I 

116TH CONGRESS 

1ST SESSION H. R. 1265 

To amend titles XVIII and XIX of the Social Security Act with respect 

to nursing facility requirements, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 14, 2019 

Mr. DUFFY (for himself, Mr. PETERSON, and Mr. GIANFORTE) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and 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 

with respect to nursing facility requirements, 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. 

4 This Act may be cited as the ‘‘Nursing Home Work5 force Quality Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Nursing facilities are an integral component 

2 of the continuum of care for Medicare and Medicaid 

3 patients. 

4 (2) Many nursing facilities have in-house edu5 cational programs approved by the Centers for Medi6 care & Medicaid Services to train individuals as cer7 tified nursing aides to provide extensive, direct care. 

8 (3) The ability to provide this training is crit9 ical for nursing facilities to ensure that— 

10 (A) residents receive the highest quality 

11 care; 

12 (B) caregivers are trained on the most 

13 timely best practices and clinical standards; and 

14 (C) facilities can— 

15 (i) sustain appropriate staffing levels; 

16 and 

17 (ii) recruit and retain qualified staff. 

18 SEC. 3. TRAINING AND COMPETENCY EVALUATION PRO19 GRAMS. 

20 (a) MEDICARE.—Section 1819 of the Social Security 

21 Act (42 U.S.C. 1395i–3) is amended— 

22 (1) in subsection (f)(2)— 

23 (A) in subparagraph (A)(iv)(I), by striking 

24 ‘‘(unless the facility is described in subpara25 graph (B)(iii)(I))’’; 


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1 (B) in subparagraph (B)— 

2 (i) in clause (i)— 

3 (I) by striking ‘‘(subject to clause 

4 (iii))’’; and 

5 (II) by inserting ‘‘and’’ after the 

6 semicolon; 

7 (ii) in clause (ii), by striking ‘‘; and’’ 

8 and inserting a period; 

9 (iii) by striking clause (iii); and 

10 (iv) by striking ‘‘A State may not del11 egate (through subcontract or otherwise) 

12 its responsibility under clause (iii)(II) to 

13 the skilled nursing facility.’’; 

14 (C) by striking subparagraphs (C) and 

15 (D); and 

16 (D) by adding at the end the following: 

17 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN18 ING AND COMPETENCY EVALUATION PROGRAMS

19 AND NURSE AIDE COMPETENCY EVALUATION

20 PROGRAMS.— 

21 ‘‘(i) IN GENERAL.—With respect to a 

22 State, the Secretary may, in consultation 

23 with such State, disapprove a nurse aide 

24 training and competency evaluation pro25 gram or a nurse aide competency evaluaVerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265

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1 tion program offered by or in a skilled 

2 nursing facility if such facility— 

3 ‘‘(I) has been assessed a civil 

4 monetary penalty under subsection 

5 (h)(2)(B)(ii) or section 

6 1919(h)(2)(A)(ii) of not less than 

7 $10,697 for providing substandard 

8 quality of care; and 

9 ‘‘(II) has not, in the determina10 tion of the Secretary, corrected the 

11 deficiencies in quality of care for 

12 which such civil monetary penalty was 

13 assessed. 

14 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

15 The Secretary shall rescind a disapproval 

16 under clause (i) upon demonstration by a 

17 facility that all deficiencies for which the 

18 civil monetary penalty described in clause 

19 (i)(I) was assessed have been remedied.’’; 

20 and 

21 (2) in subsection (h)(2)(B)(ii)(I), by striking 

22 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 

23 (b) MEDICAID.—Section 1919 of the Social Security 

24 Act (42 U.S.C. 1396r) is amended— 

25 (1) in subsection (f)(2)— 


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1 (A) in subparagraph (A)(iv)(I), by striking 

2 ‘‘(unless the facility is described in subpara3 graph (B)(iii)(I))’’; 

4 (B) in subparagraph (B)— 

5 (i) in clause (i), by inserting ‘‘and’’ 

6 after the semicolon; 

7 (ii) in clause (ii), by striking ‘‘; and’’ 

8 and inserting a period; 

9 (iii) by striking clause (iii); and 

10 (iv) by striking ‘‘A State may not del11 egate (through subcontract or otherwise) 

12 its responsibility under clause (iii)(II) to 

13 the nursing facility.’’; 

14 (C) by striking subparagraphs (C) and 

15 (D); and 

16 (D) by adding at the end the following: 

17 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN18 ING AND COMPETENCY EVALUATION PROGRAMS

19 AND NURSE AIDE COMPETENCY EVALUATION

20 PROGRAMS.— 

21 ‘‘(i) IN GENERAL.—With respect to a 

22 State, the Secretary may, in consultation 

23 with such State, disapprove a nurse aide 

24 training and competency evaluation pro25 gram or a nurse aide competency evaluaVerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265

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1 tion program offered by or in a nursing fa2 cility if such facility— 

3 ‘‘(I) has been assessed a civil 

4 monetary penalty under section 

5 1819(h)(2)(B)(ii) or subsection 

6 (h)(2)(A)(ii) of not less than $10,697 

7 for providing substandard quality of 

8 care; and 

9 ‘‘(II) has not, in the determina10 tion of the Secretary, corrected the 

11 deficiencies in quality of care for 

12 which such civil monetary penalty was 

13 assessed. 

14 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

15 The Secretary shall rescind a disapproval 

16 under clause (i) upon demonstration by a 

17 facility that all deficiencies for which the 

18 civil monetary penalty described in clause 

19 (i)(I) was assessed have been remedied.’’; 

20 and 

21 (2) in subsection (h)(3)(C)(ii)(I), by striking 

22 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 

23 (c) REGULATIONS.—Not later than 180 days after 

24 the date of enactment of this Act, the Secretary of Health 


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1 and Human Services shall promulgate regulations as nec2 essary to implement the amendments made by this section. 

3 (d) APPLICABILITY.— 

4 (1) IN GENERAL.— 

5 (A) TIMING OF DETERMINATIONS.—The 

6 amendments made by subsections (a)(1)(D) and 

7 (b)(1)(D) of this section shall apply only to a 

8 civil monetary penalty if the relevant covered 

9 determination was made on or after the date of 

10 enactment of this Act. 

11 (B) COVERED DETERMINATION DE12 FINED.—The term ‘‘covered determination’’ 

13 means, with respect to a facility in a State, a 

14 determination by the State or the Secretary of 

15 Health and Human Services that the facility 

16 has provided a substandard quality of care for 

17 which a civil monetary penalty described in sec18 tion 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) 

19 of the Social Security Act (as such sections 

20 have been amended by this Act) may be as21 sessed. 

22 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 

23 (A) WAIVER.—With respect to a facility 

24 subject, on the day before the date of enact25 ment of this Act, to a prohibition under item 


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1 (a) of either section 1819(f)(2)(B)(iii)(I) or sec2 tion 1919(f)(2)(B)(iii)(I) of the Social Security 

3 Act (as in effect on the day before such date of 

4 enactment), such prohibition shall no longer 

5 apply to the facility on or after such date of en6 actment. 

7 (B) SURVEY OR CIVIL MONETARY PEN8 ALTY.—With respect to a facility subject, on 

9 the day before the date of enactment of this 

10 Act, to a prohibition under item (b) or (c) of ei11 ther section 1819(f)(2)(B)(iii)(I) or section 

12 1919(f)(2)(B)(iii)(I) of the Social Security Act 

13 (as in effect on the day before such date of en14 actment), such prohibition shall no longer apply 

15 to the facility on or after such date of enact16 ment upon a determination by the Secretary of 

17 Health and Human Services that the facility 

18 has corrected the issue that resulted in such 

19 prohibition. 

Æ 


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