[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2522 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 2522

  To amend titles XVIII and XIX of the Social Security Act to improve 
    oversight of nursing facilities under the Medicare and Medicaid 
programs by preventing inappropriate influence over surveyors, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2011

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

_______________________________________________________________________

                                 A BILL


 
  To amend titles XVIII and XIX of the Social Security Act to improve 
    oversight of nursing facilities under the Medicare and Medicaid 
programs by preventing inappropriate influence over surveyors, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nursing Home Patient Protection and 
Standards Act of 2011''.

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

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

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

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

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

    (a) In General.--
            (1) Medicare.--Section 1819(g) of the Social Security Act 
        (42 U.S.C. 1395i-3(g)) is amended by adding the following at 
        the end:
            ``(6) Reporting of inaccuracies.--
                    ``(A) Covered individual defined.--For purposes of 
                this paragraph, the term `covered individual' means an 
                individual--
                            ``(i) who is a member of a State survey 
                        team under this subsection; or
                            ``(ii) who is an employee of the State 
                        department or agency that conducts surveys 
                        under this section.
                    ``(B) Reporting requirement.--A covered individual 
                shall report to the Secretary any instance in which the 
                individual suspects that--
                            ``(i) a survey under this subsection fails 
                        to report or under reports an issue in a 
                        facility that could impact the safety or 
                        quality of care of the residents in such 
                        facility; or
                            ``(ii) a member of the survey team or an 
                        employee of the State survey agency was 
                        inappropriately influenced (through the 
                        offering of monetary awards or through undue 
                        pressure) to alter the results of the survey.
                    ``(C) Response to report.--If the Secretary 
                receives a report under subparagraph (B), the Secretary 
                shall take appropriate action, as determined by the 
                Secretary, to ensure the accuracy of the survey.
                    ``(D) Penalties for inappropriately influencing a 
                surveyor.--Subject to subparagraph (H), any individual 
                (including an employee of a skilled nursing facility or 
                any affiliated corporate entity, a representative of 
                the skilled nursing facility industry, a member of a 
                State survey team, an employee of the State department 
                or agency that conducts surveys under this section, or 
                an elected official) who attempts to inappropriately 
                influence (as defined by the Secretary through 
                regulations) the results of a survey under this 
                subsection, or the actions of a member of a survey team 
                or an employee of a survey agency, shall be subject to 
                a civil money penalty not to exceed $10,000. The 
                provisions of section 1128A (other than subsections (a) 
                and (b)) shall apply to a civil money penalty under the 
                previous sentence in the same manner as such provisions 
                apply to a penalty or proceeding under section 
                1128A(a).
                    ``(E) Whistleblower protections.--With respect to a 
                covered individual, any officer or employee of the 
                State may not--
                            ``(i) discharge, demote, suspend, threaten, 
                        harass, or deny a promotion or other 
                        employment-related benefit to such individual, 
                        or in any other manner discriminate against an 
                        individual in the terms and conditions of 
                        employment because the individual submitted a 
                        report under subparagraph (B); or
                            ``(ii) file a complaint or a report against 
                        the individual with the appropriate State 
                        professional disciplinary agency because the 
                        individual submitted a report under 
                        subparagraph (B).
                    ``(F) Penalties for violating whistleblower 
                protections.--Subject to subparagraph (H), any officer 
                or employee of a State who engages in an activity that 
                is prohibited by subparagraph (E) shall be subject to a 
                civil money penalty not to exceed $50,000. The 
                provisions of section 1128A (other than subsections (a) 
                and (b)) shall apply to a civil money penalty under the 
                previous sentence in the same manner as such provisions 
                apply to a penalty or proceeding under section 
                1128A(a).
                    ``(G) Requirement to post notice.--Each State shall 
                post conspicuously in an appropriate location a sign 
                (in a form specified by the Secretary) specifying the 
                rights of covered individuals under this section. Such 
                sign shall include--
                            ``(i) a statement that a covered individual 
                        may file a complaint with the Secretary 
                        describing any violations of the provisions of 
                        this paragraph by an employee or officer of a 
                        State; and
                            ``(ii) information concerning the form and 
                        manner in which such a complaint should be 
                        filed. 
                    ``(H) Construction related to legislative 
                oversight.--For purposes of this paragraph, to the 
                extent that a member of a State legislature requests 
                that a covered individual appear at a hearing of a 
                committee of such legislature or asks questions of such 
                individual during such a hearing, the actions of such 
                member shall not be construed in a manner that would 
                subject such member to a penalty under this 
                paragraph.''.
            (2) Medicaid.--Section 1919(g) of the Social Security Act 
        (42 U.S.C. 1396r(g)) is amended by adding the following at the 
        end:
            ``(6) Reporting of inaccuracies.--
                    ``(A) Covered individual defined.--For purposes of 
                this paragraph, the term `covered individual' means an 
                individual--
                            ``(i) who is a member of a State survey 
                        team under this subsection; or
                            ``(ii) who is an employee of the State 
                        department or agency that conducts surveys 
                        under this section.
                    ``(B) Reporting requirement.--A covered individual 
                shall report to the Secretary any instance in which the 
                individual suspects that--
                            ``(i) a survey under this subsection fails 
                        to report or under reports an issue in a 
                        facility that could impact the safety or 
                        quality of care of the residents in such 
                        facility; or
                            ``(ii) a member of the survey team or an 
                        employee of the State survey agency was 
                        inappropriately influenced (through the 
                        offering of monetary awards or through undue 
                        pressure) to alter the results of the survey.
                    ``(C) Response to report.--If the Secretary 
                receives a report under subparagraph (B), the Secretary 
                shall take appropriate action, as determined by the 
                Secretary, to ensure the accuracy of the survey.
                    ``(D) Penalties for inappropriately influencing a 
                surveyor.--Subject to subparagraph (H), any individual 
                (including an employee of a skilled nursing facility or 
                any affiliated corporate entity, a representative of 
                the skilled nursing facility industry, a member of a 
                State survey team, an employee of the State department 
                or agency that conducts surveys under this section, or 
                an elected official) who attempts to inappropriately 
                influence (as defined by the Secretary through 
                regulations) the results of a survey under this 
                subsection, or the actions of a member of a survey team 
                or an employee of a survey agency, shall be subject to 
                a civil money penalty not to exceed $10,000. The 
                provisions of section 1128A (other than subsections (a) 
                and (b)) shall apply to a civil money penalty under the 
                previous sentence in the same manner as such provisions 
                apply to a penalty or proceeding under section 
                1128A(a).
                    ``(E) Whistleblower protections.--With respect to a 
                covered individual, any officer or employee of the 
                State may not--
                            ``(i) discharge, demote, suspend, threaten, 
                        harass, or deny a promotion or other 
                        employment-related benefit to such individual, 
                        or in any other manner discriminate against an 
                        individual in the terms and conditions of 
                        employment because the individual submitted a 
                        report under subparagraph (B); or
                            ``(ii) file a complaint or a report against 
                        the individual with the appropriate State 
                        professional disciplinary agency because the 
                        individual submitted a report under 
                        subparagraph (B).
                    ``(F) Penalties for violating whistleblower 
                protections.--Subject to subparagraph (H), any officer 
                or employee of a State who engages in an activity that 
                is prohibited by subparagraph (E) shall be subject to a 
                civil money penalty not to exceed $50,000. The 
                provisions of section 1128A (other than subsections (a) 
                and (b)) shall apply to a civil money penalty under the 
                previous sentence in the same manner as such provisions 
                apply to a penalty or proceeding under section 
                1128A(a).
                    ``(G) Requirement to post notice.--Each State shall 
                post conspicuously in an appropriate location a sign 
                (in a form specified by the Secretary) specifying the 
                rights of covered individuals under this section. Such 
                sign shall include--
                            ``(i) a statement that a covered individual 
                        may file a complaint with the Secretary 
                        describing any violations of the provisions of 
                        this paragraph by an employee or officer of a 
                        State; and
                            ``(ii) information concerning the form and 
                        manner in which such a complaint should be 
                        filed. 
                    ``(H) Construction related to legislative 
                oversight.--For purposes of this paragraph, to the 
                extent that a member of a State legislature requests 
                that a covered individual appear at a hearing of a 
                committee of such legislature or asks questions of such 
                individual during such a hearing, the actions of such 
                member shall not be construed in a manner that would 
                subject such member to a penalty under this 
                paragraph.''.
    (b) Conforming Amendments.--
            (1) Section 1819(f)(2)(B)(iii)(I)(c) of the Social Security 
        Act is amended by inserting ``, a civil monetary penalty 
        described in section 1919(g)(6)(D) of not less than $10,000'' 
        after ``of not less than $5,000''.
            (2) Section 1919(f)(2)(B)(iii)(I)(c) of the Social Security 
        Act is amended by inserting ``, a civil monetary penalty 
        described in (g)(6)(D) of not less than $10,000'' after ``of 
        not less than $5,000''.

SEC. 5. ADVISORY COMMITTEE.

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

SEC. 6. REVIEW OF SURVEYS.

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