[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1305 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1305

          To prevent health care facility-acquired infections.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 18, 2009

 Mr. Menendez introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
          To prevent health care facility-acquired infections.

    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 ``MRSA Infection Prevention and 
Patient Protection Act''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Acute care hospital.--The term ``acute care hospital'' 
        means a hospital that maintains and operates an emergency room 
        (including a trauma or burn center), surgical unit, birthing 
        facility, and such other unit that is highly susceptible to 
        acquiring or transmitting infections, as determined by the 
        Secretary through regulations.
            (2) Hospital.--The term ``hospital'' has the meaning given 
        such term in section 1861(e) of the Social Security Act (42 
        U.S.C. 1395x(e)) and includes critical access hospitals (as 
        defined in section 1861(mm) of such Act) and other entities 
        determined to be hospitals by the Secretary.
            (3) MRSA.--The term ``MRSA'' means Methicillin-resistant 
        Staphylococcus aureus.
            (4) Other infection.--The term ``other infection'' means an 
        infection that the Secretary, after consultation with the 
        Director of the Centers for Disease Control and Prevention and 
        other public health officials, as appropriate, and after public 
        hearing, determines to be, or to have the potential to become, 
        a serious source of morbidity and mortality in health care 
        facilities.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 3. HOSPITAL INFECTION PREVENTION PROGRAMS.

    (a) Regulations.--
            (1) In general.--Not later than 150 days after the date of 
        enactment of this Act, the Secretary, in consultation with the 
        Director of the Centers for Disease Control and Prevention and 
        such independent experts as the Secretary determines 
        appropriate, shall promulgate regulations that--
                    (A) provide a list of best practices for preventing 
                MRSA infections and such other antibiotic resistant 
                pathogens as the Secretary determines appropriate;
                    (B) define the term ``high risk hospital 
                departments'' for purposes of applying the best 
                practices provided for under subparagraph (A), which 
                may include surgical, burn, neonatal, and such other 
                departments as the Secretary determines;
                    (C) define the term ``serious source of morbidity 
                and mortality'' in quantitative terms for purposes of 
                determining the applicability of this Act to other 
                infections, except that such definition shall not 
                require morbidity and mortality rates of more than 1 
                percent of the estimated patient population at risk for 
                a particular infection in order for an infection to 
                qualify as a serious source of morbidity and mortality; 
                and
                    (D) provide screening, recordkeeping, and other 
                requirements as they relate to reductions in MRSA 
                infections.
            (2) Consistency.--The regulations promulgated under this 
        subsection shall be consistent with the requirements of this 
        Act.
            (3) Effective date.--The regulations promulgated under 
        paragraph (1) shall take effect on the date that is 30 days 
        after the date on which such regulations are published in the 
        Federal Register, but in no case later than 180 days after the 
        date of enactment of this Act.
    (b) Screening Requirements.--
            (1) In general.--Not later than 180 days after the date of 
        enactment of this Act, each acute care hospital shall screen 
        each patient entering an intensive care unit or other high risk 
        hospital department (as defined in the regulations promulgated 
        under subsection (a)(1)(B)).
            (2) Extension of requirements.--
                    (A) In general.--The Secretary, in consultation 
                with the Director of the Centers for Disease Control 
                and Prevention, shall establish a process and a 
                timetable for extending the screening requirements of 
                paragraph (1) to all patients admitted to all 
                hospitals.
                    (B) Requirements fully applied.--The timetable 
                established under subparagraph (A), shall require that 
                all patients be covered by the screening requirements 
                under paragraph (1) by not later than January 1, 2014.
                    (C) Waiver.--The Secretary may waive the 
                requirements of this paragraph if the Secretary 
                determines, at the recommendation of the Director of 
                the Centers for Disease Control and Prevention and 
                after public hearing, that the rate of MRSA infections 
                or other infections has declined to a level at which 
                further screening is no longer needed.
            (3) Medicare.--
                    (A) Requirement.--
                            (i) In general.--Section 1866(a)(1) of the 
                        Social Security Act (42 U.S.C. 1395cc(a)(1)) is 
                        amended--
                                    (I) by striking ``and'' at the end 
                                of subparagraph (U);
                                    (II) by striking the period at the 
                                end of subparagraph (V) and inserting 
                                ``, and''; and
                                    (III) by inserting after 
                                subparagraph (V) the following:
            ``(W) in the case of an acute care hospital (as defined in 
        section 2(1) of the MRSA Infection Prevention and Patient 
        Protection Act), to comply with the screening requirements 
        described in section 3 of such Act.''.
                            (ii) Effective date.--The amendments made 
                        by clause (i) shall apply to agreements entered 
                        into or renewed on or after the date that is 
                        180 days after the enactment of this Act.
                    (B) Medicare payment adjustments.--Not later than 
                January 1, 2011, the Secretary shall submit to the 
                appropriate committees of Congress, a report on whether 
                payment adjustments should be made under title XVIII of 
                the Social Security Act (42 U.S.C. 1395 et seq.) to 
                assist certain hospitals in defraying the cost of 
                screening for, and the subsequent treatment of, MRSA 
                infections (or other infections). In preparing such 
                report, the Secretary shall give special consideration 
                to the needs of rural, critical access, sole community, 
                and Medicare dependent hospitals, and disproportionate 
                share hospitals and other hospitals with a 
                disproportionate share of immune compromised patients.
    (c) Best Practices.--In addition to any other best practices 
contained in the regulations promulgated under subsection (a)(1)(A), 
each hospital shall comply with the following:
            (1) A hospital shall require contact (barrier) precautions, 
        as determined by the Secretary, be taken when treating patients 
        who test positive for MRSA colonization (as defined by the 
        Centers for Disease Control and Prevention).
            (2) Where possible, a hospital shall--
                    (A)(i) isolate, with the same staffing ratio per 
                bed as in the non-isolated beds of the hospital, or 
                cohort patients colonized or infected with MRSA; or
                            (ii) notify any patients with whom the 
                        infected patient may room that such patient has 
                        tested positive for MRSA;
                    (B) control and monitor the movements of such 
                patients within the hospital; and
                    (C) take whatever steps are needed to stop the 
                transmission of MRSA bacteria to patients who did not 
                come into the hospital infected or colonized with such 
                bacteria.
        The Secretary may suspend the application of this paragraph in 
        the case of an emergency.
            (3) All patients who test positive for MRSA shall be 
        informed of the results. All MRSA test results shall be noted 
        in the patient's medical record.
            (4) Each hospital shall, by January 1, 2010, adopt a policy 
        requiring any patient who has a MRSA infection to receive oral 
        and written instructions regarding aftercare and precautions to 
        prevent the spread of the infection to others.
            (5) Patients being discharged from intensive care units 
        shall be tested again for MRSA, and those patients testing 
        positive shall be informed of their status, and that status 
        shall be noted in the patient's medical records in case of 
        readmittance to a hospital.
            (6) A hospital shall educate its staff concerning modes of 
        transmission of MRSA, use of protective equipment, disinfection 
        policies and procedures, and other preventive measures.
            (7) A hospital shall provide other interventions, as the 
        Secretary determines to be necessary, for control of MRSA 
        infection.
    (d) Reporting.--
            (1) In general.--Not later than January 1, 2011, each 
        hospital shall, using the National Healthcare Safety Network of 
        the Centers for Disease Control and Prevention, report 
        hospital-acquired MRSA and other infections that occur in the 
        hospital facility. The Secretary shall develop a process for 
        the risk adjustment of such reports by hospitals.
            (2) Publication.--The Secretary shall develop a system for 
        the publication of hospital-specific infection rates, including 
        the rate of MRSA infections.
    (e) Non-Hospital Medicare Providers.--
            (1) MRSA infection reporting.--The Secretary, using the 
        MRSA infection and other infection information identified under 
        subsection (b) and such other billing and coding information as 
        necessary, shall promulgate regulations to--
                    (A) define the term ``infected transferred 
                patient'', to describe a patient who, after discharge 
                from, or treatment at, a non-hospital Medicare 
                provider, is admitted to the hospital with MRSA 
                infection (or other infection);
                    (B) establish a system for identifying infected 
                transferred patients;
                    (C) establish a system to promptly inform any 
                facility that has transferred an infected patient; and
                    (D) establish requirements that any non-hospital 
                Medicare provider that treats an infected transferred 
                patient described under subparagraph (A) and that 
                cannot provide a reasonable explanation that the 
                infection was not acquired in the facility, submit to 
                the Secretary an action plan describing how such 
                provider plans to reduce the incidence of such 
                infections.
            (2) Assistance.--The Secretary shall promulgate regulations 
        to develop a program to provide technical assistance and 
        educational materials to non-hospital Medicare providers 
        described in paragraph (1)(A) in order to assist in preventing 
        subsequent MRSA infections.
            (3) Publication of certain information.--If a non-hospital 
        Medicare provider identified using the system established under 
        paragraph (1) fails to take steps, as required by the 
        regulations promulgated under subparagraph (1)(D), to combat 
        MRSA infections, the Secretary shall publish the name of the 
        provider and the number of MRSA infections from such provider 
        in the previous year.
    (f) Assistance.--
            (1) In general.--To provide for the rapid implementation of 
        MRSA screening programs and initiatives through the 
        installation of certified MRSA screening equipment and the 
        provision of necessary support services, a hospital may submit 
        an application to the Secretary for a 1-year increase in the 
        amount of the capital-related costs payment made to the 
        hospital under the prospective payment system under section 
        1886(g) of the Social Security Act (42 U.S.C. 1395ww(g)). The 
        Secretary shall approve all requests that the Secretary 
        determines are reasonable and necessary.
            (2) Repayment.--A hospital that receives an increase under 
        paragraph (1) shall, not later than 4 years after the date of 
        receipt of such increase, reimburse the Secretary for the costs 
        of such increase. Such costs shall include the accrual of 
        interest at the rate payable for Federal Treasury notes. Such 
        reimbursement may be in the form of reduced capital-related 
        costs payments to the hospital under the system described in 
        paragraph (1) for the years following the year in which the 
        increase was received.
            (3) Certification system.--Not later than 180 days after 
        the date of enactment of this Act, the Secretary shall 
        promulgate regulations for the development of a system to 
        certify appropriate MRSA screening and support services for 
        purposes of this subsection.

SEC. 4. MRSA TESTING PILOT PROGRAM.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention (referred to in this section as the ``Director'') shall 
award a grant to 1 collaborative project involving an eligible hospital 
and qualified testing corporation on a competitive basis to carry out a 
pilot program designed to develop a rapid, cost-effective method for 
testing for MRSA using the polymerase chain reaction (referred to in 
this section as ``PCR'') or other molecular testing methods.
    (b) Purpose.--The pilot program described in subsection (a) shall 
be designed to--
            (1) develop a low-cost, nationally adoptable PCR-based 
        analytical system for timely MRSA testing and results;
            (2) develop the system described in paragraph (1) so that 
        it is affordable to hospitals, thereby enabling compliance with 
        mandated MRSA testing requirements;
            (3) develop a system for centralized reporting of results 
        receiving through such testing to appropriate governmental 
        agencies for the purpose of disease reporting and surveillance; 
        and
            (4) develop a technology platform that may be extended to 
        other infections that the Director identifies as priorities for 
        detection, treatment, and surveillance.
    (c) Eligibility.--The Secretary shall establish requirements 
regarding eligibility to receive a grant under this section, which 
shall include the following requirements:
            (1) The collaborate project shall be between a nonprofit 
        hospital organized for charitable purposes under section 
        501(c)(3) of the Internal Revenue Code of 1986 and a qualified 
        testing corporation.
            (2) The hospital shall serve as the beta test site for any 
        MRSA screening methods developed through the pilot program.
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