II 

116TH CONGRESS 

2D SESSION S. 4184 

To require States to meet assisted living facility reporting requirements to 

qualify for future COVID–19 response funds. 

IN THE SENATE OF THE UNITED STATES 

JULY 2, 2020 

Ms. WARREN (for herself and Mr. MARKEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To require States to meet assisted living facility reporting 

requirements to qualify for future COVID–19 response 

funds. 

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. 

4 This Act may be cited as the ‘‘Assisted Living Facil5 ity Coronavirus Reporting Act’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 

8 (1) ASSISTED LIVING FACILITY.—The term 

9 ‘‘assisted living facility’’ means— 

10 (A) an adult care facility that— 


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1 (i) is licensed and regulated by the 

2 State in which the facility is located (or, if 

3 there is no State law providing for such li4 censing and regulation by the State, by the 

5 municipality or other political subdivision 

6 in which the facility is located); 

7 (ii) makes available to residents sup8 portive services to assist the residents in 

9 carrying out activities of daily living, such 

10 as bathing, dressing, eating, getting in and 

11 out of bed or chairs, walking, going out12 doors, using the toilet, laundry, home man13 agement, preparing meals, shopping for 

14 personal items, obtaining and taking medi15 cation, managing money, using the tele16 phone, or performing light or heavy house17 work, and which may make available to 

18 residents home health care services, such 

19 as nursing and therapy; and 

20 (iii) provides dwelling units for resi21 dents, each of which may contain a full 

22 kitchen and bathroom, and which includes 

23 common rooms and other facilities appro24 priate for the provision of supportive serv25 ices to the residents of the facility; 


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1 (B) an adult care facility that— 

2 (i) is— 

3 (I) licensed and regulated by the 

4 State in which the facility is located 

5 (or, if there is no State law providing 

6 for such licensing and regulation by 

7 the State, by the municipality or other 

8 political subdivision in which the facil9 ity is located); and 

10 (II) similar to a skilled nursing 

11 facility, (as defined in section 1819(a) 

12 of the Social Security Act (42 U.S.C. 

13 1395i–3(a))), a nursing facility (as 

14 defined in section 1919(a) of the So15 cial Security Act (42 U.S.C. 

16 1396r(a))), or a board and care facil17 ity (as defined in section 1616(e) of 

18 the Social Security Act (42 U.S.C. 

19 1382e(e))); or 

20 (ii) is subject to the identification, in21 vestigation, and resolution of complaints 

22 by, or otherwise subject to the activities of, 

23 a State Long-Term Care Ombudsman pro24 gram established under section 712 of the 


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1 Older Americans Act of 1965 (42 U.S.C. 

2 3058g); or 

3 (C) an adult care facility receiving Federal 

4 funds through a State Medicaid program under 

5 title XIX of the Social Security Act (42 U.S.C. 

6 1396 et seq.), including through any waiver re7 lating to such a program granted under such 

8 title or title XI of such Act (42 U.S.C. 1301 et 

9 seq.). 

10 (2) SECRETARY.—The term ‘‘Secretary’’ means 

11 the Secretary of Health and Human Services. 

12 SEC. 3. STATE REPORTING REQUIREMENTS FOR ASSISTED 

13 LIVING FACILITIES AND COVID–19. 

14 (a) IN GENERAL.—As a condition of receiving fund15 ing to combat the coronavirus pandemic under Federal 

16 legislation enacted on or after the date of enactment of 

17 this Act which designates such funding as being for emer18 gency requirements pursuant to section 251(b)(2)(A)(i) of 

19 the Balanced Budget and Emergency Deficit Control Act 

20 of 1985 (2 U.S.C. 901(b)(2)(A)(i)), a State shall do the 

21 following: 

22 (1) Within 30 days of the passage of this Act, 

23 begin weekly reporting of the following information 

24 for each assisted living facility located in the State 

25 to the Centers for Disease Control and Prevention, 


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1 disaggregated by race, ethnicity, primary language, 

2 sex, sexual orientation, gender identity, age, and dis3 ability status: 

4 (A) The number of suspected and con5 firmed active cases of Coronavirus Disease 

6 2019 (COVID–19) among residents and the 

7 number of suspected and confirmed active cases 

8 of COVID–19 among staff of the facility. 

9 (B) The number of residents and staff of 

10 the facility, respectively, who, since the last re11 port under this paragraph, contracted severe 

12 respiratory infections related to COVID–19 

13 that resulted in hospitalization and the number 

14 that resulted in death, including deaths that oc15 curred outside of the facility. 

16 (C) The number of COVID–19 diagnostic 

17 tests conducted weekly on residents and staff of 

18 the facility, respectively, and the percentage of 

19 those tests that are positive among residents 

20 and staff of the facility, respectively. 

21 (D) The average time between testing a 

22 resident and receiving the results of the test. 

23 (E) The personal protective equipment, 

24 hand hygiene supplies, ventilators, and medical 

25 supplies in the facility. 


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1 (F) The total number of resident beds at, 

2 residents living in, and staff employed by the 

3 facility. 

4 (G) Other information specified by the 

5 Secretary. 

6 (2) Within 30 days of the passage of this Act, 

7 report for each assisted living facility in the State to 

8 the Centers for Disease Control and Prevention, the 

9 information specified in subparagraphs (A) through 

10 (G) of paragraph (1) for the period of time between 

11 January 1, 2020, and the passage of this Act, 

12 disaggregated by race, ethnicity, primary language, 

13 sex, sexual orientation, gender identity, age, and dis14 ability status. 

15 (3) Within 30 days of the passage of this Act, 

16 require each assisted living facility in the State to 

17 inform the Centers for Medicare & Medicaid Serv18 ices, the Centers for Disease Control and Preven19 tion, State and local health officials, residents, their 

20 representatives, and families of those residing in fa21 cilities by 5 p.m. the next calendar day following the 

22 occurrence of either a single confirmed infection of 

23 COVID–19 among the residents or staff of the facil24 ity or 3 or more residents or staff of the facility preVerDate Sep 11 2014 00:59 Jul 14, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4184.IS S4184

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1 senting new-onset of respiratory symptoms within 72 

2 hours of each other. This information shall— 

3 (A) not include personally identifiable in4 formation; 

5 (B) include information on mitigating ac6 tions implemented to prevent or reduce the risk 

7 of transmission, including if normal operations 

8 of the facility will be altered; and 

9 (C) include any cumulative updates for 

10 residents, their representatives, and families at 

11 least weekly or by 5 p.m. the next calendar day 

12 following the subsequent occurrence of— 

13 (i) the identification of a confirmed 

14 infection of COVID–19 among the resi15 dents or staff of the facility; or 

16 (ii) 3 or more residents or staff pre17 senting new onset of respiratory symptoms 

18 within 72 hours of each other. 

19 (b) SUNSET.—The requirements of subsection (a) 

20 shall terminate if and when the circumstances which led 

21 to the public health emergency period described in section 

22 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 

23 1320b–5(g)(1)(B)) (relating to the coronavirus pandemic) 

24 cease to exist and are unlikely to recur. 


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1 (c) GUIDANCE.—Within 15 days of the date of enact2 ment of this Act, the Secretary shall issue guidance to 

3 States to ensure the information reported in (a) is re4 ported in an electronic, standardized format that matches, 

5 to the extent practicable, the format applicable to informa6 tion reported to the Department of Health and Human 

7 Services by skilled nursing facilities and nursing facilities 

8 on COVID–19 under section 483.30(g) of title 42, Code 

9 of Federal Regulations (as amended by the interim final 

10 rule of the Centers for Medicare & Medicaid Services pub11 lished on May 8, 2020 (85 Fed. Reg. 27550)), to enable 

12 the comparison of COVID–19 outbreaks across congregate 

13 care settings. 

14 (d) PUBLICATION OF INFORMATION.—The Secretary 

15 shall publicly post on the website of the Department of 

16 Health and Human Services, the information received by 

17 the Department under section (a), and shall update such 

18 information on a weekly basis. 

19 (e) EXTENSIONS.—The Secretary may grant, at the 

20 request of a State, a 30-day extension for the State report 

21 the information required under paragraphs (1) and (2) of 

22 subsection (a) to allow the State to develop the reporting 

23 infrastructure necessary to gather such information from 

24 assisted living facilities. 


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1 SEC. 4. APPLICATION OF NURSING FACILITY REPORTING 

2 REQUIREMENTS TO ASSISTED LIVING FACILI3 TIES. 

4 The Secretary shall provide that any COVID–19 re5 porting requirement that applies to skilled nursing facili6 ties (as defined in section 1819(a) of the Social Security 

7 Act (42 U.S.C. 1395i–3(a))) or nursing facilities (as de8 fined in section 1919(a) of the Social Security Act (42 

9 U.S.C. 1396r(a))) and is imposed on or after the date of 

10 enactment of this Act under title XVIII or XIX of the 

11 Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) 

12 or under a regulation promulgated under such title shall 

13 apply in the same manner to assisted living facilities, 

14 which shall report such information through the States 

15 unless complying with such reporting requirement is not 

16 practicable in the assisted living facility setting. 

17 SEC. 5. GAO REPORT. 

18 Not later than 2 years after the date of enactment 

19 of this Act, the Comptroller General of the United States 

20 shall conduct an evaluation, and submit to Congress, a 

21 report including— 

22 (1) what is known about how required reporting 

23 of COVID–19 data on residents in nursing homes 

24 during the pandemic was used to prevent or control 

25 COVID–19 cases or deaths, and how this compares 


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1 to the experience of other congregate care facilities 

2 without required reporting of this data; and 

3 (2) any lessons learned from required reporting 

4 of COVID–19 cases or deaths in nursing homes that 

5 could be applied to other congregate care facilities 

6 during the COVID–19 pandemic, if it continues, and 

7 similar public health emergencies in the future. 

Æ 


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