[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4182 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 4182
To provide nursing homes with resources for responding to the COVID-19
public health emergency to protect the health and safety of residents
and workers, to reauthorize funding for programs under the Elder
Justice Act of 2009, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 2, 2020
Mr. Grassley (for himself, Mr. Daines, and Ms. McSally) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To provide nursing homes with resources for responding to the COVID-19
public health emergency to protect the health and safety of residents
and workers, to reauthorize funding for programs under the Elder
Justice Act of 2009, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Emergency Support
for Nursing Homes and Elder Justice Reform Act of 2020''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Providing resources for personal protective equipment and
testing.
Sec. 4. Promoting transparency about COVID-19-related cases and
fatalities and staffing levels in long-term
care facilities.
Sec. 5. Establishing strike teams.
Sec. 6. Promoting identification and reporting of potential abuse or
neglect in long-term care facilities.
Sec. 7. Promoting quality of life of long-term care facility residents
through televisitation.
Sec. 8. Upgrading nursing home compare and the Five-Star rating system.
Sec. 9. Enhancing Federal oversight of nursing homes participating in
Medicare or Medicaid.
Sec. 10. Continuing funding for programs to prevent and prosecute elder
abuse and neglect.
Sec. 11. Increasing resources to investigate abuse or neglect and
extend services to victims.
Sec. 12. Protecting Americans with dementia.
Sec. 13. Reducing racial and ethnic disparities in long-term care
facilities.
Sec. 14. Establishing reciprocity with Drug Enforcement Administration
to address improper prescribing of
controlled substances.
SEC. 2. DEFINITIONS.
In this Act:
(1) COVID-19 public health emergency period.--The term
``COVID-19 public health emergency period'' means the period
beginning on the first day of the emergency period defined in
paragraph (1)(B) of section 1135(g) of the Social Security Act
(42 U.S.C. 1320b-5(g)) and ending on the last day of the
calendar quarter in which the last day of such emergency period
occurs.
(2) Indian tribe.--The term ``Indian tribe'' has the
meaning given that term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304).
(3) Long-term care facility.--The term ``long-term care
facility'' has the meaning given that term in section 2011(15)
of the Social Security Act (42 U.S.C. 1397j(15)).
(4) Nursing facility.--The term ``nursing facility'' has
the meaning given that term in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a)).
(5) Participating provider.--The term ``participating
provider'' means a skilled nursing facility or a nursing
facility that has been assigned a national provider identifier
number by the Secretary and has executed an agreement to
participate in the Medicare program established under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or
the Medicaid program established under title XIX of such Act
(42 U.S.C. 1396 et seq.).
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) Skilled nursing facility.--The term ``skilled nursing
facility'' has the meaning given that term in section 1819(a)
of the Social Security Act (42 U.S.C. 1395i-3(a)).
(8) State.--Except as otherwise provided, the term
``State'' has the meaning given such term for purposes of title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(9) Tribal organization.--The term ``tribal organization''
has the meaning given that term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
5304).
(10) Other terms.--Each other term has the meaning given
the term for purposes of subtitle B of title XX of the Social
Security Act (42 U.S.C. 1397j et seq.).
SEC. 3. PROVIDING RESOURCES FOR PERSONAL PROTECTIVE EQUIPMENT AND
TESTING.
(a) In General.--A portion of any payments received or funds made
available on or after July 1, 2020, for responding to the public health
or fiscal impacts related to the Coronavirus Disease (COVID-19) under
Federal legislation enacted on or after that date which primarily makes
appropriations for the coronavirus response and related activities,
shall be used for the purposes described in subsection (b),
notwithstanding the original purpose for which the amounts were
appropriated to make such payments or funds available, or any other
provision of law restricting the use of such payments or funds.
(b) Purposes Described.--The purposes described in this subsection
are the following:
(1) To establish and maintain a supply of personal
protective equipment at a level that is sufficient, as
determined by the Centers for Disease Control and Prevention,
in collaboration with the Secretary and the Administrator of
the Federal Emergency Management Agency, to provide for the
safety of--
(A) personnel employed by participating providers
and long-term care facilities, including licensed
assisted living or residential care facilities, during
the COVID-19 public health emergency period; and
(B) State survey agency personnel who conduct
audits or investigations of participating providers and
long-term care facilities, including licensed assisted
living or residential care facilities, during the
COVID-19 public health emergency period.
(2) To provide regular COVID-19 testing for personnel and
residents of participating providers and long-term care
facilities, including licensed assisted living or residential
care facilities (at no cost to such personnel and residents),
at a level that is sufficient, based on the needs of the
locality and its circumstances, as determined by the Director
of the Centers for Disease Control and Prevention, in
collaboration with the Secretary and the Administrator of the
Federal Emergency Management Agency, to provide for the safety
of such personnel and residents. A State shall provide such
testing during the 90-day period that begins on the date on
which the Secretary, after consultation with the Director of
the Centers for Disease Control and Prevention, determines the
State is able to conduct such testing at such level and
notifies the State of the date on which the testing period is
to start.
(c) Standards and Guidance.--Not later than 30 days after the date
of enactment of this Act, the Director of the Centers for Disease
Control and Prevention, in collaboration with the Secretary and the
Administrator of the Federal Emergency Management Agency, shall issue
detailed guidance to States on compliance with the requirements of this
section as it relates to participating providers and long-term care
facilities, including licensed assisted living or residential care
facilities.
SEC. 4. PROMOTING TRANSPARENCY ABOUT COVID-19-RELATED CASES AND
FATALITIES AND STAFFING LEVELS IN LONG-TERM CARE
FACILITIES.
(a) Collection and Reporting of Staffing Data by Participating
Providers.--The Secretary shall develop a plan for ensuring that
participating providers shall resume compliance with the requirement,
under section 1128I(g) of the Social Security Act (42 U.S.C. 1320a-
7j(g)), to electronically submit direct care staffing information based
on payroll and other auditable data (including measures to ensure that
the submitted data includes direct care staffing information for the
entire duration of the emergency period).
(b) Collection and Reporting of Data Related to COVID-19 by
Participating Providers and Long-Term Care Facilities.--
(1) In general.--
(A) Reporting of covid-19 cases and fatalities by
participating providers and long-term care
facilities.--The Secretary shall ensure that
participating providers and long-term care facilities
report all suspected and confirmed cases of COVID-19
among personnel and residents of the provider or
facility, all COVID-19-related fatalities among
personnel and residents of the provider or facility,
and all fatalities among personnel and residents of the
provider or facility, whether related to COVID-19 or
unrelated to COVID-19, for the period beginning on
January 1, 2020, to the Secretary.
(B) Timing and manner of reporting.--Such data
shall be reported to the Secretary by participating
providers and long-term care facilities in a format and
manner that is consistent with any data that the
Secretary has directed participating providers to
furnish to the Centers for Disease Control and
Prevention on or after May 8, 2020, and, beginning on
the date that is 15 days after the date of enactment of
this Act, shall be collected and reported to the
Secretary by participating providers and long-term care
facilities on a daily basis.
(C) Publication of data.--Not later than 15 days
after the date of enactment of this Act, the Secretary
shall make the data collected under this paragraph
publicly available and shall update such data on a
daily basis.
(2) Collection and reporting of demographic data.--The
Secretary shall post the following information with respect to
participating providers and long-term care facilities on the
official internet website of the Federal Government for
Medicare beneficiaries (commonly referred to as the ``Nursing
Home Compare'' Medicare website) (or a successor website)
aggregated by State:
(A) The age, gender, race, ethnicity, disability,
and preferred language of the residents of
participating providers with suspected or confirmed
COVID-19 infections.
(B) With respect to residents of participating
providers and long-term care facilities who died on or
after January 1, 2020, the age, gender, race,
ethnicity, disability, and preferred language of--
(i) all of such residents; and
(ii) all of such residents whose deaths are
related to COVID-19.
(3) Confidentiality.--Any information reported under this
subsection that is made available to the public shall be made
so available in a manner that protects the identity of
residents of participating providers and long-term care
facilities.
SEC. 5. ESTABLISHING STRIKE TEAMS.
(a) In General.--A portion of any payments received or funds made
available on or after July 1, 2020, for responding to the public health
or fiscal impacts related to the Coronavirus Disease (COVID-19) under
Federal legislation enacted on or after that date which primarily makes
appropriations for the coronavirus response and related activities,
shall be used to establish and support the operation of statewide or
regional strike teams that meet the requirements of subsection (b) to
respond to COVID-19-related crises in participating providers,
notwithstanding the original purpose for which the amounts were
appropriated to make such payments or funds available, or any other
provision of law restricting the use of such payments or funds.
(b) Strike Team Requirements.--The requirements of this section
with respect to a strike team of a State are the following:
(1) Strike teams may include assessment, testing, and
clinical teams, and the State shall establish a mission for
each such team by written directive, which may include
performing medical examinations, conducting COVID-19 testing,
and assisting participating providers with the implementation
of quarantine, isolation, or disinfection procedures.
(2) Each strike team shall be comprised of individuals who
have relevant skills, qualifications, and experience to serve
as members of 1 or more of the assessment, testing, and
clinical teams described in paragraph (1), such as employees of
the State or any of its political subdivisions, members of the
militia on State activity duty, members of COVID-19 response
teams sent to the State by the Secretary, or other individuals
designated by the State agency with primary responsibility for
promoting resident and employee safety in participating
providers.
(3) Strike teams and members of such teams shall be subject
to the State's oversight and direction and team members shall
receive a State-issued letter of authorization describing--
(A) the individual's designation to serve on 1 or
more teams under an emergency proclamation;
(B) the mission of the team;
(C) the authority of the individual to perform the
team mission on the State's behalf;
(D) the individual's authority to access places,
persons, and materials necessary for the team member's
performance of the team's mission; and
(E) the requirement that team members maintain the
confidentiality of patient information shared with such
individuals by the facility.
(4) The State may, at any time, disband any strike team and
rescind the letter of authorization for any team member.
(5) A team and team member may not use the letter of
authorization described in paragraph (3) for any purpose except
in connection with the team's mission of acting in good faith
to promote resident and employee safety in participating
providers in which COVID-19 is confirmed to be present.
(6) The State shall establish protocols and procedures for
requesting the assistance of a strike team established under
this section and any other procedures deemed necessary for the
team's operation.
(7) If a strike team finds consistent quality of care
deficiencies with respect to a participating provider and such
deficiencies immediately jeopardize the health or safety of
residents of the participating provider, the team shall, within
18 hours of making such finding, alert the State survey agency
(which may take immediate enforcement action to remove the
jeopardy and correct the deficiencies through the remedies
specified in section 1819(h)(2)(B)(iii) or 1919(h)(2)(A)(iii)
of the Social Security Act (42 U.S.C. 1395i-3(h)(2)(B)(iii),
1396r(h)(2)(A)(iii)), the long-term care ombudsman of the
State, and the Medicaid fraud control unit of such State).
SEC. 6. PROMOTING IDENTIFICATION AND REPORTING OF POTENTIAL ABUSE OR
NEGLECT IN LONG-TERM CARE FACILITIES.
(a) Use of Claims Data To Identify Instances of Potential Abuse or
Neglect in Facilities.--Section 1128I of the Social Security Act (42
U.S.C. 1320a-7j) is amended by adding at the end the following new
subsection:
``(i) Use of Claims Data To Identify Instances of Potential Abuse
or Neglect.--
``(1) Compilation of codes.--Not later than 1 year after
the date of the enactment of this subsection, the Secretary, in
collaboration with the Inspector General of the Department of
Health and Human Services, shall--
``(A) compile a comprehensive list of diagnosis
codes that may indicate potential physical or sexual
abuse or neglect of the elderly; and
``(B) develop a plan for reliance on data from
claims under titles XVIII and XIX that contain 1 or
more of those codes, for the purpose of identifying
instances of potential physical or sexual abuse or
neglect in facilities receiving reimbursement under
such titles.
``(2) Availability to states.--Not later than 2 years after
the date of the enactment of this subsection, the Secretary
shall make such claims data available to State survey agencies
to help verify compliance with Federal and State mandatory
reporting laws.''.
(b) Required Training on Signs and Symptoms of Potential Abuse or
Neglect.--Section 1128I of the Social Security Act (42 U.S.C. 1320a-
7j), as amended by subsection (a), is amended by adding at the end the
following new subsection:
``(j) Required Training on Signs and Symptom of Potential Abuse or
Neglect.--Beginning not later than 1 year after the date of the
enactment of this subsection, a facility shall ensure that any staff of
the facility who provide direct care (as defined in section 2011) to
residents of the facility receive training on the signs and symptoms of
potential abuse or neglect of the elderly.''.
(c) Evaluation and Report on Protocols To Encourage Prompt
Reporting of Suspected Incidents of Potential Abuse or Neglect.--
(1) Evaluation and implementation of protocols.--The
Secretary, in collaboration with the Attorney General, shall
evaluate the effectiveness of current protocols and, if
warranted, recommend and implement improvements in those
protocols, to encourage prompt reporting of suspected incidents
of potential abuse or neglect to the appropriate law
enforcement officials or adult protective services office, by
State and Federal surveyors of Medicare and Medicaid covered
entities.
(2) Report.--Not later than 180 days after the completion
of the evaluation under paragraph (1), the Secretary shall
submit to Congress a report containing the results of such
evaluation, together with recommendations for improvements,
including such legislation and administrative action as the
Secretary determines appropriate.
(d) Issuance of Guidance To Deter Social Media Abuse in
Facilities.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall--
(A) update guidance, and, as necessary, issue new
guidance to clarify for State survey and certification
agencies the requirements applicable to facilities (as
defined in section 483.5 of title 42, Code of Federal
Regulations (or any successor regulations)) under part
483 of title 42, Code of Federal Regulations (or any
successor regulations), to protect resident privacy and
prohibit mental abuse or exploitation, specifically as
it relates to exploitative photographs, audio and video
recordings, and posting or sharing of such photographs
or recordings on social media networks or through
multimedia messages; and
(B) establish procedures to ensure that violations
of the safety and privacy requirements applicable to
facilities (as so defined) under part 483 of title 42,
Code of Federal Regulations (or any successor
regulations), which prohibit misuse of photographs,
audio and video recordings, and the inappropriate
posting or sharing of such photographs or recordings on
social media networks or through multimedia messages,
are reported by State survey agencies to law
enforcement agencies, adult protective service
agencies, and other relevant agencies and that such
violations are recorded and tracked in the Automated
Survey Processing Environment (``ASPEN'') and the ASPEN
Complaints/Incident Tracking System (``ACTS'').
(2) Clarification.--The guidance issued under paragraph (1)
shall clarify that enforcement penalties do not apply to the
posting or sharing of such photographs or recordings that
occurred solely for the purpose of documenting and promptly
reporting, to the appropriate authorities, a case of abuse in a
facility.
SEC. 7. PROMOTING QUALITY OF LIFE OF LONG-TERM CARE FACILITY RESIDENTS
THROUGH TELEVISITATION.
(a) Promoting Televisitation for Residents.--
(1) In general.--Sections 1819(c)(3) and 1919(c)(3) of the
Social Security Act (42 U.S.C. 1395i-3(c)(3), 1396r(c)(3)) are
each amended--
(A) in subparagraph (D), by striking ``and'' at the
end;
(B) in subparagraph (E), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) provide for access to telecommunications
devices and use of the internet, including assistance
from facility staff in the use of such technology, if
necessary or requested by the resident or a family
member, to support telecommunication, including but not
limited to audio, visual, text communication,
videoconference, and two-way audio/video options, by
residents of such facility with family members and
other individuals.''.
(2) Access during covid-19 public health emergency
period.--
(A) In general.--Not later than 30 days after the
date of enactment of this Act, the Secretary shall take
steps necessary to ensure that the residents of each
participating provider and licensed assisted living or
residential care facility have access to
telecommunications devices and use of the internet (to
the extent practicable), including assistance from
facility staff in the use of such technology, if
necessary or requested by the resident or a family
member, to support telecommunication, including but not
limited to audio, visual, text communication,
videoconference and two-way audio/video options, by
residents of such provider or facility with family
members and other individuals.
(B) Requirements.--In taking such steps, the
Secretary shall address--
(i) notification to residents, family
members, and other individuals of access to
televisitation described in subparagraph (A);
(ii) how such a provider or facility will
ensure or enable installation and access to a
device purchased by, or for the use or benefit
of, individual residents; and
(iii) operational issues and steps to avoid
unnecessary barriers to the timely deployment
of such televisitation.
(b) Funding.--A participating provider may use a portion of any
emergency funding that the provider receives (prior to and after the
date of enactment of this Act) from the Secretary related to the COVID-
19 public health emergency period to purchase any technology, including
telecommunications devices and internet service, or any other items or
services as necessary to implement the televisitation described in the
provisions of, and amendments made by, subsection (a), notwithstanding
any other provision of law restricting the use of such funding.
SEC. 8. UPGRADING NURSING HOME COMPARE AND THE FIVE-STAR RATING SYSTEM.
(a) Comprehensive Review of Five-Star Quality Rating System.--
Sections 1819 and 1919 of the Social Security Act (42 U.S.C. 1395i-3,
1396r) are each amended--
(1) by redesignating subsection (j) as subsection (k); and
(2) by inserting after subsection (i) the following new
subsection:
``(j) Comprehensive Review and Modification of Five-Star Quality
Rating System.--
``(1) In general.--The Secretary shall conduct a
comprehensive review of the system maintained by the Secretary
to measure and publicly report the quality of skilled nursing
facilities and nursing facilities (commonly referred to as the
`Five-Star Quality Rating System').
``(2) Timing.--The Secretary shall conduct such review not
later than 1 year after the end of the COVID-19 public health
emergency period and shall implement modifications to the Five-
Star Quality Rating System (or its successor system) not later
than 180 days after the release of the report that is required
under paragraph (4).
``(3) Requirements.--The review of the system under this
subsection shall include an evaluation of the relative weight
accorded to each of the following:
``(A) The adequacy of the facility's procedures for
preventing and reporting infection.
``(B) The adequacy of the facility's procedures for
preventing and reporting incidents of abuse, neglect,
mistreatment, or exploitation of residents of the
facility.
``(C) Deficiencies identified in the facility's
most recent standard survey and the extent to which the
facility corrected such deficiencies since the date of
the most recent survey.
``(D) The number, type, severity, and outcome of
substantiated complaints.
``(E) The number of adjudicated instances of
criminal violations by a facility or the employees of a
facility.
``(F) The number of civil monetary penalties levied
against the facility, employees, contractors, and other
agents of the facility.
``(G) Selected quality measures (such as the
percentages of long-stay residents who experience
pressure ulcers, are physically restrained, experience
falls with major injury, or received antipsychotic
medication).
``(H) Whether a facility is connected to an
assisted living facility and whether such facilities
should be rated separately from facilities that are
standalone skilled nursing facilities or nursing
facilities.
``(I) Other items determined appropriate by the
Secretary.
``(4) Report.--Not later than 180 days after the completion
of the review under paragraph (1), the Secretary shall submit
to the Committee on Finance of the Senate and the Committee on
Ways and Means of the House of Representatives a final report
that includes such findings and recommendations as the
Secretary considers appropriate based on the review, including
recommended actions to be taken to implement the specific
recommendations in such report.
``(5) Consultation.--In conducting such review and
implementing modifications of the system, the Secretary shall
consult with each of the following:
``(A) State long-term care ombudsman programs.
``(B) Adult protective services agencies.
``(C) Consumer advocacy and other nonprofit
organizations whose mission is to promote the health,
safety, and well being of older Americans.
``(D) Provider stakeholder groups.
``(E) Statewide provider agencies and advocacy
groups with relevant expertise.
``(F) Any other representatives of programs or
groups the Secretary determines appropriate.
``(6) COVID-19 public health emergency period.--In this
subsection, the term `COVID-19 public health emergency period'
means the period beginning on the first day of the emergency
period defined in paragraph (1)(B) of section 1135(g) and
ending on the last day of the calendar quarter in which the
last day of such emergency period occurs.''.
(b) Transparency.--The Secretary shall publicly report data, at
least quarterly, regarding each State's enforcement actions with
respect to deficiencies or statutory violations that have been reported
to the Centers for Medicare & Medicaid Services, corrective actions, if
any, that were recommended to resolve such deficiencies or statutory
violations, and the status of implementation of each such recommended
corrective action by the participating provider involved.
(c) Funding.--The Secretary shall transfer to the Centers for
Medicare & Medicaid Services Program Management Account, from the
Federal Hospital Insurance Trust Fund established under section 1817 of
the Social Security Act (42 U.S.C. 1395i) a one-time allocation of
$20,000,000, to be used to carry out sections 1819(j) and 1919(j) of
the Social Security Act (42 U.S.C. 1395i-3, 1396r) (as added by
subsection (a) and subsection (b)). The amount shall be available on
the date of the enactment of this Act and shall remain available until
expended.
SEC. 9. ENHANCING FEDERAL OVERSIGHT OF NURSING HOMES PARTICIPATING IN
MEDICARE OR MEDICAID.
(a) Identification of Facilities Included in, or Candidates for,
the Special Focus Facility Program.--Not later than 60 days after the
date of enactment of this Act, the Secretary shall publish the
following lists on the official internet website of the Federal
Government for Medicare beneficiaries (commonly referred to as the
``Nursing Home Compare'' Medicare website) (or a successor website):
(1) A list of all participating providers that are included
in the special focus facility program conducted under sections
1819(f)(8) and 1919(f)(10) of the Social Security Act (42
U.S.C. 1395i-3(f)(8), 1396r(f)(10)).
(2) A list of all participating providers that have been
identified as candidates for such program, based on the most
recent survey of the facility.
(b) Regularly Published Updates.--The Secretary shall publish
periodic updates of the lists published under subsection (a) no less
often than once every 30 days.
(c) Data Collection.--To the extent that the Secretary maintains a
system to collect certification deficiencies and licensure violations
relating to participating providers (such as the Automated Survey
Processing Environment ``ASPEN'' or a successor system), the Secretary
shall develop methods to separately track reports of confirmed
incidents of abuse or neglect in such providers on survey forms through
such system.
(d) Guidance on the Meaning of Terms.--Not later than 18 months
after the date of enactment of this Act, the Secretary, after
consultation with staff of participating providers and other long-term
care facilities that receive provider payments under the Medicare or
Medicaid programs, shall issue guidance for such participating
providers and other long-term care facilities to clarify the meaning of
certain terms, such as ``suspicious'', ``injuries of unknown source'',
and ``mistreatment'', when used in the statutory and regulatory
requirements for such providers relating to reporting and tracking
incidents of abuse, sexual abuse, neglect, mistreatment, or
exploitation of residents of such providers by facility staff,
including on social media.
SEC. 10. CONTINUING FUNDING FOR PROGRAMS TO PREVENT AND PROSECUTE ELDER
ABUSE AND NEGLECT.
(a) Long-Term Care Ombudsman Program Grants and Training.--Section
2043 of the Social Security Act (42 U.S.C. 1397m-2) is amended--
(1) in subsection (a)(2)--
(A) in subparagraph (B), by striking ``and'' after
the semicolon;
(B) in subparagraph (C), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following:
``(D) for each of fiscal years 2020 through 2023,
$12,000,000.''; and
(2) in subsection (b)(2), by inserting before the period
the following: ``, and for each of fiscal years 2020 through
2023, $12,000,000''.
(b) Elder Abuse, Neglect, and Exploitation Forensic Centers.--
Section 2031(f) of the Social Security Act (42 U.S.C. 1397l(f)) is
amended--
(1) in paragraph (2), by striking ``and'' after the
semicolon;
(2) in paragraph (3), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(4) for each of fiscal years 2020 through 2023,
$10,000,000.''.
(c) Elder Justice Coordinating Council.--
(1) Membership.--Section 2021(b)(1) of the Social Security
Act (42 U.S.C. 1397k(b)(1)) is amended--
(A) by redesignating subparagraph (C) as
subparagraph (D); and
(B) by inserting after subparagraph (B), the
following:
``(C) The Administrator of the Federal Emergency
Management Agency.''.
(2) Duties.--Section 2021(f)(1) of such Act (42 U.S.C.
1397k(f)(1)) is amended by inserting ``the Federal Emergency
Management Agency,'' after ``Justice,''.
(d) Adult Protective Services Functions and Grant Programs.--
Section 2042 of the Social Security Act (42 U.S.C. 1397m-1) is
amended--
(1) in subsection (a)(2), by striking ``$3,000,000'' and
all that follows through the period and inserting ``$5,000,000
for each of fiscal years 2020 through 2023.'';
(2) in subsection (b)(5), by striking ``$100,000,000'' and
all that follows through the period and inserting
``$120,000,000 for each of fiscal years 2020 through 2023.'';
and
(3) in subsection (c)(6), by striking ``$25,000,000'' and
all that follows through the period and inserting ``$30,000,000
for each of fiscal years 2020 through 2023.''.
(e) Technical Amendment.--Section 2011(12)(A) of the Social
Security Act (42 U.S.C. 1397j(12)(A)) is amended by striking ``450b''
and inserting ``5304''.
SEC. 11. INCREASING RESOURCES TO INVESTIGATE ABUSE OR NEGLECT AND
EXTEND SERVICES TO VICTIMS.
(a) Funding for Adult Protective Services During the COVID-19
Public Health Emergency.--
(1) In general.--A total of $60,000,000 of the amounts
appropriated to make payments or funds available on or after
July 1, 2020, for responding to the public health or fiscal
impacts related to the Coronavirus Disease (COVID-19) under
Federal legislation enacted on or after that date which
primarily makes appropriations for the coronavirus response and
related activities, shall be transferred and made available to
the Secretary to make direct payments under this subsection to
the agency of each State with primary responsibility for adult
protective services and to tribally operated adult protective
services agencies, notwithstanding the original purpose for
which the amounts were appropriated to make such payments or
funds available, or any other provision of law restricting the
use of such payments or funds.
(2) Payments.--
(A) In general.--From the funds transferred and
made available under paragraph (1), the Secretary
shall--
(i) reserve 3 percent of such funds for
making payments to tribally operated adult
protective services agencies in such manner,
and based on such information, as the Secretary
shall specify; and
(ii) make allotments to States from the
remainder of such funds (after the application
of clause (i)), in the same manner as amounts
are allotted to States for fiscal year 2020
under section 2003(b) of the Social Security
Act (42 U.S.C. 1397b(b)).
(B) Direct payments.--The Secretary shall make
direct payment from the amounts reserved under
subparagraph (A) to tribally operated adult protective
services agencies and from the amounts allotted under
that subparagraph to the agency of each State with
primary responsibility for adult protective services.
(3) Other requirements.--
(A) No match.--No cash or in-kind matching
requirement shall apply to the payments made under this
subsection.
(B) Deadline.--The Secretary shall make the
payments required under this subsection not later than
60 days after the date on which funds are transferred
and made available under paragraph (1).
(C) Use of funds.--Each agency that receives funds
from a payment made under this subsection shall use the
funds to provide adult protective services during the
COVID-19 public health emergency period.
(D) Prohibition.--No funds from a payment made
under this subsection shall be used to satisfy any
requirement of a federally funded program relating to
State or local matching funds or in-kind contributions.
(4) Definitions.--In this subsection:
(A) Adult protective services.--The term ``adult
protective services'' has the meaning given that term
in section 2011(2) of the Social Security Act (42
U.S.C. 1397j(2)).
(B) Indian country.--The term ``Indian country''
has the meaning given that term in section 1151 of
title 18, United States Code.
(C) State.--The term ``State'' has the meaning
given that term in section 1101(a)(1) of the Social
Security Act (42 U.S.C. 1301(a)(1)) for purposes of
title XX of such Act.
(D) Tribally operated adult protective services
agency.--The term ``tribally operated adult protective
services agency'' means an agency of the recognized
governing body of any Indian or Alaska Native Tribe,
band, Nation, pueblo, village, community, component
band, or component reservation, individually identified
(including parenthetically) in the list published most
recently as of the date of enactment of this Act
pursuant to section 104 of the Federally Recognized
Indian Tribe List Act of 1994 (25 U.S.C. 5131) whose
primary purpose is to protect any vulnerable adult who
is the victim of an alleged or substantiated incident
of abuse, neglect, or exploitation in Indian Country.
(b) Authority for Transfers From the Crime Victims Fund.--Section
1402(d)(3) of the Victims of Crime Act of 1984 (34 U.S.C. 20101(d)(3))
is amended by adding at the end the following:
``(C)(i) Notwithstanding subparagraph (B), the
Director may use not more than 3 percent of the amount
to be distributed from the Fund under this paragraph in
a particular fiscal year to provide and improve
services for victims of elder abuse, neglect, or
exploitation by a department or agency of the Federal
Government other than the Department of Justice.''.
SEC. 12. PROTECTING AMERICANS WITH DEMENTIA.
(a) Alzheimer's Disease Best Practices and Reporting.--
(1) Addressing alzheimer's disease in best practices.--
(A) In general.--Section 101(b) of the Elder Abuse
Prevention and Prosecution Act (34 U.S.C. 21711(b)) is
amended--
(i) by redesignating subparagraphs (A),
(B), and (C) of paragraph (2) as clauses (i),
(ii), and (iii), respectively, and adjusting
the margin accordingly;
(ii) by redesignating paragraphs (1), (2),
and (3) as subparagraphs (A), (B), and (C),
respectively, and adjusting the margin
accordingly;
(iii) by striking ``Not later than'' and
inserting the following:
``(1) In general.--Not later than'';
(iv) in paragraph (1)(B), as so
redesignated--
(I) in clause (ii), by inserting
``, including witnesses who have
Alzheimer's disease and related
dementias'' after ``other legal
issues''; and
(II) in clause (iii), by striking
``elder abuse cases,'' and inserting
``elder abuse cases (including victims
and witnesses who have Alzheimer's
disease and related dementias),''; and
(v) by adding at the end the following:
``(2) Training materials.--
``(A) In general.--In creating or compiling
replication guides and training materials under
paragraph (1)(B), the Elder Justice Coordinator shall
consult with the Secretary of Health and Human
Services, State, local, and Tribal adult protective
services, aging, social, and human services agencies,
Federal, State, local, and Tribal law enforcement
agencies, and nationally recognized nonprofit
associations with relevant expertise, as appropriate.
``(B) Updating.--The Elder Justice Coordinator
shall--
``(i) review the best practices identified
and replication guides and training materials
created or compiled under paragraph (1)(B) to
determine if the replication guides or training
materials require updating; and
``(ii) perform any necessary updating of
the replication guides or training
materials.''.
(B) Applicability.--The amendments made by
subparagraph (A) shall--
(i) take effect on the date of enactment of
this Act; and
(ii) apply on and after the date that is 1
year after the date of enactment of this Act.
(2) Report on outreach.--
(A) In general.--Section 101(c)(2) of the Elder
Abuse Prevention and Prosecution Act (34 U.S.C.
21711(c)(2)) is amended--
(i) by redesignating subparagraphs (A)
through (D) as clauses (i) through (iv),
respectively, and adjusting the margin
accordingly;
(ii) by striking ``a report detailing'' and
inserting the following: ``a report--
``(A) detailing''; and
(iii) by adding at the end the following:
``(B) with respect to the report by the Attorney
General, including a link to the publicly available
best practices identified under subsection (b)(1)(B)
and the replication guides and training materials
created or compiled under such subsection.''.
(B) Applicability.--The amendments made by
subparagraph (A) shall apply with respect to the report
under section 101(c)(2) of the Elder Abuse Prevention
and Prosecution Act (34 U.S.C. 21711(c)(2)) submitted
during the second year beginning after the date of
enactment of this Act, and each year thereafter.
(b) Promoting Accountability of Court-Appointed Guardians.--Section
2042(c) of the Social Security Act (42 U.S.C. 1397m-1(c)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)(E)'' and
inserting ``subparagraphs (E), (F), (G), and (H) of paragraph
(2)'';
(2) in paragraph (2)--
(A) in the matter preceding subparagraph (A)--
(i) by striking ``Funds'' and inserting
``Subject to paragraph (7), funds''; and
(ii) by striking ``subparagraph (E)'' and
inserting ``subparagraphs (E), (F), (G), and
(H)'';
(B) in subparagraph (E), by striking ``or'' at the
end;
(C) by redesignating subparagraph (F) as
subparagraph (I); and
(D) by inserting after subparagraph (E) the
following new paragraphs:
``(F) methods to assess State guardianship
statistics such as the creation of State databases to
collect information about the number and
characteristics of guardianship arrangements,
guardians, and individuals subject to guardianship;
``(G) the use of trained court visitors to improve
court administration of guardianship arrangements,
including the appointment and oversight of guardians;
``(H) methods for collecting, storing, and making
available to the appropriate individuals,
organizations, and entities information on prospective,
current, and previously appointed guardians, which may
include--
``(i) contact and identifying information;
``(ii) information relating to background
check investigations;
``(iii) court decisions regarding petitions
for appointment as a guardian, including the
rationale for such decisions; and
``(iv) information relating to the cause
for removal of the guardian or termination of
the guardianship arrangement; or'';
(3) in paragraph (4), by striking ``paragraph (2)(E)'' and
inserting ``subparagraphs (E), (F), (G), and (H) of paragraph
(2)'';
(4) in paragraph (5), by striking ``paragraph (2)(E)'' each
place it appears and inserting ``subparagraphs (E), (F), (G),
and (H) of paragraph (2)''; and
(5) by adding at the end the following new paragraph:
``(7) Ensuring demonstration program funding for the
highest courts of states.--The Secretary shall ensure that up
to 5 percent of the total of any funds made available to carry
out this subsection in a fiscal year (beginning with fiscal
year 2020) is awarded under grants to the highest courts of
States for purposes of conducting demonstration programs
described in subparagraphs (E), (F), (G), and (H) of paragraph
(2).''.
SEC. 13. REDUCING RACIAL AND ETHNIC DISPARITIES IN LONG-TERM CARE
FACILITIES.
(a) Task Force.--The Secretary shall establish a task force, to be
known as the ``Ethnic and Racial Disparities in Long-Term Care
Facilities Task Force'' (referred to in this section as the ``task
force''), to gather data on racial and ethnic disparities in long-term
care facilities and provide recommendations to Federal, State, local,
and Tribal policymakers on ways to reduce such disparities.
(b) Membership.--The task force shall be composed of the Secretary,
the Surgeon General, other Federal, State, and local government
officials, and individuals appointed by the Secretary with firsthand
knowledge of, or expertise relating to, disparities in access to
quality care for residents of long-term care facilities who are members
of racial or ethnic minority groups. In appointing such individuals,
the Secretary shall ensure the individuals appointed provide ample
representation with respect to the demographics of residents and
caregivers of such facilities, particularly with respect to residents
and caregivers of such facilities who are members of racial or ethnic
minority groups.
(c) Administration.--
(1) Chairperson.--The Secretary shall serve as the
chairperson of the task force. The Surgeon General shall serve
as the vice chairperson.
(2) Staff.--The task force shall have 2 full-time staff
members.
(3) Meetings.--The task force shall convene at least
monthly, with the first meeting to occur within 60 days after
the enactment of this Act.
(d) Reporting and Recommendations.--
(1) Monthly reports.--Not later than 45 days after the 1st
meeting of the task force, and monthly thereafter, the task
force shall submit to Congress and the Federal Emergency
Management Agency a report that includes--
(A) recommended methodologies for improving Federal
data collection on resident outcomes in long-term care
facilities with disproportionately high rates of
admission of individuals who are members of racial or
ethnic minority groups;
(B) the identification of long-term care facilities
evidencing racial or ethnic disparities in psychotropic
drug usage, infection prevention and control
deficiencies, hospitalization rates, infectious disease
rates, injury rates, abuse rates, neglect rates,
fatality rates, and any additional areas, as determined
by the task force based on available public health data
(or, if no such data are available, on the basis of
such other publicly available data or information as
the task force may determine);
(C) the identification of factors, including
Federal and State policies, that have contributed to
racial or ethnic health disparities in resident
outcomes in long-term care facilities, and actions
Congress (and if appropriate, other entities) can take
to address these factors; and
(D) recommendations for best practices to promote
improvements in long-term care facilities evidencing
racial or ethnic disparities in psychotropic drug
usage, infection prevention and control deficiencies,
hospitalization rates, infectious disease rates, injury
rates, abuse and neglect rates, fatality rates, or any
additional areas determined by the task force.
(2) Consultation with indian tribes.--In submitting reports
and recommendations under this subsection, the task force shall
consult with Indian Tribes and Tribal organizations.
(3) Sunset.--The task force shall terminate on December 31,
2021.
SEC. 14. ESTABLISHING RECIPROCITY WITH DRUG ENFORCEMENT ADMINISTRATION
TO ADDRESS IMPROPER PRESCRIBING OF CONTROLLED SUBSTANCES.
(a) Notification of the Attorney General by the Secretary of Health
and Human Services in Cases of Improper Prescribing of Controlled
Substances.--
(1) In general.--Section 1866(j) of the Social Security Act
(42 U.S.C. 1395cc(j)) is amended by adding at the end the
following new paragraph:
``(10) Notification of attorney general.--
``(A) In general.--If the Secretary makes a
determination described in subparagraph (B) with
respect to improper prescribing of a controlled
substance (as defined in section 102(6) of the
Controlled Substances Act), the Secretary shall notify
the Attorney General in accordance with subparagraph
(C).
``(B) Determination by secretary.--A determination
described in this subparagraph is a determination by
the Secretary under which--
``(i) the enrollment of a provider of
services or supplier under this title is
revoked, based in whole or in part on a finding
by the Secretary under section 424.535(a)(14)
of title 42, Code of Federal Regulations (or
any successor regulation), as applied to
improper prescribing of controlled substances;
or
``(ii) a provider of services or supplier
is placed on the preclusion list as defined
under sections 422.2 and 423.100 of such title
42 (or any successor regulation), based in
whole or in part on a finding by the Secretary
that such provider or supplier has engaged in
conduct, in connection with prescribing of
controlled substances, that would be considered
improper prescribing under such section
424.535(a)(14), if the provider of services or
supplier were enrolled under this title.
``(C) Notification.--If the Secretary revokes an
enrollment or makes a preclusion list placement as
described in subparagraph (B), the Secretary shall
notify the Attorney General of such revocation or
placement, no later than 30 days after--
``(i) the affirmation of such Secretarial
action, in response to a request for
reconsideration by the provider of services or
supplier involved under section 424.545(a) or
part 498 of such title 42, as applicable (or
any successor regulations); or
``(ii) absent such a request for
reconsideration, expiration of the time period
during which such a request may be filed.
``(D) Subsequent notification.--In the case that a
revocation of enrollment or a preclusion list placement
as described in subparagraph (B) is reversed under
proceedings subsequent to the appropriate notification
under subparagraph (C), the Secretary shall inform the
Attorney General of such reversal (and as applicable,
reinstatement of such enrollment or removal from the
preclusion list).''.
(2) Technical correction to citation for appeals
provision.--Section 1866(j)(5)(B) of the Social Security Act
(42 U.S.C. 1395cc(j)(5)(B)) is amended by striking ``paragraph
(7)'' and inserting ``paragraph (9)''.
(b) Revocation of Registration Under the Controlled Substances
Act.--Section 304 of the Controlled Substances Act (21 U.S.C. 824) is
amended by adding at the end the following:
``(h)(1) Upon receipt of a notification from the Secretary under
section 1866(j)(10)(C) of the Social Security Act (42 U.S.C.
1395cc(j)(10)(C)) of a determination of the Secretary to revoke an
enrollment or make a preclusion list placement, the Attorney General
shall revoke the registration granted under section 303 of this Act of
the registrant that is the subject of such revocation or placement.
``(2) After revocation of a registration under paragraph (1), if
the Attorney General receives information from the Secretary under
section 1866(j)(10)(D) of the Social Security Act (42 U.S.C.
1395cc(j)(10)(D)) that the determination of the Secretary described in
paragraph (1) has been reversed, the Attorney General may reverse the
revocation of the registration if the Attorney General determines such
reversal is appropriate.''.
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