[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4468 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 4468
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 24, 2019
Mr. Evans (for himself and Mr. Estes) 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 shall, in consultation with such
State, disapprove, for a period not to exceed
two years, 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
$10,697 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 skilled
nursing facility that all deficiencies for
which the civil monetary penalty described in
clause (i)(I) was assessed have been remedied.
For purposes of rescinding disapproval under
the previous sentence, the Secretary may
require additional oversight of the skilled
nursing facility for a period not to exceed the
period of disapproval imposed under clause (i)
with respect to such facility.''; and
(2) in subsection (h)(2)(B)(ii)(I), by striking ``$10,000''
and inserting ``$21,393''.
(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 shall, in consultation with such
State, disapprove, for a period not to exceed
two years, 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 $10,697
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 nursing
facility that all deficiencies for which the
civil monetary penalty described in clause
(i)(I) was assessed have been remedied. For
purposes of rescinding disapproval under the
previous sentence, the Secretary may require
additional oversight of the nursing facility
for a period not to exceed the period of
disapproval imposed under clause (i) with
respect to such facility.''; and
(2) in subsection (h)(3)(C)(ii)(I), by striking ``$10,000''
and inserting ``$21,393''.
(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
skilled nursing facility or a nursing 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 skilled nursing
facility or a nursing 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 skilled nursing facility or a nursing 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.
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