1.Short
title; table of contents
(a)This Act may be cited
as the Nursing Home Transparency and
Improvement Act of 2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Findings.
TITLE I—Improving transparency of information
Sec. 101. Required disclosure of ownership and additional
disclosable parties information.
Sec. 102. Accountability requirements.
Sec. 103. Nursing home compare Medicare website.
Sec. 104. Reporting of expenditures.
Sec. 105. Standardized complaint form.
Sec. 106. Ensuring staffing accountability.
TITLE II—Targeting Enforcement
Sec. 201. Civil money penalties.
Sec. 202. GAO study and report on the relative financial status
and performance of special focus facilities.
Sec. 203. National independent monitor pilot
program.
Sec. 204. Notification of facility closure.
Sec. 205. National demonstration projects on culture change and
use of information technology in nursing homes.
TITLE III—Improving staff training
Sec. 301. Dementia and abuse prevention training.
Sec. 302. Study and report on training required for certified
nurse aides and supervisory staff.
2.Congress makes the following
findings:
(1)The Nursing Home
Reform Act of 1987 remains one of the strongest laws in the United States to
protect the health, safety, and quality of life of elderly people and
individuals with disabilities who live in nursing homes.
(2)The nursing home
industry has changed dramatically in the 21 years since the enactment of the
Nursing Home Reform Act of 1987, with real estate asset holdings frequently
separated from operations in a manner that can frustrate efforts by regulators
to hold parent companies accountable for the quality of services that are
provided in their facilities.
(3)Although the
Centers for Medicare & Medicaid Services reimburses nursing homes for
services each year in an amount in excess of $75,000,000,000, the agency does
not always know who the owners and operators of the facilities are.
(4)Greater
transparency and accountability in the nursing home industry can be achieved by
simply requiring publicly and privately owned nursing homes to disclose
corporate entities that own individual nursing homes, and other entities with
which individual nursing homes have key financial, operational, and management
relationships.
(5)Transparency and
accountability can be further strengthened by development of an independent
monitor pilot program that would allow the Centers for Medicare & Medicaid
Services to examine the management of certain nursing home chains that have a
record of poor performance and to identify the root causes of quality and
safety problems occurring in individual nursing homes.
(6)The
Nursing Home Compare
Medicare website would be significantly
improved by the inclusion of timely, auditable information that is derived from
payroll data about the direct care staffing levels in all nursing homes across
the United States. Inclusion of information about staffing turnover and
retention rates in nursing homes, which are closely linked to the quality and
consistency of services, would also provide consumers with valuable
information.
(7)According to the
Alzheimer's Association, an estimated 70 percent of current residents of
nursing homes have some degree of cognitive impairment and direct care staff
who provide services to such residents would benefit from dementia management
and abuse prevention instruction as part of their training.
(8)When nursing
homes elect to close, residents and families generally require help finding
another suitable residence and to minimize transfer trauma
. Good
resident outcomes are achievable when nursing homes provide sufficient written
notice and develop a relocation plan for each resident, and when State
officials take responsibility for assuring that each resident is transferred to
the most appropriate facility or other community setting.
<enum>I</enum><header>Improving
transparency of information</header>
<section commented="no" display-inline="no-display-inline" id="HC94707591010497E8339B27F15E89098" section-type="subsequent-section"><enum>101.</enum><header>Required disclosure
of ownership and additional disclosable parties information</header>
<subsection commented="no" id="H6E65B08911734DBAA7F6141D646303AD"><enum>(a)</enum><header>In
general</header><text>Section 1124 of the Social Security Act (42 U.S.C.
1320a–3) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HDB071C2BAC2E4FF29D6B36EFB65FC31E" style="OLC">
<subsection commented="no" id="H5C74D816CC52417E9755A7EF36469932"><enum>(c)</enum><header>Required
disclosure of ownership and additional disclosable parties information</header>
<paragraph commented="no" id="HE4E919051477450DA85FC90996A60046"><enum>(1)</enum><header>Disclosure</header><text>A
facility shall have the information described in paragraph (2)
available—</text>
<subparagraph commented="no" id="H0E913B9CDA1541FFAE31F05DC1633E86"><enum>(A)</enum><text display-inline="yes-display-inline">during the period beginning on the date of
the enactment of this subsection and ending on the date such information is
made available to the public under section 101(b) of the
<short-title>Nursing Home Transparency and Improvement Act
of 2009</short-title>, for submission to the Secretary, the Inspector General
of the Department of Health and Human Services, the State in which the facility
is located, and the State long-term care ombudsman in the case where the
Secretary, the Inspector General, the State, or the State long-term care
ombudsman requests such information; and</text>
</subparagraph><subparagraph commented="no" id="H060ED8C8495944B69B0975D9384EB2C"><enum>(B)</enum><text>beginning on the
effective date of the final regulations promulgated under paragraph (3)(A), for
reporting such information in accordance with such final regulations.</text>
</subparagraph><continuation-text commented="no" continuation-text-level="paragraph">Nothing in subparagraph (A) shall be
construed as authorizing a facility to dispose of or delete information
described in such subparagraph after the effective date of the final
regulations promulgated under paragraph (3)(A).</continuation-text></paragraph><paragraph commented="no" id="H4A57ED78B6324E099ED8E7C328178D2F"><enum>(2)</enum><header>Information
described</header>
<subparagraph commented="no" id="HBD3DC888EE554C7498002D047900D89F"><enum>(A)</enum><header>In
general</header><text>The following information is described in this
paragraph:</text>
<clause commented="no" id="HC4C7751760314B43B3C729DCB79100A6"><enum>(i)</enum><text>The information
described in subsections (a) and (b), subject to subparagraph (C).</text>
</clause><clause commented="no" id="H791D0E3106BE49FAAF18A3279BF2722"><enum>(ii)</enum><text>The identity of
and information on—</text>
<subclause commented="no" id="H5F9385843F7B41D4B2A18CD0E0CC659E"><enum>(I)</enum><text>each member of the
governing body of the facility, including the name, title, and period of
service of each such member;</text>
</subclause><subclause commented="no" id="HB1191DAFBB214CD2A0D304A0CAD55710"><enum>(II)</enum><text>each person or
entity who is an officer, director, member, partner, trustee, or managing
employee of the facility, including the name, title, and period of service of
each such person or entity; and</text>
</subclause><subclause commented="no" id="H4D29E60FB8DD4A14B03EEC0300C2C600"><enum>(III)</enum><text>each person or
entity who is an additional disclosable party of the facility.</text>
</subclause></clause><clause commented="no" id="H76F711008C404C26893BEE4CF823972B"><enum>(iii)</enum><text>The
organizational structure of each additional disclosable party of the facility
and a description of the relationship of each such additional disclosable party
to the facility and to one another.</text>
</clause></subparagraph><subparagraph commented="no" id="HC943982A116B488CB7FE4F0182DDC0C0"><enum>(B)</enum><header>Special rule
where information is already reported or submitted</header><text>To the extent
that information reported by a facility to the Internal Revenue Service on Form
990, information submitted by a facility to the Securities and Exchange
Commission, or information otherwise submitted to the Secretary or any other
Federal agency contains the information described in clauses (i), (ii), or
(iii) of subparagraph (A), the facility may provide such Form or such
information submitted to meet the requirements of paragraph (1).</text>
</subparagraph><subparagraph commented="no" id="HA8C4567D6AE9413E8C6037535C030994"><enum>(C)</enum><header>Special
rule</header><text>In applying subparagraph (A)(i)—</text>
<clause commented="no" id="HE575A92ACA9F46FB97BA00DA81E90275"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to subsections (a) and (b),
<quote>ownership or control interest</quote> shall include direct or indirect
interests, including such interests in intermediate entities; and</text>
</clause><clause commented="no" id="H001ED964BFA449AB95DF6BB7A028036E"><enum>(ii)</enum><text>subsection
(a)(3)(A)(ii) shall include the owner of a whole or part interest in any
mortgage, deed of trust, note, or other obligation secured, in whole or in
part, by the entity or any of the property or assets thereof, if the interest
is equal to or exceeds 5 percent of the total property or assets of the
entirety.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="HBEBF04C52AEE4FFD8BAA5FE00B939C9"><enum>(3)</enum><header>Reporting</header>
<subparagraph commented="no" id="HC4089CF4CC474CB1BD4833E0C900E145"><enum>(A)</enum><header>In
general</header><text>Not later than the date that is 2 years after the date of
the enactment of this subsection, the Secretary shall promulgate final
regulations requiring, effective on the date that is 90 days after the date on
which such final regulations are published in the Federal Register, a facility
to report the information described in paragraph (2) to the Secretary in a
standardized format, and such other regulations as are necessary to carry out
this subsection. Such final regulations shall ensure that the facility
certifies, as a condition of participation and payment under the program under
title XVIII or XIX, that the information reported by the facility in accordance
with such final regulations is, to the maximum extent practicable (as
determined by the facility), accurate and current.</text>
</subparagraph><subparagraph commented="no" id="H57036E3FB1504CF299689D6C9F3BAA57"><enum>(B)</enum><header>Guidance</header><text>The
Secretary shall provide guidance and technical assistance to States on how to
adopt the standardized format under subparagraph (A).</text>
</subparagraph></paragraph><paragraph commented="no" id="H17DB32E8FA564A95B6C8EF62CC4439DA"><enum>(4)</enum><header>No effect on
existing reporting requirements</header><text>Nothing in this subsection shall
reduce, diminish, or alter any reporting requirement for a facility that is in
effect as of the date of the enactment of this subsection.</text>
</paragraph><paragraph commented="no" id="H56296579BEEF407BBA7D769C95CFAF0"><enum>(5)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph commented="no" id="H212F3AD308394DFB8EFAEE89F8B19B4C"><enum>(A)</enum><header>Additional
disclosable party</header><text>The term <term>additional disclosable
party</term> means, with respect to a facility, any person or entity
who—</text>
<clause commented="no" id="H8CCE317CDE2E481C81CF4B1DD5826497"><enum>(i)</enum><text display-inline="yes-display-inline">exercises operational, financial, or
managerial control over the facility or a part thereof, or provides policies or
procedures for any of the operations of the facility, or provides financial or
cash management services to the facility;</text>
</clause><clause commented="no" id="H3DB246341E9F43D4B4FE00180427A5BB"><enum>(ii)</enum><text display-inline="yes-display-inline">leases or subleases real property to the
facility, or owns a whole or part interest equal to or exceeding 5 percent of
the total value of such real property;</text>
</clause><clause commented="no" id="H1F12E5514AC747089D817F9F74DFB791"><enum>(iii)</enum><text>lends funds or
provides a financial guarantee to the facility in an amount which is equal to
or exceeds $50,000; or</text>
</clause><clause commented="no" id="HC6EF3C064E594B3985BB211F9BD66814"><enum>(iv)</enum><text>provides
management or administrative services, management or clinical consulting
services, or accounting or financial services to the facility.</text>
</clause></subparagraph><subparagraph commented="no" id="H9548B38C35DA41AD8BFCFD8D5519327D"><enum>(B)</enum><header>Facility</header><text>The
term <term>facility</term> means a disclosing entity which is—</text>
<clause commented="no" id="H022585BAA43D4599875E1DF4F44F7620"><enum>(i)</enum><text>a skilled nursing
facility (as defined in section 1819(a)); or</text>
</clause><clause commented="no" id="HCBB0EB08C8914DA98592C88E30BB3199"><enum>(ii)</enum><text>a nursing
facility (as defined in section 1919(a)).</text>
</clause></subparagraph><subparagraph commented="no" id="HF2233F5A2C7E450B0000DF77DCE7065C"><enum>(C)</enum><header>Managing
employee</header><text>The term <term>managing employee</term> means, with
respect to a facility, an individual (including a general manager, business
manager, administrator, director, or consultant) who directly or indirectly
manages, advises, or supervises any element of the practices, finances, or
operations of the facility.</text>
</subparagraph><subparagraph commented="no" id="HE42918F5F6C74AF9BF1B5290DF736600"><enum>(D)</enum><header>Organizational
structure</header><text>The term <term>organizational structure</term> means,
in the case of—</text>
<clause commented="no" id="HAE1E261090284531867E6CF0D650EF22"><enum>(i)</enum><text>a corporation, the
officers, directors, and shareholders of the corporation who have an ownership
interest in the corporation which is equal to or exceeds 5 percent;</text>
</clause><clause commented="no" id="H477FFCC0EDC44C4091DBE77052D206B9"><enum>(ii)</enum><text>a limited
liability company, the members and managers of the limited liability company
(including, as applicable, what percentage each member and manager has of the
ownership interest in the limited liability company);</text>
</clause><clause commented="no" id="H61F29ABFD4D1493DAC065331253156AE"><enum>(iii)</enum><text>a general
partnership, the partners of the general partnership;</text>
</clause><clause commented="no" id="H9AADA5568D044BEF8374261B6F3F4B77"><enum>(iv)</enum><text>a limited
partnership, the general partners and any limited partners of the limited
partnership who have an ownership interest in the limited partnership which is
equal to or exceeds 10 percent;</text>
</clause><clause commented="no" id="HFF2D56B496814ADD82C2E527D51744E"><enum>(v)</enum><text>a trust, the
trustees of the trust;</text>
</clause><clause commented="no" id="H9293AEF9633549EF9C09A82392858908"><enum>(vi)</enum><text>an individual,
contact information for the individual; and</text>
</clause><clause commented="no" id="H5DD4FC47A6924DBF99AE00532CC666DA"><enum>(vii)</enum><text>any other person
or entity, such information as the Secretary determines
appropriate.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HF4C90724BBD444D59EB0E1A298EFED37"><enum>(b)</enum><header>Public
availability of information</header>
<paragraph commented="no" id="HCA70F7E0B9F74961ADF5E500E01E2D81"><enum>(1)</enum><header>In
general</header><text>Not later than the date that is 1 year after the date on
which the final regulations promulgated under section 1124(c)(3)(A) of the
Social Security Act, as added by subsection (a), are published in the Federal
Register, the Secretary shall make the information reported in accordance with
such final regulations available to the public in accordance with procedures
established by the Secretary.</text>
</paragraph><paragraph commented="no" id="HE11686731C97428EA80091FADEF70040"><enum>(2)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph commented="no" id="H1E570C2255DE4829A1D1E63002F3C23"><enum>(A)</enum><header>Nursing
facility</header><text>The term <term>nursing facility</term> has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).</text>
</subparagraph><subparagraph commented="no" id="H30966D3A6310401693F135FA8F94F146"><enum>(B)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</subparagraph><subparagraph commented="no" id="HCC7A7DC26B504DB7B0C9147079E6BFB5"><enum>(C)</enum><header>Skilled nursing
facility</header><text>The term <term>skilled nursing facility</term> has the
meaning given such term in section 1819(a) of the Social Security Act (42
U.S.C. 1395i–3(a)).</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H915663BFFC31461582C3581B2CC9F9F0"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph commented="no" id="id29071803862948BB95C3688B6627D553"><enum>(1)</enum><header>In
general</header>
<subparagraph commented="no" id="HEA7DF9440EFF4856909294CD42695934"><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 striking subparagraph (B) and redesignating
subparagraph (C) as subparagraph (B).</text>
</subparagraph><subparagraph commented="no" id="H76BD72C462C34451934D2FFF971C16C4"><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 striking subparagraph (B) and redesignating
subparagraph (C) as subparagraph (B).</text>
</subparagraph></paragraph><paragraph commented="no" id="id8FB777E73C6847CFB0FF0F529DFD63D9"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by paragraph (1) shall take effect on
the date on which the Secretary makes the information described in subsection
(b)(1) available to the public under such subsection.</text>
</paragraph></subsection></section><section id="HA1B339EF583245CF86DDAD30722F9E5C" section-type="subsequent-section"><enum>102.</enum><header>Accountability
requirements</header>
<subsection id="H071744F4551A49BC8B44B5021D45FB6E"><enum>(a)</enum><header>Effective
compliance and ethics programs</header>
<paragraph id="H0EDA43DB599C4317933B20C9D42E3F5E"><enum>(1)</enum><header>Skilled nursing
facilities</header><text display-inline="yes-display-inline">Section 1819(d)(1)
of the Social Security Act (42 U.S.C. 1395i–3(d)(1)) is amended by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H7ADEC3AD3DED4A30A3E7F3039221C8CD" style="OLC">
<subparagraph id="HBB4E215F190149DAA9A83BC3DEBD08C"><enum>(D)</enum><header>Compliance and
ethics programs</header>
<clause display-inline="no-display-inline" id="HEDC3736C96C345DAA47BA9E722B5324"><enum>(i)</enum><header>Requirement</header><text display-inline="yes-display-inline">On or after the date that is 36 months
after the date of the enactment of this subparagraph, a skilled nursing
facility shall, with respect to the entity that operates the facility (in this
subparagraph referred to as the <quote>operating organization</quote> or
<quote>organization</quote>), have in operation a compliance and ethics program
that is effective in preventing and detecting criminal, civil, and
administrative violations under this Act and in promoting quality of care
consistent with regulations developed under clause (ii).</text>
</clause><clause id="H7321FB1A7CA5474092A03430273D6B00"><enum>(ii)</enum><header>Development of
regulations</header>
<subclause id="HC3045884AA2241AD004C7890D4CFAA32"><enum>(I)</enum><header>In
general</header><text>Not later than the date that is 2 years after such date
of the enactment, the Secretary, working jointly with the Inspector General of
the Department of Health and Human Services, shall promulgate regulations for
an effective compliance and ethics program for operating organizations, which
may include a model compliance program.</text>
</subclause><subclause id="H954EB7175B6E486BA63282DA5D2FF555"><enum>(II)</enum><header> Design of
regulations</header><text display-inline="yes-display-inline">Such regulations
with respect to specific elements or formality of a program may vary with the
size of the organization, such that larger organizations should have a more
formal program and include established written policies defining the standards
and procedures to be followed by its employees. Such requirements may
specifically apply to the corporate level management of multi unit nursing home
chains.</text>
</subclause><subclause id="HFB9232AE01274AE9AD40D4D5D6CA8BE6"><enum>(III)</enum><header>Evaluation</header><text>Not
later than 3 years after the date of promulgation of regulations under this
clause, the Secretary shall complete an evaluation of the compliance and ethics
programs required to be established under this subparagraph. Such evaluation
shall determine if such programs led to changes in deficiency citations,
changes in quality performance, or changes in other metrics of patient quality
of care. The Secretary shall submit to Congress a report on such evaluation and
shall include in such report such recommendations regarding changes in the
requirements for such programs as the Secretary determines appropriate.</text>
</subclause></clause><clause id="H46D98600186B4281BAD14227A94200E9"><enum>(iii)</enum><header>Requirements
for compliance and ethics programs</header><text display-inline="yes-display-inline">In this subparagraph, the term
<term>compliance and ethics program</term> means, with respect to a skilled
nursing facility, a program of the operating organization that—</text>
<subclause id="HA465CE1906CE476AB58CBA6121B380EE"><enum>(I)</enum><text>has been
reasonably designed, implemented, and enforced so that it generally will be
effective in preventing and detecting criminal, civil, and administrative
violations under this Act and in promoting quality of care; and</text>
</subclause><subclause id="HBAA8EF5D13394DAA8912E62C1318A108"><enum>(II)</enum><text>includes at least
the required components specified in clause (iv).</text>
</subclause></clause><clause id="HCE08F8077E4A4DD4B71796E5B8EAC7E"><enum>(iv)</enum><header>Required
components of program</header><text>The required components of a compliance and
ethics program of an organization are the following:</text>
<subclause id="HD88FB231C596411A8648CF00CC92180"><enum>(I)</enum><text display-inline="yes-display-inline">The organization must have established
compliance standards and procedures to be followed by its employees and other
agents that are reasonably capable of reducing the prospect of criminal, civil,
and administrative violations under this Act.</text>
</subclause><subclause id="H171159BE0AFB4AD386E760BF753409E"><enum>(II)</enum><text display-inline="yes-display-inline">Specific individuals within high-level
personnel of the organization must have been assigned overall responsibility to
oversee compliance with such standards and procedures and has sufficient
resources and authority to assure such compliance.</text>
</subclause><subclause id="H3B558F5A3C6B4CB1ABA9564C9585C158"><enum>(III)</enum><text display-inline="yes-display-inline">The organization must have used due care
not to delegate substantial discretionary authority to individuals whom the
organization knew, or should have known through the exercise of due diligence,
had a propensity to engage in criminal, civil, and administrative violations
under this Act.</text>
</subclause><subclause id="H0859E13165D54D2AAFCCE8815C5957E"><enum>(IV)</enum><text display-inline="yes-display-inline">The organization must have taken steps to
communicate effectively its standards and procedures to all employees and other
agents, such as by requiring participation in training programs or by
disseminating publications that explain in a practical manner what is
required.</text>
</subclause><subclause id="H76B82EDEF97941E1A72407A2791BAE19"><enum>(V)</enum><text display-inline="yes-display-inline">The organization must have taken reasonable
steps to achieve compliance with its standards, such as by utilizing monitoring
and auditing systems reasonably designed to detect criminal, civil, and
administrative violations under this Act by its employees and other agents and
by having in place and publicizing a reporting system whereby employees and
other agents could report violations by others within the organization without
fear of retribution.</text>
</subclause><subclause id="H127C8C2B455C4170906EACAAED6ED500"><enum>(VI)</enum><text display-inline="yes-display-inline">The standards must have been consistently
enforced through appropriate disciplinary mechanisms, including, as
appropriate, discipline of individuals responsible for the failure to detect an
offense.</text>
</subclause><subclause id="H0829ADC3100D404DAB87809D9C65A965"><enum>(VII)</enum><text display-inline="yes-display-inline">After an offense has been detected, the
organization must have taken all reasonable steps to respond appropriately to
the offense and to prevent further similar offenses, including any necessary
modification to its program to prevent and detect criminal, civil, and
administrative violations under this Act.</text>
</subclause><subclause id="H18C56787C4774C50BECCCBC1C01F1BF8"><enum>(VIII)</enum><text display-inline="yes-display-inline">The organization must periodically
undertake reassessment of its compliance program to identify changes necessary
to reflect changes within the organization and its
facilities.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H36A17F171E5B4A16A442400089474E60"><enum>(2)</enum><header>Nursing
facilities</header><text>Section 1919(d)(1) of the Social Security Act (42
U.S.C. 1396r(d)(1)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H98868F1091594916872CBA655383006C" style="OLC">
<subparagraph id="HBE8C7BA4C172478A00E79CC333B0BE00"><enum>(D)</enum><header>Compliance and
ethics program</header>
<clause display-inline="no-display-inline" id="HC979EAE2AE304B91A18F8EB48DB98C00"><enum>(i)</enum><header>Requirement</header><text>On
or after the date that is 36 months after the date of the enactment of this
subparagraph, a nursing facility shall, with respect to the entity that
operates the facility (in this subparagraph referred to as the <quote>operating
organization</quote> or <quote>organization</quote>), have in operation a
compliance and ethics program that is effective in preventing and detecting
criminal, civil, and administrative violations under this Act and in promoting
quality of care consistent with regulations developed under clause (ii).</text>
</clause><clause id="HA1F6AD43314044B58BE5007328AED9FB"><enum>(ii)</enum><header>Development of
regulations</header>
<subclause id="H5DA569570DA748F98D7107B5CA6F5EB1"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than the
date that is 2 years after such date of the enactment, the Secretary, in
consultation with the Inspector General of the Department of Health and Human
Services, shall develop regulations for an effective compliance and ethics
program for operating organizations, which may include a model compliance
program.</text>
</subclause><subclause id="HF27818A06F0D4F6C9C3409B02E009383"><enum>(II)</enum><header> Design of
regulations</header><text display-inline="yes-display-inline">Such regulations
with respect to specific elements or formality of a program may vary with the
size of the organization, such that larger organizations should have a more
formal program and include established written policies defining the standards
and procedures to be followed by its employees. Such requirements may
specifically apply to the corporate level management of multi unit nursing home
chains.</text>
</subclause><subclause id="H90FD99247E7845A9A535D929D93B7E43"><enum>(III)</enum><header>Evaluation</header><text display-inline="yes-display-inline">Not later than 3 years after the date of
promulgation of regulations under this clause the Secretary shall complete an
evaluation of the compliance and ethics programs required to be established
under this subparagraph. Such evaluation shall determine if such programs led
to changes in deficiency citations, changes in quality performance, or changes
in other metrics of patient quality of care. The Secretary shall submit to
Congress a report on such evaluation and shall include in such report such
recommendations regarding changes in the requirements for such programs as the
Secretary determines appropriate.</text>
</subclause></clause><clause id="H396FE65397664268BB22896DBDC8CBFA"><enum>(iii)</enum><header>Requirements
for compliance and ethics programs</header><text display-inline="yes-display-inline">In this subparagraph, the term
<term>compliance and ethics program</term> means, with respect to a nursing
facility, a program of the operating organization that—</text>
<subclause id="H3A1E5D96C856429F8E12D9BF564938E4"><enum>(I)</enum><text>has been
reasonably designed, implemented, and enforced so that it generally will be
effective in preventing and detecting criminal, civil, and administrative
violations under this Act and in promoting quality of care; and</text>
</subclause><subclause id="H6694B9F1D6C64D01AA912EDA7CA1ED5B"><enum>(II)</enum><text>includes at least
the required components specified in clause (iv).</text>
</subclause></clause><clause id="HD81ED47E18BF470AB295F8188053124B"><enum>(iv)</enum><header>Required
components of program</header><text>The required components of a compliance and
ethics program of an organization are the following:</text>
<subclause id="H1999B401C51E44F782C936F9DADE9155"><enum>(I)</enum><text display-inline="yes-display-inline">The organization must have established
compliance standards and procedures to be followed by its employees and other
agents that are reasonably capable of reducing the prospect of criminal, civil,
and administrative violations under this Act.</text>
</subclause><subclause id="H39BC607DB9E346B3B43886F8A261C8EF"><enum>(II)</enum><text display-inline="yes-display-inline">Specific individuals within high-level
personnel of the organization must have been assigned overall responsibility to
oversee compliance with such standards and procedures and has sufficient
resources and authority to assure such compliance.</text>
</subclause><subclause id="HBF9DCFE6DC7C4B07BD93BA00E952AAD0"><enum>(III)</enum><text display-inline="yes-display-inline">The organization must have used due care
not to delegate substantial discretionary authority to individuals whom the
organization knew, or should have known through the exercise of due diligence,
had a propensity to engage in criminal, civil, and administrative violations
under this Act.</text>
</subclause><subclause id="H957DBE04A01A4C07BCCB16002F5B5372"><enum>(IV)</enum><text display-inline="yes-display-inline">The organization must have taken steps to
communicate effectively its standards and procedures to all employees and other
agents, such as by requiring participation in training programs or by
disseminating publications that explain in a practical manner what is
required.</text>
</subclause><subclause id="H0B1EA14A3B1A45B49C3D4FBAF9269724"><enum>(V)</enum><text display-inline="yes-display-inline">The organization must have taken reasonable
steps to achieve compliance with its standards, such as by utilizing monitoring
and auditing systems reasonably designed to detect criminal, civil, and
administrative violations under this Act by its employees and other agents and
by having in place and publicizing a reporting system whereby employees and
other agents could report violations by others within the organization without
fear of retribution.</text>
</subclause><subclause id="H5614BC4EB2D2453A8DD891389761FB30"><enum>(VI)</enum><text display-inline="yes-display-inline">The standards must have been consistently
enforced through appropriate disciplinary mechanisms, including, as
appropriate, discipline of individuals responsible for the failure to detect an
offense.</text>
</subclause><subclause id="H4171C91C698743C993AC85E26BF1088"><enum>(VII)</enum><text display-inline="yes-display-inline">After an offense has been detected, the
organization must have taken all reasonable steps to respond appropriately to
the offense and to prevent further similar offenses, including any necessary
modification to its program to prevent and detect criminal, civil, and
administrative violations under this Act.</text>
</subclause><subclause id="H918ADFD3363144FA849B67009E7467F2"><enum>(VIII)</enum><text display-inline="yes-display-inline">The organization must periodically
undertake reassessment of its compliance program to identify changes necessary
to reflect changes within the organization and its
facilities.</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF00D8105341F42FBBC82C930E5973F00"><enum>(b)</enum><header>Quality
assurance and performance improvement program</header>
<paragraph id="id76974AF59ACC45A092DD9CDD44E5739B"><enum>(1)</enum><header>Skilled nursing
facilities</header><text>Section 1819(b)(1)(B) of the Social Security Act (42
U.S.C. 1395i–3(b)(1)(B)) is amended—</text>
<subparagraph id="idEB017464927E486693AD9627D66B7800"><enum>(A)</enum><text>by striking
<quote><header-in-text level="subparagraph" style="OLC">Assurance</header-in-text>.—A skilled nursing facility</quote> and
inserting “<header-in-text level="subparagraph" style="OLC">Assurance and
Quality Assurance and Performance Improvement Program</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="idAC007FCB188B447C815C42B77791A397" style="OLC">
<clause id="id1B23D63F707049D2B6DDBB5A2E2B1AC0"><enum>(i)</enum><header>In
general</header><text>A skilled nursing
facility</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id687546140BB64B5399352D8945B9941B"><enum>(B)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id27CC1166E99046B28897BCE1690F282F" style="OLC">
<clause id="idD8AF3A5FF0474BBCB094F688636CDA2C"><enum>(ii)</enum><header>Quality
assurance and performance improvement program</header>
<subclause id="idCF8A38B848E54FFABF2E93DDC5327D24"><enum>(I)</enum><header>In
general</header><text>Not later than December 31, 2011, the Secretary shall
establish and implement a quality assurance and performance improvement program
(in this subparagraph referred to as the <quote>QAPI program</quote>) for
skilled nursing facilities, including multi unit chains of such facilities.
Under the QAPI program, the Secretary shall establish standards relating to
quality assurance and performance improvement with respect to such facilities
and provide technical assistance to such facilities on the development of best
practices in order to meet such standards. Not later than 1 year after the date
on which the regulations are promulgated under subclause (II), a skilled
nursing facility must submit to the Secretary a plan for the facility to meet
such standards and implement such best practices, including how to coordinate
the implementation of such plan with quality assessment and assurance
activities conducted under clause (i).</text>
</subclause><subclause id="id1F7C47AE56B4498A8EB6B5D0F75E33C8"><enum>(II)</enum><header>Regulations</header><text>The
Secretary shall promulgate regulations to carry out this
clause.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="idBBB92A7FBC0542A29D508675B3A33067"><enum>(2)</enum><header>Nursing
facilities</header><text>Section 1919(b)(1)(B) of the Social Security Act (42
U.S.C. 1396r(b)(1)(B)) is amended—</text>
<subparagraph id="id140FA7E91423476C8AB53FF7116CCDA1"><enum>(A)</enum><text>by striking
<quote><header-in-text level="subparagraph" style="OLC">Assurance</header-in-text>.—A nursing facility</quote> and
inserting “<header-in-text level="subparagraph" style="OLC">Assurance and
Quality Assurance and Performance Improvement Program</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="idDC22F52162714A3B87B14B9E8146CEE6" style="OLC">
<clause id="idD52D498CBA3940A2955DB76F3AF6254C"><enum>(i)</enum><header>In
general</header><text>A nursing
facility</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id88D5FD1497B1490F8689B8272B7880B5"><enum>(B)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="idC5E863322FAE4FDAB71144E8BD8A985D" style="OLC">
<clause id="id56E4F702CC7C4560BFC72DB2BF1B738A"><enum>(ii)</enum><header>Quality
assurance and performance improvement program</header>
<subclause id="idED935F9381354C4DBE50AA6B2DC3BA56"><enum>(I)</enum><header>In
general</header><text>Not later than December 31, 2011, the Secretary shall
establish and implement a quality assurance and performance improvement program
(in this subparagraph referred to as the <quote>QAPI program</quote>) for
nursing facilities, including multi unit chains of such facilities. Under the
QAPI program, the Secretary shall establish standards relating to quality
assurance and performance improvement with respect to such facilities and
provide technical assistance to such facilities on the development of best
practices in order to meet such standards. Not later than 1 year after the date
on which the regulations are promulgated under subclause (II), a nursing
facility must submit to the Secretary a plan for the facility to meet such
standards and implement such best practices, including how to coordinate the
implementation of such plan with quality assessment and assurance activities
conducted under clause (i).</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="idFA335E285DCA4B83935564EDC5442ED7"><enum>(II)</enum><header>Regulations</header><text>The
Secretary shall promulgate regulations to carry out this
clause.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></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="idC053576C1DBC43F2822AC9F9095702A7"><enum>(i)</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>(ii)</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 links to the facility plan of correction or other
response to such report.</text>
</clause><clause id="idDEDA554144A84DC3A9E63D3D959A9CFC"><enum>(iii)</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>(iv)</enum><text>A summary of
information on enforcement that includes the number of complaints, including
the number of such complaints which the Secretary finds are substantiated, and
remedies proposed and imposed by the Secretary or a State with respect to a
skilled nursing facility during the preceding 3 years.</text>
</clause><clause id="id2123B97784DD46C59358AD3F1812136E"><enum>(v)</enum><text>A
summary of expenditures by skilled nursing facilities for wages and benefits of
direct care staff (based on information submitted under section
1888(f)).</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 the
enactment of this subsection.</text>
</clause><clause id="id266FED9674664E6585577B0327520D6B"><enum>(ii)</enum><header>Exception</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 requirement under subsection (b)(8)(C)(ii) is implemented.</text>
</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 the
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 the 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 the 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="idED885648D3114BE59901ADDBD9222E39"><enum>(i)</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>(ii)</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 links to the facility plan of correction or other
response to such report.</text>
</clause><clause id="idF0BF669A71E747C19824C79FEBA43DC4"><enum>(iii)</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>(iv)</enum><text>A summary of
information on enforcement that includes the number of complaints, including
the number of such complaints which the Secretary finds are substantiated, and
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 the
enactment of this subsection.</text>
</clause><clause id="idAD52591968F542628E33AF5E57CE8D7E"><enum>(ii)</enum><header>Exception</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 requirement under subsection (b)(8)(C)(ii) is implemented.</text>
</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 the
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 the 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 the 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>(E)</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>(E)</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 the 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="H4D4969212E834D65AC47ACA731F48"><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="HC5275DB17B6445C500AF9926CEC74CD" style="OLC">
<subsection commented="no" id="H8808E009680B4CAB885C2EDC0000B2D9"><enum>(f)</enum><header>Reporting of
direct care expenditures</header>
<paragraph id="HA3C0BF5A1EA24CD4B22CF8378E11D45D"><enum>(1)</enum><header>In
general</header><text>For cost reports submitted under this title for cost
reporting periods beginning on or after the date that is 2 years after the date
of the enactment of this subsection, skilled nursing facilities shall
separately report expenditures for wages and benefits for direct care staff
(breaking out (at a minimum) registered nurses, licensed professional nurses,
certified nurse assistants, and other medical and therapy staff).</text>
</paragraph><paragraph id="H386AEB7341E344C3A2D400205700FD64"><enum>(2)</enum><header>Modification of
form</header><text>The Secretary, in consultation with private sector
accountants experienced with Medicare and Medicaid nursing facility home cost
reports, shall redesign such reports to meet the requirement of paragraph (1)
not later than 1 year after the date of the enactment of this
subsection.</text>
</paragraph><paragraph id="H17B1B90C2C3F44D88419FEFA9D069650"><enum>(3)</enum><header>Categorization
by functional accounts</header><text>Not later than 30 months after the date of
the enactment of this subsection, the Secretary, working in consultation with
the Medicare Payment Advisory Commission, the Medicaid and CHIP Payment and
Access Commission, the Inspector General of the Department of Health and Human
Services, and other expert parties the Secretary determines appropriate, shall
take the expenditures listed on cost reports, as modified under paragraph (1),
submitted by skilled nursing facilities and categorize such expenditures,
regardless of any source of payment for such expenditures, for each skilled
nursing facility into the following functional accounts on an annual
basis:</text>
<subparagraph commented="no" id="HCDDC9E1126C14F1F89CC02A2077C8E14"><enum>(A)</enum><text>Spending on direct
care services (including nursing, therapy, and medical services).</text>
</subparagraph><subparagraph commented="no" id="HEFE6BBEA53774561B66FF2D6B81EEA23"><enum>(B)</enum><text>Spending on
indirect care (including housekeeping and dietary services).</text>
</subparagraph><subparagraph commented="no" id="H84003DD6DEFE4F0AA8CC3244F09E6853"><enum>(C)</enum><text>Capital assets
(including building and land costs).</text>
</subparagraph><subparagraph commented="no" id="H7094D7B8F1784C60898FDDE8D95C3EDB"><enum>(D)</enum><text>Administrative
services costs.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFA94F23CCD084C80A6F69948960230D7"><enum>(4)</enum><header>Availability of
information submitted</header><text>The Secretary shall establish procedures to
make information on expenditures submitted under this subsection readily
available to interested parties upon request, subject to such requirements as
the Secretary may specify under the procedures established under this
paragraph.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="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 the enactment of this Act.</text>
</subsection></section><section id="HEAB5CC15623F457483348FBCF186AE07"><enum>106.</enum><header>Ensuring
staffing accountability</header>
<subsection id="HC5244FB7F66142788E4E5D9D2E75A97D"><enum>(a)</enum><header>Skilled nursing
facilities</header><text>Section 1819(b)(8) of the Social Security Act (42
U.S.C. 1395i–3(b)(8)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H4A52BC95197C4F1D93CB2EDE057E374D" style="OLC">
<subparagraph id="H884D602043DD407691CE2BB50430010"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header><text display-inline="yes-display-inline">Beginning not later than 2 years after the
date of the enactment of this subparagraph, and after consulting with State
long-term care ombudsman programs, consumer advocacy groups, provider
stakeholder groups, employees and their representatives, and other parties the
Secretary deems appropriate, the Secretary shall require a skilled nursing
facility to electronically submit to the Secretary direct care staffing
information (including information with respect to agency and contract staff)
based on payroll and other verifiable and auditable data in a uniform format
(according to specifications established by the Secretary in consultation with
such programs, groups, and parties). Such specifications shall require that the
information submitted under the preceding sentence—</text>
<clause id="H41D6934A9A45419EA7CDC13E55736688"><enum>(i)</enum><text display-inline="yes-display-inline">specify the category of work a certified
employee performs (such as whether the employee is a registered nurse, licensed
practical nurse, licensed vocational nurse, certified nursing assistant,
therapist, or other medical personnel);</text>
</clause><clause id="HC2FAA0C741374CB3BDF22300B81C0946"><enum>(ii)</enum><text>include resident
census data and information on resident case mix;</text>
</clause><clause id="HAA4766600385450397B7E307BC9D921F"><enum>(iii)</enum><text>include a
regular reporting schedule; and</text>
</clause><clause id="H07FAE88EC6EB411200D44098584788C6"><enum>(iv)</enum><text>include
information on employee turnover and tenure and on the hours of care provided
by each category of certified employees referenced in clause (i) per resident
per day.</text>
</clause><continuation-text continuation-text-level="subparagraph">Nothing
in this subparagraph shall be construed as preventing the Secretary from
requiring submission of such information with respect to specific categories,
such as nursing staff, before other categories of certified employees.
Information under this subparagraph with respect to agency and contract staff
shall be kept separate from information on employee
staffing.</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H74677E639C7F4F3A85CFFED406BA7F01"><enum>(b)</enum><header>Nursing
facilities</header><text>Section 1919(b)(8) of the Social Security Act (42
U.S.C. 1396r(b)(8)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H0CD586B67F4E46F9BAA983E08054D400" style="OLC">
<subparagraph commented="no" id="H6515EA4AC9E74A4DB9D474EA74AAC000"><enum>(C)</enum><header>Submission of
staffing information based on payroll data in a uniform format</header><text display-inline="yes-display-inline">Beginning not later than 2 years after the
date of the enactment of this subparagraph, and after consulting with State
long-term care ombudsman programs, consumer advocacy groups, provider
stakeholder groups, employees and their representatives, and other parties the
Secretary deems appropriate, the Secretary shall require a nursing facility to
electronically submit to the Secretary direct care staffing information
(including information with respect to agency and contract staff) based on
payroll and other verifiable and auditable data in a uniform format (according
to specifications established by the Secretary in consultation with such
programs, groups, and parties). Such specifications shall require that the
information submitted under the preceding sentence—</text>
<clause commented="no" id="HC3532A48EC534D39853723D72978979F"><enum>(i)</enum><text>specify the
category of work a certified employee performs (such as whether the employee is
a registered nurse, licensed practical nurse, licensed vocational nurse,
certified nursing assistant, therapist, or other medical personnel);</text>
</clause><clause commented="no" id="H60B57A7E80ED4636A83337FEFDDE6ED"><enum>(ii)</enum><text display-inline="yes-display-inline">include resident census data and
information on resident case mix;</text>
</clause><clause commented="no" id="HEDAFFEECCD4A470B8BFB165800174C73"><enum>(iii)</enum><text>include a
regular reporting schedule; and</text>
</clause><clause commented="no" id="H75DF49DD057D4C86B0A6ED53C047D702"><enum>(iv)</enum><text>include
information on employee turnover and tenure and on the hours of care provided
by each category of certified employees referenced in clause (i) per resident
per day.</text>
</clause><continuation-text commented="no" continuation-text-level="subparagraph">Nothing in this subparagraph shall
be construed as preventing the Secretary from requiring submission of such
information with respect to specific categories, such as nursing staff, before
other categories of certified employees. Information under this subparagraph
with respect to agency and contract staff shall be kept separate from
information on employee
staffing.</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><enum>II</enum><header>Targeting
Enforcement</header>
<section id="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—</text>
<subparagraph id="idE973B147E2074275B07489D4F0532B97"><enum>(A)</enum><text>by striking
<quote><header-in-text level="clause" style="OLC">Penalties</header-in-text>.—The Secretary</quote> and inserting
<header-in-text level="clause" style="OLC">“Penalties</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="idF0917EA32EC942EA90E9ADF438B77F1C" style="OLC">
<subclause id="idF0656FD3671A4855A691087F20D3653A"><enum>(I)</enum><header>In
general</header><text>Subject to subclause (II), the
Secretary</text>
</subclause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id8294B9A9D0684DB7A60F757758D9DDF2"><enum>(B)</enum><text>by adding at the
end the following new subclauses:</text>
<quoted-block display-inline="no-display-inline" id="idC1F219CC660D4DA5A351173A58D4C312" style="OLC">
<subclause commented="no" id="id384BFE18F6E542239586A0A5106912F5"><enum>(II)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>Subject to
subclause (III), 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="id7FE8BDB6C64341A48561762A8C90DCDE"><enum>(III)</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 (II) 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="idEEF327B1F80F47CD944A87984C3950BB"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (II) if the penalty is imposed on the facility for a deficiency
that is found to result in a pattern of harm or widespread harm, immediately
jeopardizes the health or safety of a resident or residents of the facility, or
results in the death of a resident of the facility.</text>
</item></subclause><subclause id="id89ADBB66E0544744BA43AD15AC2A7F7E"><enum>(IV)</enum><header>Collection of
civil money penalties</header><text>In the case of a civil money penalty
imposed under this clause, the Secretary shall issue regulations that—</text>
<item id="id6D0C2757848649758D25C5E7DA323C4B"><enum>(aa)</enum><text>subject to item
(cc), not later than 30 days after the imposition of the penalty, provide for
the facility to have the opportunity to participate in an independent informal
dispute resolution process which generates a written record prior to the
collection of such penalty;</text>
</item><item id="id567CB213CB384C938F09C7FD07762A07"><enum>(bb)</enum><text>in
the case where the penalty is imposed for each day of noncompliance, provide
that a penalty may not be imposed for any day during the period beginning on
the initial day of the imposition of the penalty and ending on the day on which
the informal dispute resolution process under item (aa) is completed;</text>
</item><item id="id523CF0828F8645A4B423EF9F878B7738"><enum>(cc)</enum><text>may provide for
the collection of such civil money penalty and the placement of such amounts
collected in an escrow account under the direction of the Secretary 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>(dd)</enum><text>may provide that
such amounts collected are kept in such account pending the resolution of any
subsequent appeals;</text>
</item><item id="id9F3F6E78BE5E4C198505F72CDDB5CC80"><enum>(ee)</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>(ff)</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 of 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),
projects that support resident and family councils and other consumer
involvement in assuring quality care in facilities, and facility improvement
initiatives approved by the Secretary (including joint training of facility
staff and surveyors, technical assistance for facilities implementing quality
assurance programs, the appointment of temporary management firms, and other
activities approved by the
Secretary).</text>
</item></subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></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)(IV),</quote> after <quote>(i),</quote>.</text>
</paragraph></subsection><subsection id="id5B6006F9B02842A5974DA0CCC82EF0FC"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="id38AFE41084E44BF196ACC8F52A156E2E"><enum>(1)</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—</text>
<subparagraph id="idF94143DD253049F4951B9B9DD2BB87F1"><enum>(A)</enum><text>by striking
<quote><header-in-text level="clause" style="OLC">Penalties</header-in-text>.—The Secretary</quote> and inserting
<header-in-text level="clause" style="OLC">“Penalties</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="id9E11B99A86B84958B116FC6416286C12" style="OLC">
<subclause id="id6F177C368DB14D2E8FBF9C256B232F01"><enum>(I)</enum><header>In
general</header><text>Subject to subclause (II), the
Secretary</text>
</subclause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idBF3E7370CC7B4B178B68962766179598"><enum>(B)</enum><text>by adding at the
end the following new subclauses:</text>
<quoted-block display-inline="no-display-inline" id="id1538F35DEE0C42458BAC6B420C6E864D" style="OLC">
<subclause commented="no" id="id904FE6E8F21D474196DE85739C13615E"><enum>(II)</enum><header>Reduction of
civil money penalties in certain circumstances</header><text>Subject to
subclause (III), 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="id8ADEC29157824C018D7D07C3758AD0C0"><enum>(III)</enum><header>Prohibitions
on reduction for certain deficiencies</header>
<item commented="no" id="id274AC176741D469CA4942728A5EF277E"><enum>(aa)</enum><header>Repeat
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (II) 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="id24D6C06DA36C4D0D81952ECCD537D8AE"><enum>(bb)</enum><header>Certain other
deficiencies</header><text>The Secretary may not reduce the amount of a penalty
under subclause (II) if the penalty is imposed on the facility for a deficiency
that is found to result in a pattern of harm or widespread harm, immediately
jeopardizes the health or safety of a resident or residents of the facility, or
results in the death of a resident of the facility.</text>
</item></subclause><subclause id="idF651E46A70CF46B3A6A96F5EE01C4A0B"><enum>(IV)</enum><header>Collection of
civil money penalties</header><text>In the case of a civil money penalty
imposed under this clause, the Secretary shall issue regulations that—</text>
<item id="idD4D517C4434B49B7B1A743549E276CC7"><enum>(aa)</enum><text>subject to item
(cc), not later than 30 days after the imposition of the penalty, provide for
the facility to have the opportunity to participate in an independent informal
dispute resolution process which generates a written record prior to the
collection of such penalty;</text>
</item><item id="id2B70D1F0912745F5815264425595D576"><enum>(bb)</enum><text>in
the case where the penalty is imposed for each day of noncompliance, provide
that a penalty may not be imposed for any day during the period beginning on
the initial day of the imposition of the penalty and ending on the day on which
the informal dispute resolution process under item (aa) is completed;</text>
</item><item id="idA78E395CC5C44E64B6597A4BEB3C7C70"><enum>(cc)</enum><text>may provide for
the collection of such civil money penalty and the placement of such amounts
collected in an escrow account under the direction of the Secretary 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="idEFCCBAD70BC847D6A97CB2CAF8D0FA6C"><enum>(dd)</enum><text>may provide that
such amounts collected are kept in such account pending the resolution of any
subsequent appeals;</text>
</item><item id="id451C2C5EAD6948BE86773D59A225718E"><enum>(ee)</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="id4FE685FCCD824D5E8A2B7E8EF50A587A"><enum>(ff)</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 of 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),
projects that support resident and family councils and other consumer
involvement in assuring quality care in facilities, and facility improvement
initiatives approved by the Secretary (including joint training of facility
staff and surveyors, technical assistance for facilities implementing quality
assurance programs, the appointment of temporary management firms, and other
activities approved by the
Secretary).</text>
</item></subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id49144A92E4BE4D5ABB05F994C677833F"><enum>(2)</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)(IV),</quote> after
<quote>(i),</quote>.</text>
</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 the 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 the enactment of this Act, the Comptroller
General of the United States shall submit to Congress and the Secretary a
report 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 pilot program</header>
<subsection commented="no" id="id4CD2D752A1F7400F8D567016F1BED4F8"><enum>(a)</enum><header>Establishment</header>
<paragraph commented="no" id="id17475A6024864E2382972C6240BA24BB"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a pilot program to develop,
test, and implement an independent monitor program to oversee interstate and
large intrastate chains of skilled nursing facilities and nursing
facilities.</text>
</paragraph><paragraph commented="no" id="id5CE63672293B4B179CEC5DF72A57A959"><enum>(2)</enum><header>Selection</header><text>The
Secretary shall select chains of skilled nursing facilities and nursing
facilities described in paragraph (1) to participate in the pilot program under
this section from among those chains that submit an application to the
Secretary at such time, in such manner, and containing such information as the
Secretary may require.</text>
</paragraph><paragraph commented="no" id="idDAA2ED50BCF344369933121920058977"><enum>(3)</enum><header>Duration</header><text>The
Secretary shall conduct the pilot program under this section for a 2-year
period.</text>
</paragraph><paragraph commented="no" id="id64682E4B9E174CC9A068768504822407"><enum>(4)</enum><header>Implementation</header><text>The
Secretary shall implement the pilot program under this section not later than 1
year after the date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" id="id46AF2D15B4574F70813ABF746DC89540"><enum>(b)</enum><header>Requirements</header><text>The
Secretary shall evaluate chains selected to participate in the pilot program
under this section based on criteria selected by the Secretary, including where
evidence suggests that 1 or more facilities of the chain are experiencing
serious safety and quality of care problems. Such criteria may include the
evaluation of a chain that includes 1 or more facilities participating in the
“Special Focus Facility” program (or a successor program) or 1 or more
facilities with a record of repeated serious safety and quality of care
deficiencies.</text>
</subsection><subsection commented="no" id="id8336F7BF56454681B7106EA963589FCF"><enum>(c)</enum><header>Responsibilities</header><text>An
independent monitor that enters into a contract with the Secretary to
participate in the conduct of the pilot program under this section
shall—</text>
<paragraph commented="no" id="id8F4528A540E24A47A721A3C6750FF845"><enum>(1)</enum><text>conduct periodic
reviews and prepare root-cause quality and deficiency analyses of a chain to
assess if facilities of the chain are in compliance with State and Federal laws
and regulations applicable to the facilities;</text>
</paragraph><paragraph commented="no" id="idB56B61AFDA3E45C39601897D1C8E624A"><enum>(2)</enum><text>undertake
sustained oversight of the chain, whether publicly or privately held, to
involve the owners of, and any additional disclosable party with respect to a
facility of, the chain in facilitating compliance by facilities of the chain
with State and Federal laws and regulations applicable to the
facilities;</text>
</paragraph><paragraph commented="no" id="id40DF7D5BB7FE4B44AD70693B098D0F12"><enum>(3)</enum><text>analyze the
management structure, distribution of expenditures, and nurse staffing levels
of facilities of the chain in relation to resident census, staff turnover
rates, and tenure;</text>
</paragraph><paragraph commented="no" id="id5822950C4654499CB88ECDC6D0B13673"><enum>(4)</enum><text>report findings
and recommendations with respect to such reviews, analyses, and oversight to
the chain and facilities of the chain, to the Secretary, and to relevant
States; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idB53813BD1BD94D279DAFDCFC999320C4"><enum>(5)</enum><text>publish the
results of such reviews, analyses, and oversight.</text>
</paragraph></subsection><subsection commented="no" id="ID0cc4913dceb94b5597929192c9e980dc"><enum>(d)</enum><header>Implementation
of recommendations</header>
<paragraph commented="no" id="idB7D850799EF94B00895B8A2FA45D24BF"><enum>(1)</enum><header>Receipt of
finding by chain</header><text>Not later than 10 days after receipt of a
finding of an independent monitor under subsection (c)(4), a chain
participating in the pilot program shall submit to the independent monitor a
report—</text>
<subparagraph commented="no" id="id6044FB9FC44B4B34980F0613108945D4"><enum>(A)</enum><text>outlining
corrective actions the chain will take to implement the recommendations in such
report; or</text>
</subparagraph><subparagraph commented="no" id="idEDC702DD10084FBDB6EAF2E453FA8275"><enum>(B)</enum><text>indicating that
the chain will not implement such recommendations, and why it will not do
so.</text>
</subparagraph></paragraph><paragraph commented="no" id="id31216C8F6C3B4DA0993C83CD56AFD2B9"><enum>(2)</enum><header>Receipt of
report by independent monitor</header><text>Not later than 10 days after
receipt of a report submitted by a chain under paragraph (1), an 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>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id11C26C7124154A87A1B3B37094D6D6D2"><enum>(e)</enum><header>Cost of
appointment</header><text>A chain shall be responsible for a portion of the
costs associated with the appointment of independent monitors under the pilot
program under this section. The chain shall pay such portion to the Secretary
(in an amount and in accordance with procedures established by the
Secretary).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id508D3B02FB2B4065B59DC0DB1B89CD34"><enum>(f)</enum><header>Waiver
authority</header><text>The Secretary may waive such requirements of titles
XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.)
as may be necessary for the purpose of carrying out the pilot program under
this section.</text>
</subsection><subsection commented="no" id="id70E6E16F2EC84D33A1F9FF8C4085973E"><enum>(g)</enum><header>Authorization
of appropriations</header><text>There are authorized to be appropriated such
sums as may be necessary to carry out this section.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id7DBFBAF31B3840BDA35C4B639FCD5A4A"><enum>(h)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph commented="no" display-inline="no-display-inline" id="id28DB74BFDCA541A3B3341009C3330B4B"><enum>(1)</enum><header>Additional
disclosable party</header><text>The term <term>additional disclosable
party</term> has the meaning given such term in section 1124(c)(5)(A) of the
Social Security Act, as added by section 101(a).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6251836F54CA413293709FE9EF8D10C1"><enum>(2)</enum><header>Facility</header><text>The
term <term>facility</term> means a skilled nursing facility or a nursing
facility.</text>
</paragraph><paragraph commented="no" id="id422B97B01561421B8703C3C3C5CD4DB4"><enum>(3)</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 commented="no" id="id61CFD329692C45D5ABB808275ACF5EE0"><enum>(4)</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>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id193314115E52450BB2B035F44D8CAA02"><enum>(5)</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 commented="no" display-inline="no-display-inline" id="id8A24F3DB4FD54B258879C728FE9D4C14"><enum>(i)</enum><header>Evaluation and
report</header>
<paragraph commented="no" display-inline="no-display-inline" id="id1A3F2D394C734D1EB1529CA856C3C977"><enum>(1)</enum><header>Evaluation</header><text>The
Inspector General of the Department of Health and Human Services shall evaluate
the pilot program conducted under this subsection. Such evaluation
shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idF4D0207FDB2249E396B9990187DFCAFE"><enum>(A)</enum><text>determine whether
the independent monitor program should be established on a permanent basis;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id0F9057987BEC40BAB3E1E78EEE535F54"><enum>(B)</enum><text>if the Inspector
General determines that such program should be established on a permanent
basis, recommend appropriate procedures and mechanisms for such
establishment.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id98833084E10B482CB16F5BECF5D4FFA4"><enum>(2)</enum><header>Report</header><text>Not
later than 180 days after the completion of the pilot program under this
section, the Inspector General shall submit to Congress and the Secretary a
report containing the results of the evaluation conducted under paragraph (1),
together with recommendations for such legislation and administrative action as
the Inspector General determines appropriate.</text>
</paragraph></subsection></section><section id="id09AB79D2B92746A39A51CF6147F75E4E"><enum>204.</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 the enactment of this Act.</text>
</subsection></section><section id="idCBA3DD5B25954C50A15B1076D85326BF"><enum>205.</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>Duration and
implementation</header>
<paragraph id="id881EB32446784618884D2F4B44FF4A26"><enum>(1)</enum><header>Duration</header><text>The
demonstration projects shall each be conducted for a period not to exceed 3
years.</text>
</paragraph><paragraph id="idD34657287C504D3F9A816F1FFB5C60B1"><enum>(2)</enum><header>Implementation</header><text>The
demonstration projects shall each be implemented not later than 1 year after
the date of the enactment of this Act.</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 may be 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 to Congress a report 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>
<paragraph id="id9E04C85A640344E489627E959D0DE810"><enum>(1)</enum><header>In
general</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>
</paragraph><paragraph id="id1B0DBDEC0F8946E6AD067EC1163B15C3"><enum>(2)</enum><header>Clarification
of definition of nurse aide</header><text>Section 1819(b)(5)(F) of the Social
Security Act (42 U.S.C. 1395i–3(b)(5)(F)) is amended by adding at the end the
following flush sentence:</text>
<quoted-block display-inline="no-display-inline" id="id2E656A1365834936AEE719548DFB8D3E" style="OLC">
<quoted-block-continuation-text quoted-block-continuation-text-level="subparagraph">Such
term includes an individual who provides such services through an agency or
under a contract with the
facility.</quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="idFCA6C67A6A2243B394B922F4749B717F"><enum>(b)</enum><header>Nursing
facilities</header>
<paragraph id="id59776A4B8E814638BD3783FB6B25DCB2"><enum>(1)</enum><header>In
general</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 training</quote> before <quote>, (II)</quote>.</text>
</paragraph><paragraph id="idE43E2F06C9B74EB7B9AC0A5ADE30A8A8"><enum>(2)</enum><header>Clarification
of definition of nurse aide</header><text>Section 1919(b)(5)(F) of the Social
Security Act (42 U.S.C. 1396r(b)(5)(F)) is amended by adding at the end the
following flush sentence:</text>
<quoted-block display-inline="no-display-inline" id="id623B35E3D1D94588B8C1F85A75349D6E" style="OLC">
<quoted-block-continuation-text quoted-block-continuation-text-level="subparagraph">Such
term includes an individual who provides such services through an agency or
under a contract with the
facility.</quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></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 the 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 commented="no" display-inline="no-display-inline" id="idB40A674FAD574F4DA0E6C95AC9F1002F"><enum>(A)</enum><header>Nurse
aide</header><text>The term <term>nurse aide</term> has the meaning given such
term in sections 1819(b)(5)(F) and 1919(b)(5)(F) of the Social Security Act (42
U.S.C. 1395i–3(b)(5)(F); 1396r(b)(5)(F)), as amended by section 301.</text>
</subparagraph><subparagraph id="id1DF91CA4848542E5ABB22BAB0C2E4959"><enum>(B)</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>(C)</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>(D)</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>