[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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