[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6986 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 6986

 To amend titles XVIII and XIX of the Social Security Act with respect 
       to nursing facility requirements, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2018

  Mr. Duffy 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 with respect 
       to nursing facility requirements, 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 Workforce Quality 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Nursing facilities are an integral component of the 
        continuum of care for Medicare and Medicaid patients.
            (2) Many nursing facilities have in-house educational 
        programs approved by the Centers for Medicare & Medicaid 
        Services to train individuals as certified nursing aides to 
        provide extensive, direct care.
            (3) The ability to provide this training is critical for 
        nursing facilities to ensure that--
                    (A) residents receive the highest quality care;
                    (B) caregivers are trained on the most timely best 
                practices and clinical standards; and
                    (C) facilities can--
                            (i) sustain appropriate staffing levels; 
                        and
                            (ii) recruit and retain qualified staff.

SEC. 3. TRAINING AND COMPETENCY EVALUATION PROGRAMS.

    (a) Medicare.--Section 1819 of the Social Security Act (42 U.S.C. 
1395i-3) is amended--
            (1) in subsection (f)(2)--
                    (A) in subparagraph (A)(iv)(I), by striking 
                ``(unless the facility is described in subparagraph 
                (B)(iii)(I))'';
                    (B) in subparagraph (B)--
                            (i) in clause (i)--
                                    (I) by striking ``(subject to 
                                clause (iii))''; and
                                    (II) by inserting ``and'' after the 
                                semicolon;
                            (ii) in clause (ii), by striking ``; and'' 
                        and inserting a period;
                            (iii) by striking clause (iii); and
                            (iv) by striking ``A State may not delegate 
                        (through subcontract or otherwise) its 
                        responsibility under clause (iii)(II) to the 
                        skilled nursing facility.'';
                    (C) by striking subparagraphs (C) and (D); and
                    (D) by adding at the end the following:
                    ``(C) Disapproval of nurse aide training and 
                competency evaluation programs and nurse aide 
                competency evaluation programs.--
                            ``(i) In general.--With respect to a State, 
                        the Secretary may, in consultation with such 
                        State, disapprove a nurse aide training and 
                        competency evaluation program or a nurse aide 
                        competency evaluation program offered by or in 
                        a skilled nursing facility if such facility--
                                    ``(I) has been assessed a civil 
                                monetary penalty under subsection 
                                (h)(2)(B)(ii) or section 
                                1919(h)(2)(A)(ii) of not less than 
                                $10,483 for providing substandard 
                                quality of care; and
                                    ``(II) has not, in the 
                                determination of the Secretary, 
                                corrected the deficiencies in quality 
                                of care for which such civil monetary 
                                penalty was assessed.
                            ``(ii) Rescission of disapproval.--The 
                        Secretary shall rescind a disapproval under 
                        clause (i) upon demonstration by a facility 
                        that all deficiencies for which the civil 
                        monetary penalty described in clause (i)(I) was 
                        assessed have been remedied.''; and
            (2) in subsection (h)(2)(B)(ii)(I), by striking ``$10,000'' 
        and inserting ``$20,628''.
    (b) Medicaid.--Section 1919 of the Social Security Act (42 U.S.C. 
1396r) is amended--
            (1) in subsection (f)(2)--
                    (A) in subparagraph (A)(iv)(I), by striking 
                ``(unless the facility is described in subparagraph 
                (B)(iii)(I))'';
                    (B) in subparagraph (B)--
                            (i) in clause (i), by inserting ``and'' 
                        after the semicolon;
                            (ii) in clause (ii), by striking ``; and'' 
                        and inserting a period;
                            (iii) by striking clause (iii); and
                            (iv) by striking ``A State may not delegate 
                        (through subcontract or otherwise) its 
                        responsibility under clause (iii)(II) to the 
                        nursing facility.'';
                    (C) by striking subparagraphs (C) and (D); and
                    (D) by adding at the end the following:
                    ``(C) Disapproval of nurse aide training and 
                competency evaluation programs and nurse aide 
                competency evaluation programs.--
                            ``(i) In general.--With respect to a State, 
                        the Secretary may, in consultation with such 
                        State, disapprove a nurse aide training and 
                        competency evaluation program or a nurse aide 
                        competency evaluation program offered by or in 
                        a nursing facility if such facility--
                                    ``(I) has been assessed a civil 
                                monetary penalty under section 
                                1819(h)(2)(B)(ii) or subsection 
                                (h)(2)(A)(ii) of not less than $10,483 
                                for providing substandard quality of 
                                care; and
                                    ``(II) has not, in the 
                                determination of the Secretary, 
                                corrected the deficiencies in quality 
                                of care for which such civil monetary 
                                penalty was assessed.
                            ``(ii) Rescission of disapproval.--The 
                        Secretary shall rescind a disapproval under 
                        clause (i) upon demonstration by a facility 
                        that all deficiencies for which the civil 
                        monetary penalty described in clause (i)(I) was 
                        assessed have been remedied.''; and
            (2) in subsection (h)(3)(C)(ii)(I), by striking ``$10,000'' 
        and inserting ``$20,628''.
    (c) Regulations.--Not later than 180 days after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
promulgate regulations as necessary to implement the amendments made by 
this section.
    (d) Applicability.--
            (1) In general.--
                    (A) Timing of determinations.--The amendments made 
                by subsections (a)(1)(D) and (b)(1)(D) of this section 
                shall apply only to a civil monetary penalty if the 
                relevant covered determination was made on or after the 
                date of enactment of this Act.
                    (B) Covered determination defined.--The term 
                ``covered determination'' means, with respect to a 
                facility in a State, a determination by the State or 
                the Secretary of Health and Human Services that the 
                facility has provided a substandard quality of care for 
                which a civil monetary penalty described in section 
                1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 
                Social Security Act (as such sections have been amended 
                by this Act) may be assessed.
            (2) Previously prohibited programs.--
                    (A) Waiver.--With respect to a facility subject, on 
                the day before the date of enactment of this Act, to a 
                prohibition under item (a) of either section 
                1819(f)(2)(B)(iii)(I) or section 1919(f)(2)(B)(iii)(I) 
                of the Social Security Act (as in effect on the day 
                before such date of enactment), such prohibition shall 
                no longer apply to the facility on or after such date 
                of enactment.
                    (B) Survey or civil monetary penalty.--With respect 
                to a facility subject, on the day before the date of 
                enactment of this Act, to a prohibition under item (b) 
                or (c) of either section 1819(f)(2)(B)(iii)(I) or 
                section 1919(f)(2)(B)(iii)(I) of the Social Security 
                Act (as in effect on the day before such date of 
                enactment), such prohibition shall no longer apply to 
                the facility on or after such date of enactment upon a 
                determination by the Secretary of Health and Human 
                Services that the facility has corrected the issue that 
                resulted in such prohibition.
                                 <all>