id9F3F6E78BE5E4C198505F72CDDB5CC80"><enum>(dd)</enum><text>in
the case where the facility successfully appeals the penalty, may provide for
the return of such amounts collected (plus interest) to the facility;
and</text>
</item><item commented="no" id="idC9966B3E820C4D05AC93B7C0E027B025"><enum>(ee)</enum><text>in the case
where all such appeals are unsuccessful, may provide that some portion of such
amounts collected may be used to support activities 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="id3038AF65A4B943008CF7F5ABF8CEB22E"><enum>(VI)</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 (V)) 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>
</paragraph><paragraph id="id74E6F4FC04FF4D349E6BBD1F87383B6E"><enum>(2)</enum><header>Conforming
amendment</header><text>The second sentence of section 1819(h)(5) of the Social
Security Act (42 U.S.C. 1395i–3(h)(5)) is amended by inserting
<quote>(ii)(V),</quote> after <quote>(i),</quote>.</text>
</paragraph></subsection><subsection id="id5B6006F9B02842A5974DA0CCC82EF0FC"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="id933FC8D551864AFC8ABAC5F0E95CD508"><enum>(1)</enum><header>Penalties
imposed by the State</header>
<subparagraph id="id4EC98D2B841E4FA3BB10B6BC45299B29"><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="id512F952AC42C4CB7A2E8B29F8FD15F2B"><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="id53694B755BCB46FA80AFE9A1FA0CE39E"><enum>(ii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id7E6D1D766A0641108F77CF1FF893F1EA" style="OLC">
<subparagraph id="id3D753818558C4670AA9D57D539892264"><enum>(G)</enum><header>Civil money
penalties</header>
<clause id="idDEC039C0949A48E3A450691DBE9AA487"><enum>(i)</enum><header>In
general</header><text>Subject to clause (iii), the State may impose a civil
money penalty under subparagraph (A)(ii) in the applicable amount for each day
or each instance of noncompliance (as determined appropriate by the
State).</text>
</clause><clause id="id8BD7EF96A28E43FCBFFD4B12AE737C04"><enum>(ii)</enum><header>Definition of
applicable amount</header><text>In this subparagraph, the term <term>applicable
amount</term> means—</text>
<subclause id="id8CB84FC21F9A4B8BAAFA78D0D62A05EC"><enum>(I)</enum><text>in the case where
the deficiency results in the death of a resident of the facility, an amount
not to exceed $100,000;</text>
</subclause><subclause id="id71C948327BCF4C30A3C7373B08453BFD"><enum>(II)</enum><text>in the case of a
deficiency where the facility is cited for actual harm or immediate jeopardy,
an amount not less than $3,000 and not more than $25,000; and</text>
</subclause><subclause id="idA1C9990F672C4AC8925C65588D5631B8"><enum>(III)</enum><text>in the case of
any other deficiency, an amount not to exceed $3,000.</text>
</subclause></clause><clause id="id21643E66433C4B699A092EDD07E26555"><enum>(iii)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>Subject to clause
(iv), 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 by not more than 50 percent.</text>
</clause><clause commented="no" id="idC4DAA1F97866412B9762797A836FB801"><enum>(iv)</enum><header>Prohibition on
reduction for certain deficiencies</header>
<subclause commented="no" id="idBEA107B541C146219C665461B562539F"><enum>(I)</enum><header>Repeat
deficiencies</header><text>The State may not reduce the amount of a penalty
under clause (iii) 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="idDF6F34A2E026480F9CCFC60DC379CB8B"><enum>(II)</enum><header>Certain other
deficiencies</header><text>The State may not reduce the amount of a penalty
under clause (iii) if the penalty is imposed for a deficiency described in
clause (ii)(II) 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="idA44A617010084D7A8A7BA56C535871E4"><enum>(v)</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), the State—</text>
<subclause id="id68D57DFC8701409B80320924513D6823"><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="idCD3A8B559B1D44FDA68274706DE363DB"><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="id94B52F7CB7F347F8A97FD9CB67360CF5"><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="id7BE0FA23DD0B4418B40A98DEE0C2FBCF"><enum>(IV)</enum><text>in the case
where the facility successfully appeals the penalty, may provide for the return
of such amounts collected (plus interest) to the facility; and</text>
</subclause><subclause commented="no" id="id5C3E605E989745FFAAC408B0E5969A03"><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></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" id="idDBB949D5513A400DBB8E54EB977DC1C9"><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 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="idF4968BD815E24EAB9F69BEB59A7F57DE"><enum>(2)</enum><header>Penalties
imposed by the Secretary</header>
<subparagraph id="id38AFE41084E44BF196ACC8F52A156E2E"><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="id4AA3716FC39541EABB063C940A98EF41" style="OLC">
<clause id="id0FF0E7DE9806422EA88986E5DAAB968A"><enum>(ii)</enum><header>Authority with
respect to civil money penalties</header>
<subclause id="idBDD560C42FD24C09A252D40B2BF44C67"><enum>(I)</enum><header>Amount</header><text>Subject
to subclause (III), the Secretary may impose a civil money penalty in the
applicable amount (as defined in subclause (II)) for each day or each instance
of noncompliance (as determined appropriate by the Secretary).</text>
</subclause><subclause id="idC4D1CA503C7F4EE881BEB047FDA32A4F"><enum>(II)</enum><header>Applicable
amount</header><text>In this clause, the term <term>applicable amount</term>
means—</text>
<item id="id4FB2B9AA2ED74B289F5E3A6911A37EB3"><enum>(aa)</enum><text>in
the case where the deficiency results in the death of a resident of the
facility, an amount not to exceed $100,000;</text>
</item><item id="idCCEE7EBA94514301A82593C0372E398A"><enum>(bb)</enum><text>in
the case of a deficiency where the facility is cited for actual harm or
immediate jeopardy, an amount not less than $3,000 and not more than $25,000;
and</text>
</item><item id="id4BEC90846F564EC181799BDB50263CE0"><enum>(cc)</enum><text>in
the case of any other deficiency, an amount not to exceed $3,000.</text>
</item></subclause><subclause commented="no" id="id4683C0DAE357460EB942F612AF6011E8"><enum>(III)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>Subject to
subclause (IV), 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 by not more than 50 percent.</text>
</subclause><subclause commented="no" id="id610218BB109E4830AC146E8FEA4A0DC9"><enum>(IV)</enum><header>Prohibitions
on reduction for certain deficiencies</header>
<item commented="no" id="idA7AF48330433442F9421F684D71916C0"><enum>(aa)</enum><header>Repeat
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (III) 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="idABF6B8B513FF444594BA06E9FD34C90C"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (III) if the penalty is imposed for a deficiency described in
subclause (II)(bb) 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="id6871C1499C0841F4BDF2D32CB755A6AF"><enum>(V)</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), the Secretary—</text>
<item id="id17CA40FED15B49128EC5301568FAED10"><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="idA1761F7B41B241F7BC3CB258EFBD817A"><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="id37152C590B8F409C8B25C770A53BFE79"><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="idF39DF6FF223D4C6983E61ED31CE2DC13"><enum>(dd)</enum><text>in
the case where the facility successfully appeals the penalty, may provide for
the return of such amounts collected (plus interest) to the facility;
and</text>
</item><item commented="no" id="id24EAC8912AAD4CFEB3617726CB0D11F0"><enum>(ee)</enum><text>in the case
where all such appeals are unsuccessful, may provide that some portion of such
amounts collected may be used to support activities 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="id7C47D4DFCE0B4667BA6B407CB8FE61AC"><enum>(VI)</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 (V)) 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="id49144A92E4BE4D5ABB05F994C677833F"><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="idDB0CECE2BB2442F49C89A1B0E79E9497"><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="ID76b7110bd2574091a8d01c16be2a45de"><enum>202.</enum><header>GAO study and
report on the relative financial status and performance of special focus
facilities</header>
<subsection id="idA92E9157B1334444804C7DC18034244F"><enum>(a)</enum><header>Study</header>
<paragraph id="id8DC907CE5977416E8B50A518E1703105"><enum>(1)</enum><header>In
general</header><text>The Comptroller General of the United States shall
conduct a study on the financial status, resident care, and performance of
skilled nursing facilities and nursing facilities in the Special Focus Facility
program (or a successor program) established by the Centers for Medicare &
Medicaid Services relative to a comparable sample of facilities that are not in
such program. Such study shall include an examination of the ownership and
control interests, and any affiliated parties, of the facilities studied (as
applicable).</text>
</paragraph><paragraph id="id8F8CCEF8F66C406095ED51CF66C41BB9"><enum>(2)</enum><header>Definitions</header><text>In
this section:</text>
<subparagraph id="id9A38B92D4E944FE59EB3DA36FFCEFAB1"><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="id81AFFE1BF75E42228C7D88D415071CAB"><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="idEE95D8C3499B4B4ABBBD9C6BF2A060A0"><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 id="id21A40290F2A142CC9ED1F29230E6B3B4"><enum>(b)</enum><header>Report</header><text>Not
later than 1 year after the date of enactment of this Act, the Comptroller
General of the United States shall submit a report to Congress and the
Secretary 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></section><section commented="no" id="id87C3933799B84636843D3A637EC35087"><enum>203.</enum><header>National
independent monitor program</header>
<subsection commented="no" id="id9148B0E35CC14B229341166F51FD4B20"><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="id8113AC2D37B64F1C820C3192CFD925C0"><enum>(1)</enum><text>by redesignating
paragraphs (5) and (6) as paragraphs (6) and (7), respectively; and</text>
</paragraph><paragraph commented="no" id="id4029641B868F4A9B812DACA07E0A9C7C"><enum>(2)</enum><text>by inserting
after paragraph (4) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id6834C001893D4D3586FE4D0635B5062F" style="OLC">
<paragraph commented="no" id="idA9D20FA66BCC4D7598B5144D2A80F04A"><enum>(5)</enum><header>National
independent monitor program</header>
<subparagraph commented="no" id="id4CD2D752A1F7400F8D567016F1BED4F8"><enum>(A)</enum><header>In
general</header><text>Not later than 1 year after the date of enactment of this
paragraph, the Secretary, in consultation with the Inspector General of the
Department of Health and Human Services, shall develop, test, and implement a
protocol for the establishment of an independent monitoring program to oversee
interstate and large intrastate chains of skilled nursing facilities. Such
program shall be designed to analyze such chains in 1 or more of the following
instances:</text>
<clause commented="no" id="idDDFECFB1E3B7450B994CC07B8D24E149"><enum>(i)</enum><text>Where 3 or more
facilities of the chain were 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.</text>
</clause><clause commented="no" id="id999971DF7555411F9088646D37CF3327"><enum>(ii)</enum><text>Where the chain
has been experiencing financial problems that may be linked to serious quality
deficiencies.</text>
</clause><clause commented="no" id="id27C8F5FB02534CF99004DBCDB97E2BD6"><enum>(iii)</enum><text>Where the chain
has a record of chronic poor performance.</text>
</clause></subparagraph><subparagraph commented="no" id="id8336F7BF56454681B7106EA963589FCF"><enum>(B)</enum><header>Responsibilities</header><text>The
independent monitoring program established under subparagraph (A) shall include
the following responsibilities:</text>
<clause commented="no" id="id8F4528A540E24A47A721A3C6750FF845"><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>
</clause><clause commented="no" id="idB56B61AFDA3E45C39601897D1C8E624A"><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>
</clause><clause commented="no" id="id40DF7D5BB7FE4B44AD70693B098D0F12"><enum>(iii)</enum><text>Analyzing the
management structure, distribution of expenditures, and nurse staffing levels
of facilities of such a chain in relation to resident census, staff turnover
rates, and tenure.</text>
</clause><clause commented="no" id="id5822950C4654499CB88ECDC6D0B13673"><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.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idB53813BD1BD94D279DAFDCFC999320C4"><enum>(v)</enum><text>Publishing the
results of such reviews, analyses, and oversight.</text>
</clause></subparagraph><subparagraph id="ID0cc4913dceb94b5597929192c9e980dc"><enum>(C)</enum><header>Implementation
of recommendations</header>
<clause id="idB7D850799EF94B00895B8A2FA45D24BF"><enum>(i)</enum><header>Receipt of
finding by chain</header><text>Not later than 10 days after receipt of a
finding reported under subparagraph (B)(iv), the chain shall submit a report to
the independent monitor—</text>
<subclause id="id6044FB9FC44B4B34980F0613108945D4"><enum>(I)</enum><text>outlining
corrective actions to be taken by the chain to implement the recommendations in
such report; or</text>
</subclause><subclause id="idEDC702DD10084FBDB6EAF2E453FA8275"><enum>(II)</enum><text>indicating that
the chain will not implement such recommendations, and why it will not do
so.</text>
</subclause></clause><clause id="id31216C8F6C3B4DA0993C83CD56AFD2B9"><enum>(ii)</enum><header>Receipt of
report by independent monitor</header><text>Not later than 10 days after
receipt of the report submitted by the chain under clause (i), the independent
monitor shall finalize its recommendations and submit a report to the chain and
facilities of the chain, the Secretary, and the State or States, as
appropriate, containing such final recommendations.</text>
</clause><clause id="id61EA51FB993C402D841B72FB6CF937F8"><enum>(iii)</enum><header>Civil money
penalty</header><text>The Secretary may impose a civil money penalty under
subsection (h)(2)(B)(ii) on a chain that fails to respond to or to take
corrective actions to implement the recommendations of the independent monitor
in accordance with this subparagraph.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id11C26C7124154A87A1B3B37094D6D6D2"><enum>(D)</enum><header>Cost of
appointment</header><text>A chain shall be responsible for all costs associated
with the appointment of independent monitors under the program under this
paragraph. The chain shall pay such costs to the Secretary (in accordance with
procedures established by the Secretary).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id8A24F3DB4FD54B258879C728FE9D4C14"><enum>(E)</enum><header>Evaluation and
report</header>
<clause commented="no" display-inline="no-display-inline" id="id1A3F2D394C734D1EB1529CA856C3C977"><enum>(i)</enum><header>Evaluation</header><text>The
Inspector General of the Department of Health and Human Services shall evaluate
the independent monitoring program under this paragraph.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id98833084E10B482CB16F5BECF5D4FFA4"><enum>(ii)</enum><header>Report</header><text>Not
later than 2 years after the implementation of such program under subparagraph
(A), the Inspector General shall submit a report to Congress containing the
results of the evaluation conducted under clause (i), together with
recommendations for such legislation and administrative action as the Inspector
General determines appropriate.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id26F02C2008904787A398F305662AB8BD"><enum>(F)</enum><header>Intermediate
remedy</header><text>The appointment of an independent monitor shall be an
intermediate remedy that may be in addition to or in lieu of other remedies
under this
subsection.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="id5E6D60A23DF64B70AF94826EDB6AA472"><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="id676A96306DE44292A635EB496388BEE0"><enum>(1)</enum><text>by redesignating
paragraphs (8) and (9) as paragraphs (9) and (10), respectively; and</text>
</paragraph><paragraph commented="no" id="id30E9AE7323C144F9A9679DCA194C1491"><enum>(2)</enum><text>by inserting
after paragraph (7) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id4039AE6DA7BA4E5DB9432AB642B1960D" style="OLC">
<paragraph commented="no" id="idBE787F4D0F114F698BCC4509113CF53A"><enum>(8)</enum><header>National
independent monitor program</header>
<subparagraph commented="no" id="idF4B8D46AEE8F4E829FF72F426CE4D726"><enum>(A)</enum><header>In
general</header><text>Not later than 1 year after the date of enactment of this
paragraph, the Secretary, in consultation with the Inspector General of the
Department of Health and Human Services, shall develop, test, and implement a
protocol for the establishment of an independent monitoring program to oversee
interstate and large intrastate chains of nursing facilities. Such program
shall be designed to analyze such chains in 1 or more of the following
instances:</text>
<clause commented="no" id="idB94D165B983341CFBCD0C0FAC0861B95"><enum>(i)</enum><text>Where 3 or more
facilities of the chain were 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.</text>
</clause><clause commented="no" id="idB6293CF6783E471E973F8CB1469C9AA8"><enum>(ii)</enum><text>Where the chain
has been experiencing financial problems that may be linked to serious quality
deficiencies.</text>
</clause><clause commented="no" id="idE4D08AF5D1334A989AA783713BF98DC0"><enum>(iii)</enum><text>Where the chain
has a record of chronic poor performance.</text>
</clause></subparagraph><subparagraph commented="no" id="id975F5820704943898C820D582E11EECD"><enum>(B)</enum><header>Responsibilities</header><text>The
independent monitoring program established under subparagraph (A) shall include
the following responsibilities:</text>
<clause commented="no" id="idEE25BBD6F2C94C3E9BEB5094482880B5"><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>
</clause><clause commented="no" id="id56B981F66F004476AE0F31AFC6C2126A"><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>
</clause><clause commented="no" id="idC705D18655014956B29E965A2B226DF7"><enum>(iii)</enum><text>Analyzing the
management structure, distribution of expenditures, and nurse staffing levels
of facilities of such a chain in relation to resident census, staff turnover
rates, and tenure.</text>
</clause><clause commented="no" id="id0BA450799617428ABEC9237C6DFA0735"><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.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idDA0B706F32F348EFA799E3402A0CE515"><enum>(v)</enum><text>Publishing the
results of such reviews, analyses, and oversight.</text>
</clause></subparagraph><subparagraph id="id5F09E432E2D24D45A2799CEA7BD757BD"><enum>(C)</enum><header>Implementation
of recommendations</header>
<clause id="idF46164B36B534DDAA76116BA27F95929"><enum>(i)</enum><header>Receipt of
finding by chain</header><text>Not later than 10 days after receipt of a
finding reported under subparagraph (B)(iv), the chain shall submit a report to
the independent monitor—</text>
<subclause id="id7185C3110BE94D478E72B4436E456051"><enum>(I)</enum><text>outlining
corrective actions to be taken by the chain to implement the recommendations in
such report; or</text>
</subclause><subclause id="id1432C240C90A4908AF4B5C0EAA4A52CF"><enum>(II)</enum><text>indicating that
the chain will not implement such recommendations, and why it will not do
so.</text>
</subclause></clause><clause id="id1FFB9FC8632B4ACB88FA5B3E4063B3D2"><enum>(ii)</enum><header>Receipt of
report by independent monitor</header><text>Not later than 10 days after
receipt of the report submitted by the chain under clause (i), the independent
monitor shall finalize its recommendations and submit a report to the chain and
facilities of the chain, the Secretary, and the State or States, as
appropriate, containing such final recommendations.</text>
</clause><clause id="id43C56D6A11DF4A54BF82D3B9A4A44273"><enum>(iii)</enum><header>Civil money
penalty</header><text>A State or the Secretary may impose a civil money penalty
under subsection (h)(2)(A)(ii), or (h)(3)(C)(ii), respectively, on a chain that
fails to respond to or to take corrective actions to implement the
recommendations of the independent monitor in accordance with this
subparagraph.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id49B733D80DBE4E9C9258C4A3997B0CA2"><enum>(D)</enum><header>Cost of
appointment</header><text>A chain shall be responsible for all costs associated
with the appointment of independent monitors under the program under this
paragraph. The chain shall pay such costs to the Secretary (in accordance with
procedures established by the Secretary).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id96172E27425E4DC188AB41127FA4A49C"><enum>(E)</enum><header>Evaluation and
report</header>
<clause commented="no" display-inline="no-display-inline" id="id868F1267B37544009307CAD962F05913"><enum>(i)</enum><header>Evaluation</header><text>The
Inspector General of the Department of Health and Human Services shall evaluate
the independent monitoring program under this paragraph.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idBD343D02721343DB8C35EAC162CBD652"><enum>(ii)</enum><header>Report</header><text>Not
later than 2 years after the implementation of such program under subparagraph
(A), the Inspector General shall submit a report to Congress containing the
results of the evaluation conducted under clause (i), together with
recommendations for such legislation and administrative action as the Inspector
General determines appropriate.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id07C7FA41B0644FC080A14A99162008F4"><enum>(F)</enum><header>Intermediate
remedy</header><text>The appointment of an independent monitor shall be an
intermediate remedy that may be in addition to or in lieu of other remedies
under this
subsection.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="id744FD620FF3544E5B8DDB70495E69E5A"><enum>204.</enum><header>GAO studies
and reports on temporary management and barriers to purchasing facilities with
a record of poor care</header>
<subsection id="id92997CCA9ACB4F769E62D31C7D098EEE"><enum>(a)</enum><header>Study and
report on temporary management</header>
<paragraph id="id0A8F187561AF4A0198D0A12B93CB04E9"><enum>(1)</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>
<subparagraph id="id958C0B008B0B4F569633E6E5A5760F34"><enum>(A)</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>
</subparagraph><subparagraph id="idE52FD9BA90FC41BFB20727F99757C18F"><enum>(B)</enum><text>barriers to the
appointment of such temporary management.</text>
</subparagraph></paragraph><paragraph id="id90AB96050C4E47E394BFC5DCFFD01101"><enum>(2)</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 paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller General determines
appropriate.</text>
</paragraph><paragraph id="id1616E998898C4993973F65144ABDDD8A"><enum>(3)</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 paragraph (2).</text>
</paragraph></subsection><subsection id="id9A9AC07F671444F2AAC1A3483DCBA001"><enum>(b)</enum><header>Study and
report on barriers to purchasing facilities with a record of poor care</header>
<paragraph id="idD2B2465E75614294B901534B752A1434"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct a study on the extent
and the nature of any barriers for new owners who purchase, and potential
owners who wish to purchase, skilled nursing facilities and nursing facilities
with a record of poor care.</text>
</paragraph><paragraph id="id108CDB90E5F14D0D925BCE981EBE1E9C"><enum>(2)</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 paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller General determines
appropriate to address any barriers identified in such study.</text>
</paragraph><paragraph id="id164B01A6E4AE412F8AFB25799E879D74"><enum>(3)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="id7BA62E0EEEF045889C80F9A57D5CD8DA"><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="idA933B6CC9F714905A50058982D611F20"><enum>(B)</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></section><section id="id09AB79D2B92746A39A51CF6147F75E4E"><enum>205.</enum><header>Notification
of facility closure</header>
<subsection id="id4FCC906716824727854E6285AA0B733A"><enum>(a)</enum><header>Skilled nursing
facilities</header>
<paragraph id="idFD9DF49DF80747DA988FAC2516D431A5"><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="idB24D53B08B7248349BBD27F5594BA340" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="id930C82F09F93424BB46A1259808CDE5A"><enum>(7)</enum><header display-inline="yes-display-inline">Notification of Facility Closure</header>
<subparagraph commented="no" display-inline="no-display-inline" id="id9B01EFC137FB42ABB30C3E43FDCB68D2"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any individual who is the administrator of
a skilled nursing facility must—</text>
<clause commented="no" display-inline="no-display-inline" id="IDB3F82B5E5263458C840D1FB180655C3F"><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="id3DDBCAD47B6949CEA811AD15E015D3D1"><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="idE8D46A1F4E9B485381576F4078C749F1"><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="id1F56746150104CC0B780606D037D3251"><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="ID15E2FF72F9314820A4041FF0DC58BDD8"><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 and best interests of each resident.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idD94D9CD10E0544029D3B6C9A6E186878"><enum>(B)</enum><header>Relocation</header>
<clause commented="no" display-inline="no-display-inline" id="id265303BD3A4A49889DAC782480D67ACF"><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="idADB61F81B8994AF2AA77289B7C4B782C"><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="id90EFF00F145B46E6B043F4795F6F15E0"><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="idAC7173AF025C4DDE9418D5774C01BB37"><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="id73D82448DA454E12A3AD93EB3A8B0107"><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="id8F8112CAA2084140854D5640AD7B6D85"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="idD95A909D06BF4BF9BF48C5ADA2C27714"><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="id11C909D5D058480FA8E78357436DED20" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="idFF1F66BA349A4BA89076640518AA6250"><enum>(9)</enum><header display-inline="yes-display-inline">Notification of Facility Closure</header>
<subparagraph commented="no" display-inline="no-display-inline" id="id5DC6C4361AA946D99CDD60AF6F23990A"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any individual who is an administrator of a
nursing facility must—</text>
<clause commented="no" display-inline="no-display-inline" id="id37F600C2646949BFAF22880E996A9B9D"><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="id41BE681E5EEC41A282AD9F0171A93C9C"><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="idDC2CCE42C04F4F159413FD6958212D90"><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="id03653FA01ACD4993B2D85DAB06FD265C"><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="id1985C6FE62224189960065815060C2A5"><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 and best interests of each resident.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id194848ECB7004D9CB66DCA3E69E5D20F"><enum>(B)</enum><header>Relocation</header>
<clause commented="no" display-inline="no-display-inline" id="id32164B92D0444AC3832477E35F6546E9"><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="id3421F001E57D4CD59C3BB85DF0C5E6E3"><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="idDA4F508685844F7CA54E8335174E135F"><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="idCBA3DD5B25954C50A15B1076D85326BF"><enum>206.</enum><header>National
demonstration projects on culture change and use of information technology in
nursing homes</header>
<subsection id="idB8C9389165654F658BF8D9A137DED530"><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="idF460DB156B1144F8BC0FEECAFD13A9E8"><enum>(b)</enum><header>Conduct of
demonstration projects</header>
<paragraph id="id81B6D84C9EA941AFADC6999A3B92E3CA"><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="id253451258BA0482D815941DD3BF3AC50"><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="idB31A8BE703BF49B8BCB3076802E0B22D"><enum>(c)</enum><header>Implementation
and duration</header>
<paragraph id="idD34657287C504D3F9A816F1FFB5C60B1"><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="id881EB32446784618884D2F4B44FF4A26"><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="id3FAA47FC21A647FFBF342B0D4E4E0039"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="id84B14B93578443C492B241F006FCA0E3"><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="id6F13050135AD4F0D858FB1FE585763E6"><enum>(2)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="idD45C2EF048DE47499A431F4ABC563E17"><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="idA828070119114FC7947D69E6BB6292A3"><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="id55E6CE15816D405A80ADB6FCEE4AD2E0"><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="id32DC46C5C2FD40B3B2CBC28ED969AD3D"><enum>301.</enum><header>Dementia and
abuse prevention training</header>
<subsection id="id33A1525DFA724AE7B72E0E8D1DF66B16"><enum>(a)</enum><header>Skilled nursing
facilities</header><text>Section 1819(f)(2)(A)(i)(I) of the Social Security Act
(42 U.S.C. 1395i–3(f)(2)(A)(i)(I)) is amended by inserting <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="idFCA6C67A6A2243B394B922F4749B717F"><enum>(b)</enum><header>Nursing
facilities</header><text>Section 1919(f)(2)(A)(i)(I) of the Social Security Act
(42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by inserting <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="id7F66ADFED21B402ABCF5210ACE68FB4E"><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="idFBEC3ECA46414B12AF33200C5B73FE29"><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="idA56F58DAA2234AABB92FF9143EC70E9E"><enum>(a)</enum><header>Study</header>
<paragraph commented="no" display-inline="no-display-inline" id="id2CB5C02762624BC392C87AB2101205C3"><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="id4F5D9347D65043F9876585CB62B8225F"><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="id6C56E0D637114968B8DA402DA14E1AC9"><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="idBC5B060CFCAC48AFA413457D33E32BD5"><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="id959C655BC4D1416AA16E32AB7DA350C9"><enum>(3)</enum><header>Definitions</header><text>In
this section:</text>
<subparagraph id="id1DF91CA4848542E5ABB22BAB0C2E4959"><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="idA74714055F3842409D22002ACF0C3DAA"><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="id0956A95404504EF8A85860D8EE42F0AA"><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="id5512E5261C924DEAAF6D653A65504C1A"><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>