[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8624 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 8624
To amend title XI of the Social Security Act to provide for additional
requirements for disclosing entities relating to the quality of care
furnished at skilled nursing facilties and nursing facilites, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 29, 2022
Ms. Schakowsky (for herself and Mr. Takano) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, 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 title XI of the Social Security Act to provide for additional
requirements for disclosing entities relating to the quality of care
furnished at skilled nursing facilties and nursing facilites, 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 ``Linking Investors and Nursing Home
Quality Act'' or the ``LINHQ Act''.
SEC. 2. REGULATING OWNERSHIP OF SKILLED NURSING FACILITIES AND NURSING
FACILITIES.
(a) Requirement To Submit Timely Disclosures To Admit New Residents
of Skilled Nursing Facilities and Nursing Facilities.--Section 1124 of
the Social Security Act (42 U.S.C. 1320a-3) is amended by adding at the
end the following new subsection:
``(d) Suspension of Certain Payments for Certain Entities That Fail
To Submit Timely Ownership Disclosures.--
``(1) In general.--In the case of a covered nursing
facility that fails to submit specified information to the
Secretary by the date that is 30 days after the date that such
information is required to be submitted pursuant to regulations
or contract provisions described in subsection (a)(1) (or, in
the case of a party with an ownership interest in such facility
that fails to submit information to the Secretary in accordance
with paragraph (3))--
``(A) the Secretary shall suspend payment under
title XVIII with respect to items and services
furnished to a specified resident during the applicable
payment suspension period; and
``(B) the Secretary shall suspend payment under
title XIX for medical assistance consisting of items
and services furnished by such facility to such a
resident during such period.
``(2) Quality review.--
``(A) In general.--The Secretary shall, with
respect to each covered nursing facility, on a periodic
basis, conduct a review of the quality of care
furnished by each such facility using information
reported by such a facility as part of a survey
conducted under section 1819(g) or 1919(g) or as part
of the minimum data set described in section 1819(f)(6)
or 1919(f)(6). For purposes of conducting such reviews,
the Secretary shall establish quality metrics relating
to such information to evaluate each such facility.
``(B) Quality metrics.--
``(i) In general.--For purposes of
subparagraph (A), the quality metrics described
in this subparagraph are quality metrics
specified by the Secretary, taking into account
input from the Data Liaison Team established
under section 2(c) of the LINHQ Act, that may
be used to evaluate the information described
in subparagraph (A). Such metrics shall include
a metric with respect to the average number of
direct care hours furnished to residents.
``(ii) Specification.--The Secretary shall
publish on a public website each quality
measure specified under this subparagraph at
least 180 days prior to such quality metric
being used in a quality review under this
paragraph, except that, with respect to such
reviews beginning during the 1-year period
beginning on the date of the enactment of this
subsection, the Secretary may use any such
metric that the Secretary publishes on such a
website at least 14 days prior to the beginning
of such review.
``(C) Establishment of standards.--The Secretary
shall specify standards with respect to quality
measures described in subparagraph (B), taking into
account input from the Data Liaison Team so described.
Such standards shall include, with respect to the
metric relating to the average number of direct care
hours furnished to residents, a standard of at least
4.1 direct care hours furnished per resident per day.
``(D) Notification and publication of facilities
falling below standards.--If the Secretary determines
that a covered nursing facility has failed to meet a
standard established under subparagraph (C) with
respect to a quality measure described in subparagraph
(B) pursuant to a review conducted under this
paragraph, the Secretary shall--
``(i) notify such facility of such
determination;
``(ii) publish the name of such facility on
the Care Compare website (or a successor
website) described in section 1819(i) with an
explanation that such facility has failed to
meet such standard; and
``(iii) suspend payment under title XVIII
to such facility, and payment under title XIX
for medical assistance furnished by such
facility, until such facility demonstrates that
such facility has met such standard.
``(3) Submission of third-party information.--The Secretary
shall establish a process under which, with respect to a
covered nursing facility, any party that has an ownership
interest in such facility and that also has an ownership
interest in an entity that contracts with such facility to
provide any service to such facility submits to the Secretary
the following information:
``(A) A balance sheet detailing the assets,
liabilities, and net worth of the entity.
``(B) A statement of income, expenses, and
operating surplus or deficit.
``(C) A statement of cashflows, including ongoing
and new capital expenditures and depreciation.
``(4) Submission of additional info by facilities.--The
Secretary shall require a covered nursing facility, as part of
the information submitted under subsection (a)(1), to provide
to the Secretary a detailed document outlining a visual
representation of the facility's structure that includes both
of the following:
``(A) Any entity in which any party that has an
ownership or control interest in the covered nursing
facility and that also has an ownership interest or
control interest of 5 percent or more in such entity
that provides any service, facility, or supply to such
covered nursing facility.
``(B) Unrelated parties that provide services to
such facility or to facilities that are operated,
conducted, owned, managed, or maintained by the
organization, including management companies and
property companies, and that are paid more than
$200,000 by such facility.
``(5) Definitions.--In this subsection:
``(A) Applicable payment suspension period.--The
term `applicable payment suspension period' means, with
respect to specified information required to be
submitted by a covered nursing facility pursuant to
regulations or contract provisions described in
subsection (a)(1) (or with respect to third-party
information required to be submitted by a party with an
ownership interest in such facility), the period
beginning on the day that is 30 days after the date
that such information is required to be so submitted by
such facility (or party) and ending on the date that is
5 days after such facility (or party) submits such
information.
``(B) Covered nursing facility.--The term `covered
nursing facility' means a skilled nursing facility (as
defined in section 1819(a)(1)) or a nursing facility
(as defined in section 1919(a)(1)).
``(C) Specified information.--The term `specified
information' means any information required to be
submitted under subsection (a)(1).
``(D) Specified resident.--The term `specified
resident' means a resident of a covered nursing
facility who is admitted to such facility during an
applicable payment suspension period with respect to
such facility.
``(E) Ownership interest.--The term `ownership
interest' means a direct or indirect interest of at
least 5 percent.''.
(b) Requiring Annual Reporting for Disclosing Entities.--Section
1124(c)(3)(A) of the Social Security Act (42 U.S.C. 1320a-3(c)(3)(A))
is amended by adding at the end the following new sentence: ``The
Secretary shall, not later than 90 days after the date of the enactment
of this sentence, amend such regulations to provide that such
information is reported not less frequently than annually.''.
(c) Increasing Oversight of Facilities.--
(1) Data liaison team.--
(A) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of
Health and Human Services (in this subsection referred
to as the ``Secretary'') shall establish a task force
(in this paragraph, referred to as the ``Data Liaison
Team'') to carry out the activities described in
subparagraph (B).
(B) Activities described.--For purposes of
subparagraph (A), the activities described in this
subparagraph are--
(i) reviewing information submitted under
section 1124 of the Social Security Act (42
U.S.C. 1320a-3) to identify any common
ownership patterns with respect to skilled
nursing facilities' (as defined in section
1819(a)(1) of such Act (42 U.S.C. 1395i-
3(a)(1))) and nursing facilities' (as defined
in section 1919(a)(1) of such Act (42 U.S.C.
1396r(a)(1))) that--
(I) are at least 30 days delinquent
in supplying the ownership information
required pursuant to section 1124(a)(1)
of such Act (42 U.S.C. 1320a-3(a)(1));
(II) in the preceding quarterly
reporting period, failed to meet a
payroll based journal level of 4.1
hours of direct resident care hours
(including registered nurse, licensed
practical nurse, and nursing assistant
or certified nursing assistant care)
per resident per day; or
(III) in the preceding year of
reporting, failed to meet any quality
standard established by the Secretary
under subsection (d) of such section or
established by the Secretary or a State
with respect to surveys conducted under
section 1819(g) or 1919(g) of such Act
(42 U.S.C. 1395i-3(g); 42 U.S.C.
1396r(g));
(ii) assessing potential misuse of payments
under titles XVIII and XIX of such Act (42
U.S.C. 1395 et seq.; 1396 et seq.) through
review of data collected by the Treasury
Department, facility organization charts, and
cost reports submitted under such title XVIII;
(iii) on a monthly basis, reporting any
disclosing entities (as defined for purposes of
section 1124 of such Act (42 U.S.C. 1320a-3))
with common ownership identified pursuant to
clause (i), or with respect to which the Team
has found a potential misuse of payments
pursuant to clause (ii), to the Interagency
Board, the Office of Inspector General of the
Department of Health and Human Services, and
the Department of Justice;
(iv) regularly reviewing skilled nursing
facilities and nursing facilities with a one-
star rating in health inspections or staffing
on the Care Compare website (or a successor
website) described in section 1819(i) of such
Act (42 U.S.C. 1395i-3(i)), as well as such
facilities that are ranked among the lowest 20
percent of facilities on such website with
respect to quality; and
(v) at the discretion of the Data Liaison
Team, requiring skilled nursing facilities and
nursing facilities to submit to the Team
information on whether such facilities--
(I) do business (including business
relating to laundry services, staffing
agencies, food and beverage services,
medical supplies, or consulting) with
any other entity (including a
specification of such other entity);
(II) lease their building or
property from another entity (including
a specification of such other entity);
or
(III) share an individual who has
directly or indirectly (as determined
by the Secretary pursuant to a notice
and comment rulemaking) any ownership
interest of 5 percent or more in an
entity described in subclause (II) and
the skilled nursing facility or nursing
facility.
(C) Provision of information.--
(i) Treasury information.--For purposes of
subparagraph (B)(ii), the Secretary of the
Treasury shall furnish to the Data Liaison Team
such information as such Team may request.
(ii) Facility information.--For purposes of
subparagraph (B)(v), a skilled nursing facility
or nursing facility shall submit to the Data
Liaison Team such information as may be
requested by the Team. Any failure to submit
such information shall be deemed to constitute
a violation of section 1124(a)(1) of such Act
(42 U.S.C. 1320a-3(a)(1)).
(D) Composition.--
(i) In general.--The Data Liaison Team
shall consist of--
(I) the Administrator of the
Centers for Medicare & Medicaid
Services of the Department of Health
and Human Services (or designee); and
(II) any other employees of the
agency specified in subclause (I) (as
determined appropriate by the
Secretary).
(ii) Manager.--An employee of the Centers
for Medicare & Medicaid Services of the
Department of Health and Human Services shall
manage the Data Liaison Team.
(2) Interagency board.--
(A) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of
Health and Human Services shall establish a task force
(in this paragraph, referred to as the ``Interagency
Board'') to carry out the activities described in
subparagraph (B).
(B) Activities described.--For purposes of
subparagraph (A), the activities described in this
subparagraph are--
(i) reviewing the list of disclosing
entities reported pursuant to paragraph
(1)(B)(iii) to determine which entities to
refer to the Office of Inspector General of the
Department of Health and Human Services and the
Department of Justice for further
investigation;
(ii) reporting any such referrals to the
Data Liaison Team, and the reasoning for any
such referrals, not later than 7 days after
such a referral is made; and
(iii) on an biannual basis, submitting to
Congress a report on the findings made by and
results from any referrals made by the
Interagency Board, including any reason for not
pursuing action on referrals in the event that
action was not taken (if the Interagency Board
has been informed of such reason).
(C) Composition.--
(i) In general.--The Interagency Board
shall consist of--
(I) the Administrator of Centers
for Medicare & Medicaid Services of the
Department of Health and Human Services
(or designee);
(II) the Inspector General of the
Office of the Inspector General of the
Department of Health and Human Services
(or designee);
(III) the Attorney General of the
Department of Justice (or designee);
and
(IV) any other employees of the
agencies specified in subclauses (I)
through (III) (as determined
appropriate by the Secretary of Health
and Human Services).
(ii) Chair.--An employee of the Office of
Inspector General of the Department of Health
and Human Services shall chair the Interagency
Board.
SEC. 3. FUNDING FOR NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE
AND USE OF INFORMATION TECHNOLOGY IN NURSING HOMES.
Section 6114 of the Patient Protection and Affordable Care Act (42
U.S.C. 1395i-3 note) is amended--
(1) in subsection (a), by adding at the end the following
new sentence: ``Beginning in fiscal year 2023, the Secretary
shall implement 2 additional demonstration projects, split in
accordance with the previous sentence.'';
(2) in subsection (b)--
(A) in paragraph (1), by adding at the end the
following new sentence: ``For the carrying out of the
implementation of demonstration projects beginning in
fiscal year 2023, the Secretary shall award grants (in
a number determined appropriate) in accordance with the
provisions of this subsection.''; and
(B) by adding at the end the following new
paragraph:
``(3) Requirement for one of the renewed demonstration
projects.--With respect to the grants which are awarded under 1
of the 2 demonstration projects which is implemented pursuant
to the second sentence of subsection (a), all of the grants
which are so awarded shall be awarded to skilled nursing
facilities and nursing facilities which have a high proportion
of residents receiving medical assistance under title XIX of
the Social Security Act for nursing facility services.'';
(3) in subsection (c)--
(A) in paragraph (1), by striking ``The
demonstration projects'' and inserting ``Subject to
paragraph (3), the demonstration projects''; and
(B) by adding at the end the following new
paragraph:
``(3) Implementation of demonstration projects.--The
demonstration projects described in the second sentence of
subsection (a) shall be implemented for a period not to exceed
5 years.'';
(4) in subsection (d), by adding at the end the following
new paragraph:
``(4) Culture change.--The term `culture change' means,
with respect to a skilled nursing facility or a nursing
facility carrying out a demonstration project under this
section, the process of promoting person-centered care and
person-centered work culture at such facility.''; and
(5) in subsection (e), by adding at the end the following
new sentence: ``With respect to the implementation of the
demonstration projects pursuant to the second sentence of
subsection (a), there are authorized to be appropriated
$50,000,000 to carry out the demonstration project relating to
culture change and $30,000,000 to carry out the demonstration
project relating to information technology for the period of
fiscal years 2023 through 2027.''.
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