I

106TH CONGRESS

2D SESSION H. R. 5646

To amend titles XVIII and XIX of the Social Security Act to provide for

increased accountability of nursing facilities and adequate nurse staffing

for patient needs in the facilities.

IN THE HOUSE OF REPRESENTATIVES

DECEMBER 7, 2000

Mr. STARK introduced the following bill; which was referred to the Committee

on Ways and Means, and in addition to the Committee on Commerce,

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 titles XVIII and XIX of the Social Security Act

to provide for increased accountability of nursing facilities and adequate nurse staffing for patient needs in

the facilities.

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 ‘‘Nursing Facility Staff5 ing Improvement Act of 2000’’.
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1 SEC. 2. INTERIM SURVEYS FOR NURSING HOMES FOR DEFI2 CIENCIES ATTRIBUTABLE TO INADEQUATE

3 NURSE STAFFING.

4 (a) INTERIM SURVEYS FOR QUALITY DEFICIENCIES

5 ATTRIBUTABLE TO INADEQUATE NURSE STAFFING.—

6 (1) ESTABLISHMENT OF REQUIREMENT FOR IN7 TERIM SURVEYS.—Sections 1819(g)(2) and

8 1919(g)(2) of the Social Security Act (42 U.S.C.

9 1395i–3(g)(2) and 1396r(g)(2)) are each amended—

10 (A) in subparagraph (A)(ii)—

11 (i) in subclause (II), by striking

12 ‘‘and’’ at the end;

13 (ii) in subclause (III), by striking the

14 period and inserting ‘‘, and’’; and

15 (iii) by adding at the end the fol16 lowing new subclause:

17 ‘‘(IV) for each quality deficiency

18 identified in the survey that resulted

19 in actual harm to a resident of the fa20 cility or that posed a risk of imme21 diate jeopardy to the health or safety

22 of the resident, an assessment of

23 whether inadequate nurse staffing is a

24 contributing factor to that defi25 ciency.’’; and
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1 (B) by adding at the end the following new

2 subparagraph:

3 ‘‘(F) INTERIM SURVEYS FOR INADEQUATE

4 STAFFING.—

5 ‘‘(i) IN GENERAL.—With respect to

6 each quality deficiency of a facility identi7 fied in a survey to which inadequate nurse

8 staffing is determined to be a contributing

9 factor under subparagraph (A)(ii)(IV), the

10 facility shall be subject to interim surveys

11 under this subparagraph.

12 ‘‘(ii) INITIAL 2 MANDATORY SUR13 VEYS.—

14 ‘‘(I) PERIOD FOR CONDUCT OF

15 INTERIM SURVEYS.—Two interim sur16 veys shall be conducted during the pe17 riod beginning on the date of the im18 plementation by the facility of a plan

19 of correction for such quality defi20 ciencies and ending before the date of

21 the succeeding standard survey con22 ducted under subparagraph (A).

23 ‘‘(II) REQUIRED ASSESSMENT OF

24 INTERIM SURVEYS.—Such surveys

25 shall assess the adequacy of nurse
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1 staffing at the facility and the contin2 ued compliance of the facility with

3 such plan of correction.

4 ‘‘(III) CONDUCT OF INTERIM

5 SURVEYS WITHOUT NOTICE TO FACIL6 ITY.—Such surveys shall be conducted

7 without any prior notice to the facil8 ity. Any individual who notifies (or

9 causes to be notified) a facility of the

10 time or date on which such a survey

11 is scheduled to be conducted is subject

12 to a civil money penalty in the same

13 manner as provided for under the sec14 ond and third sentences of subpara15 graph (A)(i).

16 ‘‘(iii) FINDING OF INADEQUATE

17 NURSE STAFFING IN AN INTERIM SUR18 VEY.—In the case of a finding in a facility

19 of a quality deficiency that is identified in

20 an interim survey under clause (ii) to

21 which inadequate nurse staffing is deter22 mined to be a contributing factor, during

23 the two-year period beginning on the date

24 of such finding, the facility shall be subject

25 to such additional interim surveys as the
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1 State determines appropriate to verify the

2 maintenance of adequate nurse staffing in

3 the facility and continued compliance by

4 the facility with the plan of correction.

5 ‘‘(iv) NURSE STAFFING DEFINED.—In

6 this paragraph and subsection (b)(1)(B),

7 the term ‘nurse staffing’ means nursing

8 staff consisting of registered professional

9 nurses, licensed practical nurses, or cer10 tified nurse aides.’’.

11 (2) CONFORMING AMENDMENT.—Section

12 1864(d) of the Social Security Act (42 U.S.C.

13 1395aa(d)) is amended by inserting ‘‘(including in14 terim surveys under section 1819(g)(2)(F))’’ after

15 ‘‘section 1819(g)’’.

16 (b) PROMPT IMPLEMENTATION OF PLANS OF COR17 RECTION FOR DEFICIENCIES ATTRIBUTABLE TO INAD18 EQUATE NURSE STAFFING.—Sections 1819(b)(1)(B) and

19 1919(b)(1)(B) of the Social Security Act (42 U.S.C.

20 1395i–3(b)(1)(B) and 1396r(b)(1)(B)) are each amended

21 by adding at the end the following: ‘‘In the case of a plan

22 of correction to correct quality deficiencies of a facility

23 identified in a survey to which inadequate nurse staffing

24 is determined to be a contributing factor under subsection

25 (g)(2)(A)(ii)(IV), such plan shall specify the number and
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1 type of additional nurse staff necessary to provide the req2 uisite care required under paragraph (2) for each resident

3 of the facility and shall be implemented not later than 30

4 days after receipt of notice of the deficiency.’’.

5 (c) COLLECTION OF DATA ON NURSE STAFFING

6 LEVELS.—

7 (1) MEDICARE.—Section 1819(b) of the Social

8 Security Act (42 U.S.C. 1395i–3(b)) is amended by

9 adding at the end the following new paragraph:

10 ‘‘(8) COLLECTION OF DATA.—

11 ‘‘(A) SUBMISSION TO SECRETARY.—

12 ‘‘(i) ON STAFFING LEVELS.—A skilled

13 nursing facility shall submit to the Sec14 retary, in such form and manner and at

15 such intervals as the Secretary may re16 quire, data with respect to nursing staff of

17 the facility. Such data shall include the

18 total number of nursing staff hours fur19 nished during the period specified by the

20 Secretary (including totals for each shift

21 worked during such period) by the facility

22 to residents for which payment is made

23 under section 1888(e), broken down by

24 total certified nurse aide hours, total li25 censed practical or vocational nurse hours,
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1 and total registered nurse hours, and shall

2 also include the average wage rate for each

3 class of nursing staff employed by the fa4 cility.

5 ‘‘(ii) INFORMATION CONCERNING

6 RESIDENTS.—The skilled nursing facility

7 shall provide the Secretary, in such form

8 and manner and at such intervals as the

9 Secretary may require, a classification of

10 all residents of the skilled nursing facility

11 that accords with the patient classification

12 system described in section

13 1888(e)(3)(B)(ii), or such successor system

14 as the Secretary may identify.

15 ‘‘(B) PUBLICATION.—The Secretary shall

16 provide for the publication on the Internet site

17 of the Department of Health and Human Serv18 ices known as ‘Nursing Home Compare’ the fa19 cility-specific nursing staff information collected

20 pursuant to subparagraph (A). The Secretary

21 shall update such information periodically.

22 ‘‘(C) REVIEW OF DATA.—The Secretary

23 shall determine for each year from data col24 lected under subparagraph (A) whether a facil-
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1 ity maintains adequate nurse staffing for resi2 dent care in the facility.’’.

3 (2) MEDICAID.—Section 1919(b) of the Social

4 Security Act (42 U.S.C. 1396r(b)) is amended by

5 adding at the end the following new paragraph:

6 ‘‘(9) SUBMISSION OF DATA.—

7 ‘‘(A) SUBMISSION TO SECRETARY.—

8 ‘‘(i) ON STAFFING LEVELS.—A nurs9 ing facility shall submit to the Secretary,

10 in such form and manner and at such in11 tervals as the Secretary may require, data

12 with respect to nursing staff of the facility.

13 Such data shall include the total number

14 of nursing staff hours furnished during the

15 period specified by the Secretary (including

16 totals for each shift worked during such

17 period) by the facility to residents for

18 which payment is made under section

19 1888(e), broken down by total certified

20 nurse aide hours, total licensed practical or

21 vocational nurse hours, and total registered

22 nurse hours, and shall also include the av23 erage wage rate for each class of nursing

24 staff employed by the facility.
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1 ‘‘(ii) INFORMATION CONCERNING

2 RESIDENTS.—The nursing facility shall

3 provide the Secretary, in such form and

4 manner and at such intervals as the Sec5 retary may require, a classification of all

6 residents of the skilled nursing facility that

7 accords with the patient classification sys8 tem described in section 1888(e)(3)(B)(ii),

9 or such successor system as the Secretary

10 may identify.

11 ‘‘(B) PUBLICATION.—The Secretary shall

12 provide for the publication on the Internet site

13 of the Department of Health and Human Serv14 ices known as ‘Nursing Home Compare’ the fa15 cility-specific nursing staff information collected

16 pursuant to subparagraph (A). The Secretary

17 shall update such information periodically.

18 ‘‘(C) REVIEW OF DATA.—The Secretary

19 shall determine for each year from data col20 lected under subparagraph (A) whether a facil21 ity maintains adequate nurse staffing for resi22 dent care in the facility.’’.

23 (d) EFFECTIVE DATE.—The amendments made by

24 this section apply with respect to surveys conducted on
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1 or after the date that is 6 months after the date of the

2 enactment of this Act.

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