[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1749 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 1749

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 18, 2023

Mr. Warner (for himself and Mr. Scott of South Carolina) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 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 ``Ensuring Seniors' Access to Quality 
Care Act''.

SEC. 2. TRAINING AND COMPETENCY EVALUATION PROGRAMS.

    (a) Medicare.--Section 1819(f)(2) of the Social Security Act (42 
U.S.C. 1395i-3(f)(2)) is amended--
            (1) in subparagraph (A)(iv)(I), by striking ``(unless the 
        facility is described in subparagraph (B)(iii)(I))'';
            (2) in subparagraph (B)--
                    (A) in clause (i)--
                            (i) by striking ``(subject to clause 
                        (iii))''; and
                            (ii) by inserting ``and'' after the 
                        semicolon;
                    (B) in clause (ii), by striking ``; and'' and 
                inserting a period; and
                    (C) by striking clause (iii);
            (3) by striking ``A State may not delegate (through 
        subcontract or otherwise) its responsibility under clause 
        (iii)(II) to the skilled nursing facility.'';
            (4) by striking subparagraphs (C) and (D); and
            (5) 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 2 
                        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--
                                    ``(I) all deficiencies for which 
                                the civil monetary penalty described in 
                                clause (i)(I) was assessed have been 
                                remedied;
                                    ``(II) the facility has not 
                                received deficiencies related to direct 
                                patient harm for substandard quality of 
                                care deficiencies in the prior 2 years; 
                                and
                                    ``(III) the Secretary certifies 
                                that the civil monetary penalty 
                                assessed under clause (i)(I) did not 
                                result in immediate jeopardy for direct 
                                patient harm or injury related to an 
                                abuse or neglect deficiency.
                        For purposes of rescinding disapproval under 
                        this clause, 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.''.
    (b) Medicaid.--Section 1919(f)(2) of the Social Security Act (42 
U.S.C. 1396r(f)(2)) is amended--
            (1) in subparagraph (A)(iv)(I), by striking ``(unless the 
        facility is described in subparagraph (B)(iii)(I))'';
            (2) in subparagraph (B)--
                    (A) in clause (i), by inserting ``and'' after the 
                semicolon;
                    (B) in clause (ii), by striking ``; and'' and 
                inserting a period;
                    (C) by striking clause (iii); and
                    (D) by striking ``A State may not delegate (through 
                subcontract or otherwise) its responsibility under 
                clause (iii)(II) to the nursing facility.'';
            (3) by striking subparagraphs (C) and (D); and
            (4) 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 2 
                        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--
                                    ``(I) all deficiencies for which 
                                the civil monetary penalty described in 
                                clause (i)(I) was assessed have been 
                                remedied;
                                    ``(II) the facility has not 
                                received deficiencies related to direct 
                                patient harm for substandard quality of 
                                care deficiencies in the prior 2 years; 
                                and
                                    ``(III) the Secretary certifies 
                                that the civil monetary penalty 
                                assessed under clause (i)(I) did not 
                                result in immediate jeopardy for direct 
                                patient harm or injury related to an 
                                abuse or neglect deficiency.
                        For purposes of rescinding disapproval under 
                        this clause, 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.''.
    (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)(4) and (b)(4) 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.

SEC. 3. PERMITTING MEDICARE AND MEDICAID PROVIDERS TO ACCESS THE 
              NATIONAL PRACTITIONER DATA BANK TO CONDUCT EMPLOYEE 
              BACKGROUND CHECKS.

    Section 1921(b)(6) of the Social Security Act (42 U.S.C. 1396r-
2(b)(6)) is amended--
            (1) by striking ``and other health care entities (as 
        defined in section 431 of the Health Care Quality Improvement 
        Act of 1986)'' and inserting ``, other health care entities (as 
        defined in section 431 of the Health Care Quality Improvement 
        Act of 1986), providers of services (as defined in section 
        1861(u)), suppliers (as defined in section 1861(d)), and 
        providers of items or services under a State plan under this 
        title (or a waiver of such a plan)''; and
            (2) by striking ``such hospitals or other health care 
        entities'' and inserting ``such hospitals, health care 
        entities, providers, or suppliers''.
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