I 

110TH CONGRESS 

1ST SESSION H. R. 2123 

To amend the Public Health Service Act to establish direct care registered 

nurse-to-patient staffing ratio requirements in hospitals, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 3, 2007 

Ms. SCHAKOWSKY (for herself, Mr. STARK, Mr. GRIJALVA, Mr. KUCINICH, 

Mrs. MCCARTHY of New York, Mr. NADLER, Mr. OBERSTAR, Mr. RANGEL, Ms. SCHWARTZ, and Mr. TOWNS) 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 the Public Health Service Act to establish direct 

care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Nurse Staffing Standards for Patient Safety and Quality 

6 Care Act of 2007’’. 

7 (b) FINDINGS.—Congress finds the following: 


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1 (1) The Federal Government has a substantial 

2 interest in promoting quality care and improving the 

3 delivery of health care services to patients in health 

4 care facilities in the United States. 

5 (2) Recent changes in health care delivery sys6 tems that have resulted in higher acuity levels 

7 among patients in health care facilities increase the 

8 need for improved quality measures in order to pro9 tect patient care and reduce the incidence of medical 

10 errors. 

11 (3) Inadequate and poorly monitored registered 

12 nurse staffing practices that result in too few reg13 istered nurses providing direct care jeopardize the 

14 delivery of quality health care services. 

15 (4) Numerous studies have shown that patient 

16 outcomes are directly correlated to direct care reg17 istered nurse staffing levels, including a 2002 Joint 

18 Commission on Accreditation of Healthcare Organi19 zations report that concluded that the lack of direct 

20 care registered nurses contributed to nearly a quar21 ter of the unanticipated problems that result in in22 jury or death to hospital patients. 

23 (5) Requirements for direct care registered 

24 nurse staffing ratios will help address the registered 

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1 cruitment of new registered nurses and improving 

2 retention of registered nurses who are considering 

3 leaving direct patient care because of demands cre4 ated by inadequate staffing. 

5 (6) Establishing adequate minimum direct care 

6 registered nurse-to-patient ratios that take into ac7 count patient acuity measures will improve the deliv8 ery of quality health care services and guarantee pa9 tient safety. 

10 (7) Establishing safe staffing standards for di11 rect care registered nurses is a critical component of 

12 assuring that there is adequate hospital staffing at 

13 all levels to improve the delivery of quality care and 

14 protect patient safety. 

15 SEC. 2. MINIMUM DIRECT CARE REGISTERED NURSE 

16 STAFFING REQUIREMENT. 

17 (a) MINIMUM DIRECT CARE REGISTERED NURSE

18 STAFFING REQUIREMENT.—The Public Health Service 

19 Act (42 U.S.C. 201 et seq.) is amended by adding at the 

20 end the following new title: 

21 ‘‘TITLE XXX—MINIMUM DIRECT 

22 CARE REGISTERED NURSE 

23 STAFFING REQUIREMENT 

24 ‘‘SEC. 3001. MINIMUM NURSE STAFFING REQUIREMENT. 

25 ‘‘(a) STAFFING PLAN.— 


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1 ‘‘(1) IN GENERAL.—A hospital shall implement 

2 a staffing plan that— 

3 ‘‘(A) provides adequate, appropriate, and 

4 quality delivery of health care services and pro5 tects patient safety; and 

6 ‘‘(B) is consistent with the requirements of 

7 this title. 

8 ‘‘(2) EFFECTIVE DATES.— 

9 ‘‘(A) IMPLEMENTATION OF STAFFING

10 PLAN.—Subject to subparagraph (B), the re11 quirements under paragraph (1) shall take ef12 fect not later than 1 year after the date of the 

13 enactment of this title. 

14 ‘‘(B) APPLICATION OF MINIMUM DIRECT

15 CARE REGISTERED NURSE-TO-PATIENT RA16 TIOS.—The requirements under subsection (b) 

17 shall take effect as soon as practicable, as de18 termined by the Secretary, but not later than 2 

19 years after the date of the enactment of this 

20 title, or in the case of a hospital in a rural area 

21 (as defined in section 1886(d)(2)(D) of the So22 cial Security Act), not later than 4 years after 

23 the date of the enactment of this title. 

24 ‘‘(b) MINIMUM DIRECT CARE REGISTERED NURSE25 TO-PATIENT RATIOS.— 


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1 ‘‘(1) IN GENERAL.—A hospital’s staffing plan 

2 shall provide that, during each shift within a unit of 

3 the hospital, a direct care registered nurse may be 

4 assigned to not more than the following number of 

5 patients in that unit, subject to paragraph (3): 

6 ‘‘(A) 1 patient in operating room units and 

7 trauma emergency units. 

8 ‘‘(B) 2 patients in critical care units, in9 cluding emergency critical care and intensive 

10 care units, labor and delivery units, and 

11 postanesthesia units. 

12 ‘‘(C) 3 patients in antepartum units, emer13 gency room units, pediatrics units, stepdown 

14 units, and telemetry units. 

15 ‘‘(D) 4 patients in intermediate care nurs16 ery units, medical/surgical units, and acute care 

17 psychiatric units. 

18 ‘‘(E) 5 patients in rehabilitation units. 

19 ‘‘(F) 6 patients in postpartum (3 couplets) 

20 units and well-baby nursery units. 

21 ‘‘(2) SIMILAR UNITS WITH DIFFERENT

22 NAMES.—The Secretary may apply minimum direct 

23 care registered nurse-to-patient ratios established in 

24 paragraph (1) to a type of hospital unit not referred 

25 to in such paragraph if such other unit performs a 


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1 function similar to the function performed by the 

2 unit referred to in such paragraph. 

3 ‘‘(3) ADJUSTMENT OF RATIOS.— 

4 ‘‘(A) IN GENERAL.—If necessary to protect 

5 patient safety, the Secretary may prescribe reg6 ulations that— 

7 ‘‘(i) increase minimum direct care reg8 istered nurse-to-patient ratios under this 

9 subsection to further limit the number of 

10 patients that may be assigned to each di11 rect care nurse; or 

12 ‘‘(ii) add minimum direct care reg13 istered nurse-to-patient ratios for units not 

14 referred to in paragraphs (1) and (2). 

15 ‘‘(B) CONSULTATION.—Such regulations 

16 shall be prescribed after consultation with af17 fected hospitals and registered nurses. 

18 ‘‘(4) RELATIONSHIP TO STATE-IMPOSED RA19 TIOS.— 

20 ‘‘(A) NO PREEMPTION OF CERTAIN STATE21 IMPOSED RATIOS.—Nothing in this title shall 

22 preempt State standards that the Secretary de23 termines to be at least equivalent to Federal re24 quirements for a staffing plan established under 

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1 to-patient ratios established under this sub2 section shall not preempt State requirements 

3 that the Secretary determines are at least 

4 equivalent to Federal requirements for a staff5 ing plan established under this title. 

6 ‘‘(B) SATISFACTION OF CERTAIN FEDERAL

7 REQUIREMENTS WITH CERTAIN STATE-IMPOSED

8 NURSE-TO-PATIENT RATIOS.—States that, at 

9 least 2 years prior to the date of the enactment 

10 of this title, have enacted minimum direct care 

11 nurse-to-patient ratios that allow the use of li12 censed practical nurses to meet State-imposed 

13 minimum direct care nurse-to-patient ratios 

14 may continue to make such allowance, and such 

15 allowance shall be considered to satisfy require16 ments imposed under this subsection, so long as 

17 the particular licensed practical nurse is em18 ployed in the same or a comparable position. 

19 ‘‘(5) EXEMPTION IN EMERGENCIES.— 

20 ‘‘(A) IN GENERAL.—The requirements es21 tablished under this subsection shall not apply 

22 during a declared state of emergency if a hos23 pital is requested or expected to provide an ex24 ceptional level of emergency or other medical 

25 services. 


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1 ‘‘(B) EMERGENCY DEFINED.—For pur2 poses of subparagraph (A), the term ‘declared 

3 state of emergency’ means a state of emergency 

4 that has been declared by the Federal Govern5 ment or the head of the appropriate State or 

6 local governmental agency having authority to 

7 declare that the State, county, municipality, or 

8 locality is in a state of emergency, but such 

9 term does not include a state of emergency that 

10 results from a labor dispute in the health care 

11 industry or consistent understaffing. 

12 ‘‘(c) DEVELOPMENT AND REEVALUATION OF STAFF13 ING PLAN.— 

14 ‘‘(1) CONSIDERATIONS IN DEVELOPMENT OF

15 PLAN.—In developing the staffing plan, a hospital 

16 shall provide for direct care registered nurse-to-pa17 tient ratios above the minimum direct care reg18 istered nurse-to-patient ratios required under sub19 section (b) if appropriate based upon consideration 

20 of the following factors: 

21 ‘‘(A) The number of patients and acuity 

22 level of patients as determined by the applica23 tion of an acuity system (as defined in section 

24 3006(1)), on a shift-by-shift basis. 


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1 ‘‘(B) The anticipated admissions, dis2 charges, and transfers of patients during each 

3 shift that impacts direct patient care. 

4 ‘‘(C) Specialized experience required of di5 rect care registered nurses on a particular unit. 

6 ‘‘(D) Staffing levels and services provided 

7 by other health care personnel in meeting direct 

8 patient care needs not required by a direct care 

9 registered nurse. 

10 ‘‘(E) The level of technology available that 

11 affects the delivery of direct patient care. 

12 ‘‘(F) The level of familiarity with hospital 

13 practices, policies, and procedures by temporary 

14 agency direct care registered nurses used dur15 ing a shift. 

16 ‘‘(G) Obstacles to efficiency in the delivery 

17 of patient care presented by physical layout. 

18 ‘‘(2) DOCUMENTATION OF STAFFING.—A hos19 pital shall specify the system used to document ac20 tual staffing in each unit for each shift. 

21 ‘‘(3) ANNUAL REEVALUATION OF PLAN AND

22 ACUITY SYSTEM.— 

23 ‘‘(A) IN GENERAL.—A hospital shall annu24 ally evaluate— 


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1 ‘‘(i) its staffing plan in each unit in 

2 relation to actual patient care require3 ments; and 

4 ‘‘(ii) the accuracy of its acuity system. 

5 ‘‘(B) UPDATE.—A hospital shall update its 

6 staffing plan and acuity system to the extent 

7 appropriate based on such evaluation. 

8 ‘‘(4) REGISTERED NURSE PARTICIPATION.—A 

9 staffing plan of a hospital shall be developed and 

10 subsequent reevaluations shall be conducted under 

11 this subsection on the basis of input from direct care 

12 registered nurses at the hospital or, where such 

13 nurses are represented through collective bargaining, 

14 from the applicable recognized or certified collective 

15 bargaining representative of such nurses. Nothing in 

16 this title shall be construed to permit conduct pro17 hibited under the National Labor Relations Act or 

18 under the Federal Labor Relations Act. 

19 ‘‘(d) SUBMISSION OF PLAN TO SECRETARY.—A hos20 pital shall submit to the Secretary its staffing plan and 

21 any annual updates under subsection (c)(3)(B). A feder22 ally operated hospital may submit its staffing plan 

23 through the department or agency operating the hospital. 


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1 ‘‘SEC. 3002. POSTING, RECORDS, AND AUDITS. 

2 ‘‘(a) POSTING REQUIREMENTS.—In each unit, a hos3 pital shall post a uniform notice in a form specified by 

4 the Secretary in regulation that— 

5 ‘‘(1) explains requirements imposed under sec6 tion 3001; 

7 ‘‘(2) includes actual direct care registered 

8 nurse-to-patient ratios during each shift; and 

9 ‘‘(3) is visible, conspicuous, and accessible to 

10 staff, patients, and the public. 

11 ‘‘(b) RECORDS.— 

12 ‘‘(1) MAINTENANCE OF RECORDS.—Each hos13 pital shall maintain accurate records of actual direct 

14 care registered nurse-to-patient ratios in each unit 

15 for each shift for no less than 3 years. Such records 

16 shall include— 

17 ‘‘(A) the number of patients in each unit; 

18 ‘‘(B) the identity and duty hours of each 

19 direct care registered nurse assigned to each 

20 patient in each unit in each shift; and 

21 ‘‘(C) a copy of each notice posted under 

22 subsection (a). 

23 ‘‘(2) AVAILABILITY OF RECORDS.—Each hos24 pital shall make its records maintained under para25 graph (1) available to— 

26 ‘‘(A) the Secretary; 


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1 ‘‘(B) registered nurses and their collective 

2 bargaining representatives (if any); and 

3 ‘‘(C) the public under regulations estab4 lished by the Secretary, or in the case of a fed5 erally operated hospital, under section 552 of 

6 title 5, United States Code (commonly known 

7 as the ‘Freedom of Information Act’). 

8 ‘‘(c) AUDITS.—The Secretary shall conduct periodic 

9 audits to ensure— 

10 ‘‘(1) implementation of the staffing plan in ac11 cordance with this title; and 

12 ‘‘(2) accuracy in records maintained under this 

13 section. 

14 ‘‘SEC. 3003. MINIMUM DIRECT CARE LICENSED PRACTICAL 

15 NURSE STAFFING REQUIREMENTS. 

16 ‘‘(a) ESTABLISHMENT.—A hospital’s staffing plan 

17 shall comply with minimum direct care licensed practical 

18 nurse staffing requirements that the Secretary establishes 

19 for units in hospitals. Such staffing requirements shall be 

20 established not later than 18 months after the date of the 

21 enactment of this title, and shall be based on the study 

22 conducted under subsection (b). 

23 ‘‘(b) STUDY.—Not later than 1 year after the date 

24 of the enactment of this title, the Secretary, acting 

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1 search and Quality, shall complete a study of licensed 

2 practical nurse staffing and its effects on patient care in 

3 hospitals. The Director may contract with a qualified enti4 ty or organization to carry out such study under this para5 graph. The Director shall consult with licensed practical 

6 nurses and organizations representing licensed practical 

7 nurses regarding the design and conduct of the study. 

8 ‘‘(c) APPLICATION OF REGISTERED NURSE PROVI9 SIONS TO LICENSED PRACTICAL NURSE STAFFING RE10 QUIREMENTS.—Paragraphs (2), (3), (4)(A), and (5) of 

11 section 3001(b), section 3001(c), and section 3002 shall 

12 apply to the establishment and application of direct care 

13 licensed practical nurse staffing requirements under this 

14 section in the same manner that they apply to the estab15 lishment and application of direct care registered nurse16 to-patient ratios under section 3001. 

17 ‘‘(d) EFFECTIVE DATE.—The requirements of this 

18 section shall take effect as soon as practicable, as deter19 mined by the Secretary, but not later than 2 years after 

20 the date of the enactment of this title, or in the case of 

21 a hospital in a rural area (as defined in section 

22 1886(d)(2)(D) of the Social Security Act), not later than 

23 4 years after the date of the enactment of this title. 


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1 ‘‘SEC. 3004. ADJUSTMENT IN REIMBURSEMENT. 

2 ‘‘(a) MEDICARE REIMBURSEMENT.—The Secretary 

3 shall adjust payments made to hospitals (other than feder4 ally operated hospitals) under title XVIII of the Social Se5 curity Act in an amount equal to the net amount of addi6 tional costs incurred in providing services to medicare 

7 beneficiaries that are attributable to compliance with re8 quirements imposed under sections 3001 through 3003. 

9 The amount of such payment adjustments shall take into 

10 account recommendations contained in the report sub11 mitted by the Medicare Payment Advisory Commission 

12 under subsection (c). 

13 ‘‘(b) AUTHORIZATION OF APPROPRIATION FOR FED14 ERALLY OPERATED HOSPITALS.—There are authorized to 

15 be appropriated such additional sums as are required for 

16 federally operated hospitals to comply with the additional 

17 requirements established under sections 3001 through 

18 3003. 

19 ‘‘(c) MEDPAC REPORT.—Not later than 2 years after 

20 the date of the enactment of this title, the Medicare Pay21 ment Advisory Commission (established under section 

22 1805 of the Social Security Act) shall submit to Congress 

23 and the Secretary a report estimating total costs and sav24 ings attributable to compliance with requirements imposed 

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1 clude recommendations on the need, if any, to adjust reim2 bursement for Medicare payments under subsection (a). 

3 ‘‘SEC. 3005. PROTECTION OF NURSES AND OTHER INDIVID4 UALS. 

5 ‘‘(a) REFUSAL OF ASSIGNMENT.—A nurse may 

6 refuse to accept an assignment as a nurse in a hospital 

7 if— 

8 ‘‘(1) the assignment would violate section 3001 

9 or 3003; or 

10 ‘‘(2) the nurse is not prepared by education, 

11 training, or experience to fulfill the assignment with12 out compromising the safety of any patient or jeop13 ardizing the license of the nurse. 

14 ‘‘(b) RETALIATION FOR REFUSAL OF ASSIGNMENT

15 BARRED.— 

16 ‘‘(1) NO DISCHARGE, DISCRIMINATION, OR RE17 TALIATION.—No hospital shall discharge, discrimi18 nate, or retaliate in any manner with respect to any 

19 aspect of employment (as defined in section 

20 3006(5)), including discharge, promotion, compensa21 tion, or terms, conditions, or privileges of employ22 ment against a nurse based on the nurse’s refusal of 

23 a work assignment under subsection (a). 

24 ‘‘(2) NO FILING OF COMPLAINT.—No hospital 

25 shall file a complaint or a report against a nurse 


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1 with the appropriate State professional disciplinary 

2 agency because of the nurse’s refusal of a work as3 signment under subsection (a). 

4 ‘‘(c) CAUSE OF ACTION.—Any nurse who has been 

5 discharged, discriminated, or retaliated against in viola6 tion of subsection (b)(1) or against whom a complaint has 

7 been filed in violation of subsection (b)(2) may bring a 

8 cause of action in a United States district court. A nurse 

9 who prevails on the cause of action shall be entitled to 

10 one or more of the following: 

11 ‘‘(1) Reinstatement. 

12 ‘‘(2) Reimbursement of lost wages, compensa13 tion, and benefits. 

14 ‘‘(3) Attorneys’ fees. 

15 ‘‘(4) Court costs. 

16 ‘‘(5) Other damages. 

17 ‘‘(d) COMPLAINT TO SECRETARY.—A nurse or other 

18 individual may file a complaint with the Secretary against 

19 a hospital that violates the provisions of this title. For any 

20 complaint filed, the Secretary shall— 

21 ‘‘(1) receive and investigate the complaint; 

22 ‘‘(2) determine whether a violation of this title 

23 as alleged in the complaint has occurred; and 

24 ‘‘(3) if such a violation has occurred, issue an 

25 order that the complaining nurse or individual shall 


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1 not suffer any retaliation under subsection (b) or 

2 under subsection (e). 

3 ‘‘(e) PROTECTION FOR REPORTING.— 

4 ‘‘(1) RETALIATION BARRED.—A hospital shall 

5 not discriminate or retaliate in any manner with re6 spect to any aspect of employment, including hiring, 

7 discharge, promotion, compensation, or terms, condi8 tions, or privileges of employment against any indi9 vidual who in good faith, individually or in conjunc10 tion with another person or persons— 

11 ‘‘(A) reports a violation or a suspected vio12 lation of this title to the Secretary, a public reg13 ulatory agency, a private accreditation body, or 

14 the management personnel of the hospital; 

15 ‘‘(B) initiates, cooperates, or otherwise 

16 participates in an investigation or proceeding 

17 brought by the Secretary, a public regulatory 

18 agency, or a private accreditation body con19 cerning matters covered by this title; or 

20 ‘‘(C) informs or discusses with other indi21 viduals or with representatives of hospital em22 ployees a violation or suspected violation of this 

23 title. 

24 ‘‘(2) GOOD FAITH DEFINED.—For purposes of 

25 this subsection, an individual shall be deemed to be 


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1 acting in good faith if the individual reasonably be2 lieves— 

3 ‘‘(A) the information reported or disclosed 

4 is true; and 

5 ‘‘(B) a violation of this title has occurred 

6 or may occur. 

7 ‘‘(f) NOTICE.—A hospital shall post in an appropriate 

8 location in each unit a conspicuous notice in a form speci9 fied by the Secretary that— 

10 ‘‘(1) explains the rights of nurses and other in11 dividuals under this section; 

12 ‘‘(2) includes a statement that a nurse or other 

13 individual may file a complaint with the Secretary 

14 against a hospital that violates the provisions of this 

15 title; and 

16 ‘‘(3) provides instructions on how to file a com17 plaint under paragraph (2). 

18 ‘‘(g) EFFECTIVE DATES.— 

19 ‘‘(1) REFUSAL; RETALIATION; CAUSE OF AC20 TION.— 

21 ‘‘(A) IN GENERAL.—Subsections (a) 

22 through (c) shall apply to refusals occurring on 

23 or after the effective date of the provision to 

24 which the refusal relates. 


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1 ‘‘(B) EXCEPTION.—Subsection (a)(2) shall 

2 not apply to refusals in any hospital before the 

3 requirements of section 3001(a) apply to that 

4 hospital. 

5 ‘‘(2) PROTECTIONS FOR REPORTING.—Sub6 section (e) shall apply to actions described in sub7 paragraphs (A) and (C) of subsection (e)(1) occur8 ring on or after the effective date of the provision 

9 to which the violation relates. Subsection (e) shall 

10 apply to initiation, cooperation, or participation in 

11 an investigation or proceeding on or after the date 

12 of the enactment of this title. 

13 ‘‘(3) NOTICE.—Subsection (f) shall take effect 

14 18 months after the date of the enactment of this 

15 title. 

16 ‘‘SEC. 3006. DEFINITIONS. 

17 ‘‘For purposes of this title: 

18 ‘‘(1) ACUITY SYSTEM.—The term ‘acuity sys19 tem’ means an established measurement tool that— 

20 ‘‘(A) predicts nursing care requirements 

21 for individual patients based on severity of pa22 tient illness, need for specialized equipment and 

23 technology, intensity of nursing interventions 

24 required, and the complexity of clinical nursing 


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1 judgment needed to design, implement, and 

2 evaluate the patient’s nursing care plan; 

3 ‘‘(B) details the amount of nursing care 

4 needed, both in number of nurses and in skill 

5 mix of nursing personnel required, on a daily 

6 basis, for each patient in a nursing department 

7 or unit; 

8 ‘‘(C) takes into consideration the patient 

9 care services provided not only by registered 

10 nurses but also by direct care licensed practical 

11 nurses and other health care personnel; and 

12 ‘‘(D) is stated in terms that can be readily 

13 used and understood by nurses. 

14 ‘‘(2) DIRECT CARE LICENSED PRACTICAL

15 NURSE.—The term ‘direct care licensed practical 

16 nurse’ means an individual who has been granted a 

17 license by at least 1 State to practice as a licensed 

18 practical nurse or a licensed vocational nurse and 

19 who provides bedside care for 1 or more patients. 

20 ‘‘(3) NURSE.—The term ‘nurse’ means any di21 rect care registered nurse or direct care licensed 

22 practical nurse (as the case may be), regardless of 

23 whether or not the nurse is an employee. 

24 ‘‘(4) DIRECT CARE REGISTERED NURSE.—The 

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1 vidual who has been granted a license by at least 1 

2 State to practice as a registered nurse and who pro3 vides bedside care for 1 or more patients. 

4 ‘‘(5) EMPLOYMENT.—The term ‘employment’ 

5 includes the provision of services under a contract or 

6 other arrangement. 

7 ‘‘(6) HOSPITAL.—The term ‘hospital’ has the 

8 meaning given that term in section 1861(e) of the 

9 Social Security Act, and includes a hospital that is 

10 operated by the Department of Veterans Affairs, the 

11 Department of Defense, the Indian Health Services 

12 Program, or any other department or agency of the 

13 United States. 

14 ‘‘(7) STAFFING PLAN.—The term ‘staffing plan’ 

15 means a staffing plan required under section 3001.’’. 

16 (b) RECOMMENDATIONS TO CONGRESS.—No later 

17 than 1 year after the date of the enactment of this Act, 

18 the Secretary of Health and Human Services shall submit 

19 to Congress a report containing recommendations for en20 suring that sufficient numbers of nurses are available to 

21 meet the requirements imposed by title XXX of the Public 

22 Health Service Act, as added by subsection (a). 


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1 SEC. 3. ENFORCEMENT OF REQUIREMENTS THROUGH FED2 ERAL PROGRAMS. 

3 (a) MEDICARE PROGRAM.—Section 1866(a)(1) of the 

4 Social Security Act (42 U.S.C. 1395cc(a)(1)) is amend5 ed— 

6 (1) by striking ‘‘and’’ at the end of subpara7 graph (U); 

8 (2) by striking the period at the end of sub9 paragraph (V) and inserting ‘‘, and’’; and 

10 (3) by inserting after subparagraph (V) the fol11 lowing: 

12 ‘‘(W) in the case of a hospital, to comply with 

13 the provisions of title XXX of the Public Health 

14 Service Act.’’. 

15 (b) MEDICAID PROGRAM.—The first sentence of sec16 tion 1902(a) of the Social Security Act (42 U.S.C. 

17 1396(a)) is amended— 

18 (1) by striking ‘‘and’’ at the end of paragraph 

19 (69); 

20 (2) by striking the period at the end of para21 graph (70) and inserting ‘‘; and’’; and 

22 (3) by inserting after paragraph (70) the fol23 lowing new paragraph: 

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1 sions of title XXX of the Public Health Service 

2 Act.’’. 

3 (c) HEALTH BENEFITS PROGRAM OF THE DEPART4 MENT OF VETERANS AFFAIRS.—Section 8110(a) of title 

5 38, United States Code, is amended by adding at the end 

6 the following new paragraph: 

7 ‘‘(7) In the case of a Department medical facility that 

8 is a hospital, the hospital shall comply with the provisions 

9 of title XXX of the Public Health Service Act.’’. 

10 (d) HEALTH BENEFITS PROGRAM OF THE DEPART11 MENT OF DEFENSE.— 

12 (1) IN GENERAL.—Chapter 55 of title 10, 

13 United States Code, is amended by adding at the 

14 end the following new section: 

15 ‘‘§ 1110a. Staffing requirements 

16 ‘‘In the case of a facility of the uniformed services 

17 that is a hospital, the hospital shall comply with the provi18 sions of title XXX of the Public Health Service Act.’’. 

19 (2) CLERICAL AMENDMENT.—The table of sec20 tions at the beginning of such chapter is amended 

21 by inserting after the item relating to section 1110 

22 the following new item: 

‘‘1110a. Staffing requirements.’’. 

23 (e) INDIAN HEALTH SERVICES PROGRAM.—Title 

24 VIII of the Indian Health Care Improvement Act (25 


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1 U.S.C. 1671 et seq.) is amended by adding at the end 

2 the following new section: 

3 ‘‘SEC. 826. STAFFING REQUIREMENTS. 

4 ‘‘A hospital of the Service shall comply with the provi5 sions of title XXX of the Public Health Service Act.’’. 

Æ 


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