[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6074 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 6074

  To amend titles XVIII and XIX of the Social Security Act to enhance 
  quality under the Medicaid Program through nursing facility survey 
                          system improvements.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 30, 2010

  Mr. Stupak introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend titles XVIII and XIX of the Social Security Act to enhance 
  quality under the Medicaid Program through nursing facility survey 
                          system improvements.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Enhancing Quality through Survey 
System Improvements Act of 2010''.

SEC. 2. DATA DRIVEN MODERNIZATION OF THE SURVEY PROCESS.

    (a) Review of State and Contractor Survey Procedures.--
            (1) Medicare.--Section 1819(g)(2)(A)(i) of the Social 
        Security Act (42 U.S.C. 1395i-3(g)(2)(A)(i)) is amended--
                    (A) by striking ``of'' before ``not to exceed'' in 
                the second sentence; and
                    (B) by striking ``each State's procedures for the 
                scheduling and conduct of standard surveys to assure 
                that the State'' and inserting ``the procedures of each 
                State, or other contractor as chosen by the Secretary, 
                for scheduling and conducting standard surveys to 
                assure that the State, or other contractor,''.
            (2) Medicaid.--Section 1919(g)(2)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396r(g)(2)(A)(i)) is amended--
                    (A) by striking ``of'' before ``not to exceed'' in 
                the second sentence; and
                    (B) by striking ``each State's procedures for the 
                scheduling and conduct of standard surveys to assure 
                that the State'' and inserting ``the procedures of each 
                State, or other contractor as chosen by the Secretary, 
                for scheduling and conducting standard surveys to 
                assure that the State, or other contractor,''.
    (b) Frequency of Surveys of Top Tier and Other Facilities.--
            (1) Medicare.--Section 1819(g)(2)(A)(iii) of the Social 
        Security Act (42 U.S.C. 1395i-3(g)(2)(A)(iii)) is amended--
                    (A) by striking subclause (I);
                    (B) by redesignating subclause (II) as subclause 
                (III);
                    (C) in subclause (III), as so redesignated, by 
                striking ``subclause (I)'' and inserting ``subclauses 
                (I) and (II)''; and
                    (D) by inserting before subclause (III), as so 
                redesignated, the following subclauses:
                                    ``(I) Surveys of top tier 
                                facilities.--Each skilled nursing 
                                facility in the top tier (as defined by 
                                the Secretary in regulations) shall be 
                                subject to a complete on-site standard 
                                survey not later than 36 months after 
                                the date of the previous standard 
                                survey of such facility conducted under 
                                this subparagraph. The statewide 
                                average interval between standard 
                                surveys of top tier skilled nursing 
                                facilities under this subclause shall 
                                not exceed 39 months. Such facilities 
                                will also be subject to quarterly off-
                                site review of acuity-adjusted quality 
                                indicators (as identified by the 
                                Secretary). During any year in which a 
                                top tier skilled nursing facility does 
                                not receive a complete on-site standard 
                                survey, such facility will also be 
                                subject to an annual half-day on-site 
                                review of quality of life and safety 
                                issues. All necessary data in 
                                connection with such surveys shall be 
                                submitted to the Secretary by each such 
                                top tier skilled nursing facility at a 
                                time and in such a manner as determined 
                                by the Secretary.
                                    ``(II) Surveys of other 
                                facilities.--Skilled nursing facilities 
                                not identified in subclause (I) shall 
                                be subject to a complete standard on-
                                site survey not later than 12 months 
                                after the date of the previous standard 
                                survey of such facility conducted under 
                                this subparagraph. The statewide 
                                average interval between standard 
                                surveys of such facilities shall not 
                                exceed 15 months. Such facilities also 
                                will be subject to quarterly off-site 
                                review of acuity-adjusted quality 
                                indicators (as identified by the 
                                Secretary). All necessary data in 
                                connection with such surveys shall be 
                                submitted to the Secretary by each such 
                                facility at a time and in such a manner 
                                as determined by the Secretary.''.
            (2) Medicaid.--Section 1919(g)(2)(A)(iii) of the Social 
        Security Act (42 U.S.C. 1396r(g)(2)(A)(iii)) is amended--
                    (A) by striking subclause (I);
                    (B) by redesignating subclause (II) as subclause 
                (III);
                    (C) in subclause (III), as so redesignated, by 
                striking ``subclause (I)'' and inserting ``subclauses 
                (I) and (II)''; and
                    (D) by inserting before subclause (III), as so 
                redesignated, the following subclauses:
                                    ``(I) Surveys of top tier 
                                facilities.--Each nursing facility in 
                                the top tier (as defined by the 
                                Secretary in regulations) shall be 
                                subject to a complete on-site standard 
                                survey not later than 36 months after 
                                the date of the previous standard 
                                survey of such facility conducted under 
                                this subparagraph. The statewide 
                                average interval between standard 
                                surveys of top tier nursing facilities 
                                under this subclause shall not exceed 
                                39 months. Such facilities will also be 
                                subject to quarterly off-site review of 
                                acuity-adjusted quality indicators (as 
                                identified by the Secretary). During 
                                any year in which a top tier nursing 
                                facility does not receive a complete 
                                on-site standard survey, such facility 
                                will also be subject to an annual half-
                                day on-site review of quality of life 
                                and safety issues. All necessary data 
                                in connection with such surveys shall 
                                be submitted to the Secretary by each 
                                such top tier nursing facility at a 
                                time and in such a manner as determined 
                                by the Secretary.
                                    ``(II) Surveys of other 
                                facilities.--Nursing facilities not 
                                identified in subclause (I) shall be 
                                subject to a complete standard on-site 
                                survey not later than 12 months after 
                                the date of the previous standard 
                                survey of such facility conducted under 
                                this subparagraph. The statewide 
                                average interval between standard 
                                surveys of such facilities shall not 
                                exceed 15 months. Such facilities also 
                                will be subject to quarterly off-site 
                                review of acuity-adjusted quality 
                                indicators (as identified by the 
                                Secretary). All necessary data in 
                                connection with such surveys shall be 
                                submitted to the Secretary by each such 
                                facility at a time and in such a manner 
                                as determined by the Secretary.''.
    (c) Change in Effective Dates.--
            (1) Medicare.--Section 1819(g)(2)(C) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(2)(C)) is amended--
                    (A) in clause (i)--
                            (i) by inserting ``(I)'' before ``based on 
                        a protocol''; and
                            (ii) by striking ``, and'' and inserting 
                        ``; or
                            ``(II) with respect to surveys conducted on 
                        or after the last day of the 24-month period 
                        beginning on the date of the enactment of the 
                        Enhancing Quality through Survey System 
                        Improvements Act of 2010, based on a revision 
                        of protocol under subclause (I) that has been 
                        tested and validated not later than such last 
                        day; and''; and
                    (B) in clause (ii), by striking ``such date'' and 
                inserting ``January 1, 1990, or, with respect to 
                surveys conducted on or after the last day of the 24-
                month period beginning on the date of the enactment of 
                the Enhancing Quality through Survey System 
                Improvements Act of 2010, by such last day.''.
            (2) Medicaid.--Section 1919(g)(2)(C) of the Social Security 
        Act (42 U.S.C. 1396r(g)(2)(C)) is amended--
                    (A) in clause (i)--
                            (i) by inserting ``(I)'' before ``based on 
                        a protocol''; and
                            (ii) by striking ``, and'' and inserting 
                        ``; or
                            ``(II) with respect to surveys conducted on 
                        or after the last day of the 24-month period 
                        beginning on the date of the enactment of the 
                        Enhancing Quality through Survey System 
                        Improvements Act of 2010, based on a revision 
                        of protocol under subclause (I) that has been 
                        tested and validated not later than such last 
                        day; and''; and
                    (B) in clause (ii), by striking ``such date'' and 
                inserting ``January 1, 1990, or, with respect to 
                surveys conducted on or after the last day of the 24-
                month period beginning on the date of the enactment of 
                the Enhancing Quality through Survey System 
                Improvements Act of 2010, by such last day.''.
    (d) Consistency of Surveys.--
            (1) Medicare.--Section 1819(g)(2) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(2)) is amended by striking 
        subparagraph (D) and inserting the following:
                    ``(D) Consistency of surveys.--
                            ``(i) In general.--Each State shall 
                        implement programs to measure and reduce 
                        inconsistency in the application of survey 
                        results (including the results of both health 
                        surveys and life safety surveys) among 
                        surveyors.
                            ``(ii) Secretary provides oversight.--The 
                        Secretary shall take such actions as necessary 
                        to assure that there is consistent application, 
                        both within States and across States, of the 
                        survey process under this subsection (including 
                        the process for both health surveys and life 
                        safety surveys).
                            ``(iii) Appeals.--The Secretary will assure 
                        that there is a fair and timely appeals process 
                        for surveys under this subsection (including 
                        both health surveys and life safety surveys) in 
                        which each State office and regional office 
                        provides a timely resolution of disputes.
                            ``(iv) Report.--The Secretary shall report 
                        to the Congress annually, by October 30, on the 
                        actions taken to ensure the consistency of the 
                        survey process within and across states. Such 
                        report shall include data that assesses the 
                        consistency of the survey process. Such report 
                        also shall provide a summary of the status of 
                        appeals process, including data that assesses 
                        the timeliness of the resolution of 
                        disputes.''.
            (2) Medicaid.--Section 1919(g)(2) of the Social Security 
        Act (42 U.S.C. 1396r(g)(2)) is amended by striking subparagraph 
        (D) and inserting the following:
                    ``(D) Consistency of surveys.--
                            ``(i) In general.--Each State shall 
                        implement programs to measure and reduce 
                        inconsistency in the application of survey 
                        results (including the results of both health 
                        surveys and life safety surveys) among 
                        surveyors.
                            ``(ii) Secretary provides oversight.--The 
                        Secretary shall take such actions as necessary 
                        to assure that there is consistent application, 
                        both within States and across States, of the 
                        survey process under this subsection (including 
                        the process for both health surveys and life 
                        safety surveys).
                            ``(iii) Appeals.--The Secretary will assure 
                        that there is a fair and timely appeals process 
                        for surveys under this subsection (including 
                        both health surveys and life safety surveys) in 
                        which each State office and regional office 
                        provides a timely resolution of disputes.
                            ``(iv) Report.--The Secretary shall report 
                        to the Congress annually, by October 30, on the 
                        actions taken to ensure the consistency of the 
                        survey process within and across states. Such 
                        report shall include data that assesses the 
                        consistency of the survey process. Such report 
                        also shall provide a summary of the status of 
                        appeals process, including data that assesses 
                        the timeliness of the resolution of 
                        disputes.''.
    (e) Circumstances for Special Surveys of Compliance.--
            (1) Medicare.--Section 1819(g)(3)(D) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(3)(D)) is amended by striking 
        subparagraph (D) and inserting the following:
                    (A) By inserting ``(I) in general.--'' before 
                ``Where the Secretary has'' and adjusting the 
                indentation appropriately.
                    (B) By adding at the end the following new 
                subclause:
                                    ``(II) Circumstances for special 
                                surveys.--The Secretary shall conduct a 
                                survey under subclause (I) of a skilled 
                                nursing facility if, with respect to 
                                such facility, any of the following 
                                events occurs:
                                            ``(aa) A complaint is made 
                                        by a resident or family member 
                                        of a resident of such facility.
                                            ``(bb) The skilled nursing 
                                        facility self-reports a 
                                        reportable incident to the 
                                        State agency responsible for 
                                        surveys and certifications 
                                        under this subsection.
                                            ``(cc) A quarterly review 
                                        of quality indicator data from 
                                        such facility suggests a 
                                        potential problem at such 
                                        facility.''.
            (2) Medicaid.--Section 1919(g)(3)(D) of the Social Security 
        Act (42 U.S.C. 1396r(g)(3)(D)) is amended--
                    (A) by inserting ``(I) in general.--'' before 
                ``Where the Secretary has'' and adjusting the 
                indentation appropriately; and
                    (B) by adding at the end the following new 
                subclause:
                                    ``(II) Circumstances for special 
                                surveys.--The Secretary shall conduct a 
                                survey under subclause (I) of a nursing 
                                facility if, with respect to such 
                                facility, any of the following events 
                                occurs:
                                            ``(aa) A complaint is made 
                                        by a resident or family member 
                                        of a resident of such facility.
                                            ``(bb) The nursing facility 
                                        self-reports a reportable 
                                        incident to the State agency 
                                        responsible for surveys and 
                                        certifications under this 
                                        subsection.
                                            ``(cc) A quarterly review 
                                        of quality indicator data from 
                                        such facility suggests a 
                                        potential problem at such 
                                        facility.''.
    (f) Notice to Facilities and the Public.--
            (1) Medicare.--Section 1819(g)(5) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(5)) is amended--
                    (A) in subparagraph (A)(i), by striking 
                ``statements of deficiencies'' and inserting ``reports 
                of surveys under subparagraph (F)''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Notice to facility.--A written report of the 
                survey must be given to the skilled nursing facility 
                within 15 calendar days following the date the survey 
                team exited the facility. The report of the survey must 
                include all the positive aspects of care and facility 
                life as well as the aspects of care that may need 
                improvement.''.
            (2) Medicaid.--Section 1919(g)(5) of the Social Security 
        Act (42 U.S.C. 1396r(g)(5)) is amended--
                    (A) in subparagraph (A)(i), by striking 
                ``statements of deficiencies'' and inserting ``reports 
                of surveys under subparagraph (F)''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Notice to facility.--A written report of the 
                survey must be given to the nursing facility within 15 
                calendar days following the date the survey team exited 
                the facility. The report of the survey must include all 
                the positive aspects of care and facility life as well 
                as the aspects of care that may need improvement.''.
    (g) Treatment of Funds Collected From Civil Monetary Penalties.--
            (1) Medicare.--Section 1819(h)(2)(A) of the Social Security 
        Act (42 U.S.C. 1395i-3(h)(2)(A)) is amended by adding at the 
        end (in the flush matter following clause (ii)) the following 
        sentence: ``Notwithstanding the previous sentence, any funds 
        collected by a State as a result of the imposition of such a 
        penalty (or as a result of the imposition by the State of a 
        civil money penalty for activities described in subsections 
        (b)(3)(B)(ii)(I), (b)(3)(B)(ii)(II), or (g)(2)(A)(i)) shall be 
        used for development of acuity adjusters that will provide more 
        accurate information to the public, skilled nursing facilities, 
        and the residents of such facilities, about the quality of care 
        that is provided by each such facility.''.
            (2) Medicaid.--Section 1919(h)(2)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396r(h)(2)(A)(ii)) is amended by 
        adding at the end (in the flush matter following clause (ii)) 
        the following sentence: ``Notwithstanding the previous 
        sentence, any funds collected by a State as a result of the 
        imposition of such a penalty (or as a result of the imposition 
        by the State of a civil money penalty for activities described 
        in subsections (b)(3)(B)(ii)(I), (b)(3)(B)(ii)(II), or 
        (g)(2)(A)(i)) shall be used for development of acuity adjusters 
        that will provide more accurate information to the public, 
        nursing facilities, and the residents of such facilities, about 
        the quality of care that is provided by each such facility.''.
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