[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6261 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 6261

  To amend titles XVIII and XIX of the Social Security Act to improve 
    oversight of nursing facilities under the Medicare and Medicaid 
    programs by ensuring adequate, trained surveyors, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 29, 2010

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

_______________________________________________________________________

                                 A BILL


 
  To amend titles XVIII and XIX of the Social Security Act to improve 
    oversight of nursing facilities under the Medicare and Medicaid 
    programs by ensuring adequate, trained surveyors, and for other 
                               purposes.

    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 ``Nursing Home Patient Protection and 
Standards Act''.

SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SURVEYORS.

    (a) Medicare.--Section 1819(g)(2)(E)(iii) of the Social Security 
Act (42 U.S.C. 1395i-3(g)(2)(E)(iii)) is amended by adding the 
following at the end: ``The testing program must be sufficiently 
rigorous (as determined by the Secretary) to ensure that surveyors are 
adequately prepared to survey and certify facilities in a consistent 
and accurate manner.''
    (b) Medicaid.--Section 1919(g)(2)(E)(iii) of the Social Security 
Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is amended by adding the following 
at the end: ``The testing program must be sufficiently rigorous (as 
determined by the Secretary) to ensure that surveyors are adequately 
prepared to survey and certify facilities in a consistent and accurate 
manner.''

SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING FOR STATE SURVEYS OF 
              NURSING HOMES.

    (a) Medicare.--Section 1819(g)(2)(E) of the Social Security Act (42 
U.S.C. 1395i-3(g)(2)(E)) is amended by adding at the end the following:
                            ``(iv) Adequate qualified staff for survey 
                        teams.--The Secretary, in consultation with the 
                        advisory committee under subparagraph (F), 
                        shall establish requirements--
                                    ``(I) for the qualifications and 
                                compensation of members of a survey 
                                team under this subsection; and
                                    ``(II) that a State employs an 
                                adequate number of individuals as 
                                members of survey teams to ensure 
                                adequate oversight of skilled nursing 
                                facilities.
                            ``(v) Continuing education.--In addition to 
                        the training and testing program required under 
                        clause (iii), the Secretary shall require that 
                        State and Federal surveyors regularly complete 
                        an adequate amount (as determined by the 
                        Secretary) of continuing education courses that 
                        meet requirements determined by the Secretary 
                        for content and the rigor of the material 
                        covered by such courses. An individual shall 
                        not serve as a member of a survey team unless 
                        the individual is in compliance with the 
                        requirements of this clause.''.
    (b) Medicaid.--Section 1919(g)(2)(E) of the Social Security Act (42 
U.S.C. 1396r(g)(2)(E)) is amended by adding at the end the following:
                            ``(iv) Adequate qualifed staff for survey 
                        teams.--The Secretary, in consultation with the 
                        advisory committee under subparagraph (F), 
                        shall establish requirements--
                                    ``(I) for the qualifications and 
                                compensation of members of a survey 
                                team under this subsection; and
                                    ``(II) that a State employs an 
                                adequate number of individuals as 
                                members of survey teams to ensure 
                                adequate oversight of nursing 
                                facilities.
                            ``(v) Continuing education.--In addition to 
                        the training and testing program required under 
                        clause (iii), the Secretary shall require that 
                        State and Federal surveyors regularly complete 
                        an adequate amount (as determined by the 
                        Secretary) of continuing education courses that 
                        meet requirements determined by the Secretary 
                        for content and the rigor of the material 
                        covered by such courses. No individual shall 
                        serve as a member of a survey team unless the 
                        individual is in compliance with the 
                        requirements of this clause.''.

SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY OF SURVEYORS.

    (a) Whistle Blower Protections.--
            (1) Medicare.--Section 1819(g) of the Social Security Act 
        (42 U.S.C. 1395i-3(g)) is amended by adding the following at 
        the end:
            ``(6) Reporting of inaccuracies.--
                    ``(A) Reporting requirement.--A covered individual 
                shall report to the Secretary any instance in which the 
                individual suspects that--
                            ``(i) a survey under this subsection fails 
                        to report or under reports an issue in a 
                        facility that could impact the safety or 
                        quality of care of the residents in such 
                        facility; or
                            ``(ii) a member of the survey team or an 
                        employee of the State survey agency was 
                        inappropriately induced (through the offering 
                        of monetary awards or through undue pressure) 
                        to alter the results of the survey.
                    ``(B) Responses to report.--If the Secretary 
                receives a report under subparagraph (A), the Secretary 
                shall take appropriate action, as determined by the 
                Secretary, to ensure the accuracy of the survey.
                    ``(C) Whistle blower protections.--With respect to 
                a covered individual, a State may not--
                            ``(i) discharge, demote, suspend, threaten, 
                        harass, or deny a promotion or other 
                        employment-related benefit to such individual, 
                        or in any other manner discriminate against an 
                        individual in the terms and conditions of 
                        employment because the individual submitted a 
                        report under subparagraph (A); or
                            ``(ii) file a complaint or a report against 
                        the individual with the appropriate State 
                        professional disciplinary agency because the 
                        individual submitted a report under 
                        subparagraph (A).
                    ``(D) Remedy for violations.--If the Secretary 
                finds that a State has violated the prohibitions under 
                subparagraph (C), the Secretary shall provide for an 
                appropriate remedy.
                    ``(E) Requirement to post notice.--Each State shall 
                post conspicuously in an appropriate location a sign 
                (in a form specified by the Secretary) specifying the 
                rights of covered individuals under this section. Such 
                sign shall include a statement that a covered 
                individual may file a complaint with the Secretary 
                against the State for violating the provisions of this 
                paragraph and information with respect to the manner of 
                filing such a complaint. 
                    ``(F) Covered individual defined.--For purposes of 
                this paragraph, the term `covered individual' means an 
                individual--
                            ``(i) who is a member of a State survey 
                        team under this subsection; or
                            ``(ii) who is an employee of the State 
                        department or agency that conducts surveys 
                        under this section.''.
            (2) Medicaid.--Section 1919(g) of the Social Security Act 
        (42 U.S.C. 1396r(g)) is amended by adding the following at the 
        end:
            ``(6) Reporting of inaccuracies.--
                    ``(A) Reporting requirement.--A covered individual 
                shall report to the Secretary any instance in which the 
                individual suspects that--
                            ``(i) a survey under this subsection fails 
                        to report or under reports an issue in a 
                        facility that could impact the safety or 
                        quality of care of the residents in such 
                        facility; or
                            ``(ii) a member of the survey team or an 
                        employee of the State survey agency was 
                        inappropriately induced (through the offering 
                        of monetary awards or through undue pressure) 
                        to alter the results of the survey.
                    ``(B) Response to reports.--If the Secretary 
                receives a report under subparagraph (A), the Secretary 
                shall take appropriate action, as determined by the 
                Secretary, to ensure the accuracy of the survey.
                    ``(C) Whistle blower protections.--With respect to 
                a covered individual, a State may not--
                            ``(i) discharge, demote, suspend, threaten, 
                        harass, or deny a promotion or other 
                        employment-related benefit to such individual, 
                        or in any other manner discriminate against an 
                        individual in the terms and conditions of 
                        employment because the individual submitted a 
                        report under subparagraph (A); or
                            ``(ii) file a complaint or a report against 
                        the individual with the appropriate State 
                        professional disciplinary agency because the 
                        individual submitted a report under 
                        subparagraph (A).
                    ``(D) Penalties for retaliation.--If the Secretary 
                finds that a State has violated the prohibitions under 
                subparagraph (C), the Secretary shall provide for a 
                reduction of the payment otherwise made to the State 
                under section 1903(a)(7), with respect to a quarter, 
                equal to 5 percent. A State that is dissatisfied with 
                the Secretary's findings under this subparagraph may 
                obtain reconsideration and review of the findings under 
                section 1116 in the same manner as a State may seek 
                reconsideration and review under that section of the 
                Secretary's determination under section 1116(a)(1).
                    ``(E) Requirement to post notice.--Each State shall 
                post conspicuously in an appropriate location a sign 
                (in a form specified by the Secretary) specifying the 
                rights of covered individuals under this section. Such 
                sign shall include a statement that a covered 
                individual may file a complaint with the Secretary 
                against the State for violating the provisions of this 
                paragraph and information with respect to the manner of 
                filing such a complaint. 
                    ``(F) Covered individual defined.--For purposes of 
                this paragraph, the term `covered individual' means an 
                individual--
                            ``(i) who is a member of a State survey 
                        team under this subsection; or
                            ``(ii) who is an employee of the State 
                        department or agency that conducts surveys 
                        under this section.''.
    (b) Penalties for Inappropriately Influencing a Surveyor.--
            (1) Medicare.--Section 1819(g)(2)(E) of the Social Security 
        Act (42 U.S.C. 1395i-3(g)(2)(E)), as amended by section 3(a), 
        is further amended by adding the following at the end:
                            ``(vi) Penalties for inappropriately 
                        influencing a surveyor.--Any individual 
                        (including an employee of a skilled nursing 
                        facility or any affiliated corporate entity, a 
                        representative of the skilled nursing facility 
                        industry, a member of a State survey team, an 
                        employee of the State department or agency that 
                        conducts surveys under this section, or an 
                        elected official) who attempts to 
                        inappropriately influence, as determined by the 
                        Secretary through regulations, the results of a 
                        survey under this subsection or the actions of 
                        a member of a survey team or an employee of a 
                        survey agency under this subsection shall be 
                        subject to a civil money penalty not to exceed 
                        $10,000. The provisions of section 1128A (other 
                        than subsections (a) and (b)) shall apply to a 
                        civil money penalty under the previous sentence 
                        in the same manner as such provisions apply to 
                        a penalty or proceeding under section 
                        1128A(a).''.
            (2) Medicaid.--Section 1919(g)(2)(E) of the Social Security 
        Act (42 U.S.C. 1396r(g)(2)(E)), as amended by section 3(b), is 
        further amended by adding at the end the following:
                            ``(vi) Penalties for inappropriately 
                        influencing a surveyor.--Any individual 
                        (including an employee of a nursing facility or 
                        any affiliated corporate entity, a 
                        representative of the nursing facility 
                        industry, a member of a State survey team, an 
                        employee of the State department or agency that 
                        conducts surveys under this section, or an 
                        elected official) who attempts to 
                        inappropriately influence, as determined by the 
                        Secretary through regulations, the results of a 
                        survey under this subsection or the actions of 
                        a member of a survey team or an employee of a 
                        survey agency under this subsection shall be 
                        subject to a civil money penalty not to exceed 
                        $10,000. The provisions of section 1128A (other 
                        than subsections (a) and (b)) shall apply to a 
                        civil money penalty under the previous sentence 
                        in the same manner as such provisions apply to 
                        a penalty or proceeding under section 
                        1128A(a).''.
            (3) Conforming amendments.--
                    (A) Section 1819(f)(2)(B)(iii)(I)(c) of the Social 
                Security Act is amended by inserting ``, a civil 
                monetary penalty described in section 1919(g)(2)(E)(vi) 
                of not less than $10,000'' after ``of not less than 
                $5,000''.
                    (B) Section 1919(f)(2)(B)(iii)(I)(c) of the Social 
                Security Act is amended by inserting ``, a civil 
                monetary penalty described in (g)(2)(E)(vi) of not less 
                than $10,000'' after ``of not less than $5,000''.

SEC. 5. ADVISORY COMMITTEE.

    (a) Medicare.--Section 1819(g)(2) of the Social Security Act (42 
U.S.C. 1395i-3(g)(2)) is amended by adding at the end the following:
                    ``(F) Advisory committee.--
                            ``(i) Establishment.--The Secretary shall 
                        establish an advisory committee on surveys 
                        under this paragraph.
                            ``(ii) Membership.--The membership of the 
                        advisory committee under clause (i) shall 
                        include advocates for residents of skilled 
                        nursing facilities, members of survey teams 
                        under this subsection, and nursing home 
                        administrators, directors of nursing, 
                        registered nurses, and other skilled nursing 
                        facility stakeholders.
                            ``(iii) Recommended standards.--The 
                        advisory committee under clause (i) shall make 
                        recommendations to the Secretary on standards 
                        for--
                                    ``(I) the adequate staffing of 
                                survey teams under this subsection;
                                    ``(II) the training of members of 
                                such teams; and
                                    ``(III) disclosing any contact 
                                between such members and individuals 
                                associated with skilled nursing 
                                facilities, and limiting such contact 
                                to prevent inappropriate influence of 
                                such members by such individuals.
                            ``(iv) Other recommendations.--The advisory 
                        committee under clause (i) may also make 
                        recommendations to the Secretary on any other 
                        issue that would improve the survey process 
                        under this paragraph.''.
    (b) Medicaid.--Section 1919(g)(2) of the Social Security Act (42 
U.S.C. 1396r(g)(2)) is amended by adding at the end the following:
                    ``(F) Advisory committee.--
                            ``(i) Establishment.--The Secretary shall 
                        establish an advisory committee on surveys 
                        under this paragraph.
                            ``(ii) Membership.--The membership of the 
                        advisory committee under clause (i) shall 
                        include advocates for residents of nursing 
                        facilities, members of survey teams under this 
                        subsection, and nursing home administrators.
                            ``(iii) Recommended standards.--The 
                        advisory committee under clause (i) shall make 
                        recommendations to the Secretary on standards 
                        for--
                                    ``(I) the adequate staffing of 
                                survey teams under this subsection;
                                    ``(II) the training of members of 
                                such teams; and
                                    ``(III) disclosing any contact 
                                between such members and individuals 
                                associated with nursing facilities, and 
                                limiting such contact to prevent 
                                inappropriate influence of such members 
                                by such individuals.
                            ``(iv) Other recommendations.--The advisory 
                        committee under clause (i) may also make 
                        recommendations to the Secretary on any other 
                        issue that would improve the survey process 
                        under this paragraph.''.

SEC. 6. REVIEW OF SURVEYS.

    (a) Medicare.--Section 1819(g)(2)(D) of the Social Security Act (42 
U.S.C. 1395i-3(g)(2)(D)) is amended--
            (1) by striking ``Each State'' and inserting the following:
                            ``(i) In general.--Each State''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Review of surveys.--The supervisors 
                        of the survey teams shall review each survey 
                        conducted under this subsection to ensure that 
                        any issues that impact quality of care that are 
                        identified by such surveys are consistently and 
                        appropriately described and rated by the survey 
                        teams.''.
    (b) Medicaid.--Section 1919(g)(2)(D) of the Social Security Act (42 
U.S.C. 1396r(g)(2)(D)) is amended--
            (1) by striking ``Each State'' and inserting the following:
                            ``(i) In general.--Each State''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Review of surveys.--The supervisors 
                        of the survey teams shall review each survey 
                        conducted under this subsection to ensure that 
                        any issues that impact quality of care that are 
                        identified by such surveys are consistently and 
                        appropriately described and rated by the survey 
                        teams.''.
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