I 

115TH CONGRESS 

1ST SESSION H. R. 4704 

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

emergency preparedness final rule for skilled nursing facilities and nursing facilities as conditions of participation under the Medicare and Medicaid programs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 20, 2017 

Ms. WASSERMAN SCHULTZ (for herself and Mr. WALBERG) 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 titles XVIII and XIX of the Social Security Act 

to codify the emergency preparedness final rule for 

skilled nursing facilities and nursing facilities as conditions of participation under the Medicare and Medicaid 

programs, 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, 


lotter on DSKBCFDHB2PROD with BILLS
2 

•HR 4704 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Nursing Home Com3 fortable Air Ready for Emergencies Act’’ or the ‘‘Nursing 

4 Home CARE Act’’. 

5 SEC. 2. CODIFYING EMERGENCY PREPAREDNESS RULE 

6 FOR SKILLED NURSING FACILITIES AND 

7 NURSING FACILITIES AS CONDITIONS OF 

8 PARTICIPATION UNDER MEDICARE AND MED9 ICAID PROGRAMS. 

10 (a) MEDICARE.—Section 1819(a) of the Social Secu11 rity Act (42 U.S.C. 1395i–3(a)) is amended— 

12 (1) in paragraph (2), by striking at the end 

13 ‘‘and’’; 

14 (2) in paragraph (3), by striking the period at 

15 the end and inserting ‘‘; and’’; 

16 (3) by inserting after paragraph (3) the fol17 lowing new paragraph: 

18 ‘‘(4) beginning not later than the date of the 

19 enactment of this paragraph— 

20 ‘‘(A) meets the emergency preparedness re21 quirements applicable to skilled nursing facili22 ties under the final rule ‘Medicare and Medicaid 

23 Programs; Emergency Preparedness Require24 ments for Medicare and Medicaid Participating 

25 Providers and Suppliers’ as published by the 


lotter on DSKBCFDHB2PROD with BILLS
3 

•HR 4704 IH

1 Centers for Medicare & Medicaid Services on 

2 September 16, 2016 (81 Fed. Reg. 63859); and 

3 ‘‘(B) has in place alternative sources of en4 ergy capable of powering heating, ventilation, 

5 and air conditioning systems for at least 96 

6 hours after a catastrophic natural disaster.’’; 

7 and 

8 (4) by adding at the end the following: 

9 ‘‘Nothing in paragraph (4)(B) shall be construed to re10 quire a skilled nursing facility to continuously maintain 

11 a supply of fuel on its premise, as long as such facility 

12 is able to demonstrate to the Secretary the ability of the 

13 facility to obtain any fuel necessary to satisfy such para14 graph.’’. 

15 (b) MEDICAID.—Section 1919(a) of the Social Secu16 rity Act (42 U.S.C. 1396r(a)) is amended— 

17 (1) in paragraph (2), by striking at the end 

18 ‘‘and’’; 

19 (2) in paragraph (3), by striking the period at 

20 the end and inserting ‘‘; and’’; 

21 (3) by inserting after paragraph (3) the fol22 lowing new paragraph: 

23 ‘‘(4) beginning not later than the date of the 

24 enactment of this paragraph— 


lotter on DSKBCFDHB2PROD with BILLS
4 

•HR 4704 IH

1 ‘‘(A) meets the emergency preparedness re2 quirements applicable to nursing facilities under 

3 the final rule ‘Medicare and Medicaid Pro4 grams; Emergency Preparedness Requirements 

5 for Medicare and Medicaid Participating Pro6 viders and Suppliers’ as published by the Cen7 ters for Medicare & Medicaid Services on Sep8 tember 16, 2016 (81 Fed. Reg. 63859); and 

9 ‘‘(B) has in place alternative sources of en10 ergy capable of powering heating, ventilation, 

11 and air conditioning systems for at least 96 

12 hours after a catastrophic natural disaster.’’; 

13 and 

14 (4) by adding at the end the following new sen15 tence: 

16 ‘‘Nothing in paragraph (4)(B) shall be construed to re17 quire a nursing facility to continuously maintain a supply 

18 of fuel on its premise, as long as such facility is able to 

19 demonstrate to the Secretary the ability of the facility to 

20 obtain any fuel necessary to satisfy such paragraph.’’. 

21 (c) CIVIL MONEY PENALTIES.— 

22 (1) INCREASED PENALTY.—In the case of a de23 termination to impose a civil money penalty under 

24 section 1819(h)(2)(B)(ii) of the Social Security Act 

25 (42 U.S.C. 1395i–3(h)(2)(B)(ii)) or section 


lotter on DSKBCFDHB2PROD with BILLS
5 

•HR 4704 IH

1 1919(h)(2)(C)(ii) of such Act (42 U.S.C. 

2 1396r(h)(2)(C)(ii)), with respect to a violation of 

3 paragraph (4) of section 1819(a) of such Act (42 

4 U.S.C. 1395i–3(a)) or of paragraph (4) of section 

5 1919(a) of such Act (42 U.S.C. 1396r(a)), as added 

6 by subsections (a) and (b), respectively, such penalty 

7 shall be three times the amount that would other8 wise be imposed pursuant to the interim final rule, 

9 relating to the adjustment of civil money penalties 

10 for inflation, promulgated by the Department of 

11 Health and Human Services on September 6, 2016 

12 (81 Fed. Reg. 61538). Nothing in this paragraph 

13 shall be construed as limiting the discretion of the 

14 Secretary of Health and Human Services in deter15 mining the amount of a civil monetary penalty that 

16 would otherwise be imposed before application of 

17 this paragraph. 

18 (2) ADDITIONAL PENALTY.— 

19 (A) MEDICARE.—Section 1819(h)(2)(B)(ii) 

20 of the Social Security Act (42 U.S.C. 1395i– 

21 3(h)(2)(B)(ii)) is amended— 

22 (i) in subclause (I), by inserting ‘‘, 

23 subject to subclause (V),’’ after ‘‘exceed’’; 

24 and 


lotter on DSKBCFDHB2PROD with BILLS
6 

•HR 4704 IH

1 (ii) by adding at the end the following 

2 new subclause: 

3 ‘‘(V) INCREASED PENALTY.—In 

4 the case of noncompliance described 

5 in subclause (I) of a skilled nursing 

6 facility that results in the death of a 

7 resident of the facility, the Secretary 

8 may impose an additional civil money 

9 penalty under such subclause in an 

10 amount not to exceed $100,000.’’. 

11 (B) MEDICAID.—Section 1919(h)(3)(C)(ii) 

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

13 1396r(h)(3)(C)(ii)) is amended— 

14 (i) in subclause (I), by inserting ‘‘, 

15 subject to subclause (V),’’ after ‘‘exceed’’; 

16 and 

17 (ii) by adding at the end the following 

18 new subclause: 

19 ‘‘(V) INCREASED PENALTY.—In 

20 the case of noncompliance described 

21 in subclause (I) of a nursing facility 

22 that results in the death of a resident 

23 of the facility, the Secretary may im24 pose an additional civil monetary penVerDate Sep 11 2014 04:35 Dec 21, 2017 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4704.IH H4704

lotter on DSKBCFDHB2PROD with BILLS
7 

•HR 4704 IH

1 alty under such subclause in an 

2 amount not to exceed $100,000.’’. 

3 (3) STATE SURVEY AGENCIES COMPLIANCE RE4 VIEW.—The Secretary of Health and Human Serv5 ices shall direct State survey agencies, in consulta6 tion with emergency preparedness experts, to review 

7 findings related to the final rule ‘‘Medicare and 

8 Medicaid Programs; Emergency Preparedness Re9 quirements for Medicare and Medicaid Participating 

10 Providers and Suppliers’’ as published by the Cen11 ters for Medicare & Medicaid Services on September 

12 16, 2016 (81 Fed. Reg. 63859) and make a deter13 mination of whether a skilled nursing facility or 

14 nursing facility is substantially compliant or non15 compliant (as defined by the Secretary) with such 

16 rule, with special attention given to Ftags E–0001, 

17 E–0004, E–0013, E–0020, E–0025, E–0036, 0037, 

18 and E–0041. If a State survey agency makes a de19 termination of substantial non-compliance for any 

20 such facility in a State, the agency shall then inform 

21 those facilities of that finding, and request that this 

22 be noted as an indicator on Nursing Home Compare. 

23 SEC. 3. LOAN FUND. 

24 (a) ESTABLISHMENT.—The Secretary of Health and 

25 Human Services shall, subject to subsection (e), establish 


lotter on DSKBCFDHB2PROD with BILLS
8 

•HR 4704 IH

1 a loan program that provides loans to qualifying nursing 

2 facilities and skilled nursing facilities for costs relating to 

3 coming into compliance with the requirement of paragraph 

4 (4) of section 1819(a) of the Social Security Act (42 

5 U.S.C. 1395i–3(a)) and paragraph (4) of section 1919(a) 

6 of such Act (42 U.S.C. 1396r(a)), as added by section 2. 

7 (b) APPLICATION.—No loan may be provided under 

8 this section to a qualifying nursing facility or skilled nurs9 ing facility, except pursuant to an application that is sub10 mitted and approved in a time, manner, and form specified 

11 by the Secretary. A loan under this section shall be on 

12 such terms and conditions and meet such requirements as 

13 the Secretary determines appropriate. 

14 (c) SELECTION.— 

15 (1) IN GENERAL.—The Secretary shall establish 

16 criteria for selecting among qualifying nursing facili17 ties and skilled nursing facilities that apply for a 

18 loan under this section. 

19 (2) QUALIFYING FACILITIES.—For purposes of 

20 this section, qualifying nursing facilities and skilled 

21 nursing facilities are nursing facilities under section 

22 1919 of the Social Security Act (42 U.S.C. 1396r) 

23 and skilled nursing facilities under section 1819 of 

24 such Act (42 U.S.C. 1395i–3) that— 


lotter on DSKBCFDHB2PROD with BILLS
9 

•HR 4704 IH

1 (A) have a monthly rate of less than 

2 $6,000 for private rooms; or 

3 (B) have fewer than 50 beds. 

4 (d) FEES.—The Secretary may charge such fees as 

5 determined appropriate with respect to a loan issued 

6 under this section, in an amount established annually by 

7 the Secretary, as necessary to reduce to zero the cost (as 

8 defined in section 502 of the Federal Credit Reform Act 

9 of 1990) to the Department of Health and Human Serv10 ices of making loans under this section, which amounts 

11 shall be paid to and retained by the Secretary. 

12 (e) LIMITATION.—Commitments for loans authorized 

13 under this section shall not exceed— 

14 (1) $50,000,000 in fiscal year 2018; 

15 (2) $50,000,000 in fiscal year 2019; and 

16 (3) $100,000,000 for the duration of the loan 

17 program. 

18 SEC. 4. PRIORITIZATION UNDER ALL-HAZARDS PUBLIC 

19 HEALTH EMERGENCY PREPAREDNESS AND 

20 RESPONSE PLAN. 

21 (a) IN GENERAL.—Section 319C–1(b)(2)(A) of the 

22 Public Health Service Act (42 U.S.C. 247d–3a(b)(2)(A)) 

23 is amended— 

24 (1) in clause (viii), by striking at the end 

25 ‘‘and’’; 


lotter on DSKBCFDHB2PROD with BILLS
10 

•HR 4704 IH

1 (2) in clause (ix), by adding at the end ‘‘and’’; 

2 and 

3 (3) by inserting after clause (ix) the following 

4 new clause: 

5 ‘‘(x) a description of— 

6 ‘‘(I) the measures the entity has 

7 in place prioritizing nursing facilities 

8 and skilled nursing facilities with re9 spect to public health emergency pre10 paredness in the same manner as such 

11 plan prioritizes hospitals, while ensur12 ing that, in prioritizing nursing facili13 ties, skilled nursing facilities, and hos14 pitals, the entity retains the discretion 

15 to prioritize among such facilities; and 

16 ‘‘(II) information on the plans of 

17 each electric utility company within 

18 the entity’s jurisdiction to ensure that 

19 such facilities remain functioning or 

20 return to functioning as soon as prac21 ticable during power outages caused 

22 by natural hazards, including severe 

23 weather events;’’. 

24 (b) EFFECTIVE DATE.—The amendments made by 

25 subsection (a) shall apply with respect to cooperative 


lotter on DSKBCFDHB2PROD with BILLS
11 

•HR 4704 IH

1 agreements awarded on or after the date of the enactment 

2 of this Act. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS