II 

117TH CONGRESS 

1ST SESSION S. 230 

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

infection control and emergency preparedness regulations, to prohibit 

a reduction in the frequency of surveys of skilled nursing facilities and 

nursing facilities, and to prohibit the waiver of certain reporting requirements, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 4, 2021 

Mr. MENENDEZ introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to codify certain infection control and emergency preparedness regulations, to prohibit a reduction in the frequency of surveys of skilled nursing facilities and nursing 

facilities, and to prohibit the waiver of certain reporting 

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 ‘‘Promoting Restoration 

5 of Emergency Preparedness and Advancing Response to 


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1 Epidemics in Long-Term Care Act’’ or the ‘‘PREPARE 

2 LTC Act’’. 

3 SEC. 2. CODIFYING INFECTION CONTROL AND EMERGENCY 

4 PREPAREDNESS REGULATIONS FOR SKILLED 

5 NURSING FACILITIES AND NURSING FACILI6 TIES AS A REQUIREMENT FOR PARTICIPA7 TION UNDER THE MEDICARE AND MEDICAID 

8 PROGRAMS. 

9 (a) INFECTION CONTROL REGULATIONS.— 

10 (1) MEDICARE.—Section 1819(d)(3) of the So11 cial Security Act (42 U.S.C. 1395i–3(d)(3)) is 

12 amended— 

13 (A) by redesignating subparagraphs (A) 

14 and (B) as clauses (i) and (ii), respectively, and 

15 moving such clauses 2 ems to the right; 

16 (B) by striking ‘‘ENVIRONMENT.— A 

17 skilled nursing facility must—’’ and inserting 

18 ‘‘ENVIRONMENT.— 

19 ‘‘(A) IN GENERAL.—A skilled nursing fa20 cility must—’’; and 

21 (C) by adding at the end the following new 

22 subparagraph: 

23 ‘‘(B) APPLICATION STATEMENT.—For pur24 poses of carrying out this paragraph, the Sec25 retary shall apply by reference the provisions of 


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1 section 483.80 of title 42, Code of Federal Reg2 ulations (as in effect on the date of the enact3 ment of the Promoting Restoration of Emer4 gency Preparedness and Advancing Response to 

5 Epidemics in Long-Term Care Act), except in 

6 applying subsection (g) of such regulation— 

7 ‘‘(i) any reference to COVID–19 shall 

8 be treated as a reference to an infectious 

9 disease outbreak, as defined in subpara10 graph (C); and 

11 ‘‘(ii) any reference to ventilator capac12 ity shall be treated as a reference to med13 ical equipment and supplies critical to the 

14 infectious disease outbreak, including ven15 tilator capacity. 

16 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE17 FINED.—For purposes of subparagraph (B), 

18 the term ‘infectious disease outbreak’ means 

19 any of the following periods: 

20 ‘‘(i) COVID–19 EMERGENCY PE21 RIOD.—The emergency period described in 

22 section 1135(g)(1)(B). 

23 ‘‘(ii) OTHER INFECTIOUS DISEASE

24 OUTBREAK PERIODS.— 


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1 ‘‘(I) The period beginning on the 

2 date a nationwide emergency related 

3 to a public health emergency is de4 clared by the President pursuant to 

5 the National Emergencies Act or the 

6 Robert T. Stafford Disaster Relief 

7 and Emergency Assistance Act and 

8 ending on the date that is 6 months 

9 after the date on which the declara10 tion pursuant to the Stafford Act, a 

11 Major Disaster Declaration, or the 

12 National Emergencies Act, as applica13 ble, ends, whichever is the latest. 

14 ‘‘(II) The period during which 

15 there exists a public health emergency 

16 related to an infectious disease out17 break declared by the Secretary pur18 suant to section 319 of the Public 

19 Health Service Act. 

20 ‘‘(III) With respect to a skilled 

21 nursing facility in a State with respect 

22 to which the Governor has declared an 

23 emergency or major disaster (as de24 fined by the State) with respect to an 

25 infectious disease outbreak, the period 


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1 for which such declaration is in effect 

2 with respect to such State.’’. 

3 (2) MEDICAID.—Section 1919(d)(3) of the So4 cial Security Act (42 U.S.C. 1396r(d)(3)) is amend5 ed— 

6 (A) by redesignating subparagraphs (A) 

7 and (B) as clauses (i) and (ii), respectively, and 

8 moving such clauses 2 ems to the right; 

9 (B) by striking ‘‘ENVIRONMENT.— A nurs10 ing facility must—’’ and inserting ‘‘ENVIRON11 MENT.— 

12 ‘‘(A) IN GENERAL.—A nursing facility 

13 must—’’; and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(B) APPLICATION STATEMENT.—For pur17 poses of carrying out this paragraph, the Sec18 retary shall apply by reference the provisions of 

19 section 483.80 of title 42, Code of Federal Reg20 ulations (as in effect on the date of the enact21 ment of the Promoting Restoration of Emer22 gency Preparedness and Advancing Response to 

23 Epidemics in Long-Term Care Act), except in 

24 applying subsection (g) of such regulation— 


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1 ‘‘(i) any reference to COVID–19 shall 

2 be treated as a reference to an infectious 

3 disease outbreak, as defined in subpara4 graph (C); and 

5 ‘‘(ii) any reference to ventilator capac6 ity shall be treated as a reference to med7 ical equipment and supplies critical to the 

8 infectious disease outbreak, including ven9 tilator capacity. 

10 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE11 FINED.—The term ‘infectious disease outbreak’ 

12 has the meaning given such term in section 

13 1819(d)(3)(C).’’. 

14 (b) EMERGENCY PREPAREDNESS REGULATIONS.— 

15 (1) MEDICARE.—Section 1819(d) of such Act 

16 (42 U.S.C. 1395i–3(d)) is amended by adding at the 

17 end the following new paragraph: 

18 ‘‘(5) EMERGENCY PREPAREDNESS.—A skilled 

19 nursing facility shall meet the requirements applica20 ble to skilled nursing facilities under the provisions 

21 of section 483.73 of title 42, Code of Federal Regu22 lations (as in effect on the date of the enactment of 

23 the Promoting Restoration of Emergency Prepared24 ness and Advancing Response to Epidemics in Long25 Term Care Act).’’. 


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1 (2) MEDICAID.—Section 1919(d) of such Act 

2 (42 U.S.C. 1396r(d)) is amended by adding at the 

3 end the following new paragraph: 

4 ‘‘(5) EMERGENCY PREPAREDNESS.—A nursing 

5 facility shall meet the requirements applicable to 

6 nursing facilities under the provisions of section 

7 483.73 of title 42, Code of Federal Regulations (as 

8 in effect on the date of the enactment of the Pro9 moting Restoration of Emergency Preparedness and 

10 Advancing Response to Epidemics in Long-Term 

11 Care Act).’’. 

12 (c) REQUIREMENT TO ISSUE GUIDANCE.—Not later 

13 than 90 days after the date of the enactment of this Act, 

14 the Secretary of Health and Human Services shall issue 

15 guidance to carry out the amendments made by this sec16 tion. 

17 (d) PUBLIC AVAILABILITY OF DATA ON DEFI18 CIENCIES IN INFECTION CONTROL AND DIRECT CARE

19 STAFFING IN SKILLED NURSING FACILITIES.—Not later 

20 than 2 weeks after the beginning of a period of an infec21 tious disease outbreak (as defined in subparagraph (C) of 

22 subsection (d)(3) of section 1819 of the Social Security 

23 Act (42 U.S.C. 1395i–3), as added by subsection (a)(1)), 

24 (or, in the case of the COVID–19 emergency period de25 scribed in section 1135(g)(1)(B) of such Act (42 U.S.C. 


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1 1320b–5(g)(1)(B)), not later than 60 days after the date 

2 of the enactment of this Act), the Administrator of the 

3 Centers for Medicare & Medicaid Services shall make pub4 licly available on the internet website of the Centers for 

5 Medicare & Medicaid Services data on deficiencies identi6 fied during the survey process described under subsection 

7 (g) of such section 1819, with respect to infection control 

8 and direct care staffing in a skilled nursing facility (as 

9 defined in subsection (a) of such section 1819). Such data 

10 so posted, with respect to an infectious disease outbreak 

11 (as so defined), shall be updated every two weeks until 

12 the end of the period of such outbreak. 

13 SEC. 3. PROHIBITION ON REDUCING FREQUENCY OF 

14 STANDARD SURVEYS. 

15 (a) MEDICARE.—Section 1819(g)(2)(A)(iii) of such 

16 Act (42 U.S.C. 1395i–3(g)(2)(A)(iii)) is amended by add17 ing at the end the following new subclause: 

18 ‘‘(III) PROHIBITION ON REDUC19 ING FREQUENCY OF SURVEYS CON20 DUCTED DURING AN INFECTIOUS DIS21 EASE OUTBREAK.—The Secretary 

22 shall not reduce the frequency of sur23 veys conducted under this section dur24 ing an infectious disease outbreak (as 

25 defined in subsection (d)(3)(C)).’’. 


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1 (b) MEDICAID.—Section 1919(g)(2)(A)(iii) of such 

2 Act (42 U.S.C. 1396r(g)(2)(A)(iii)) is amended by adding 

3 at the end the following new subclause: 

4 ‘‘(I) PROHIBITION ON REDUCING

5 FREQUENCY OF SURVEYS CONDUCTED

6 DURING AN INFECTIOUS DISEASE

7 OUTBREAK.—The Secretary shall not 

8 reduce the frequency of surveys con9 ducted under this section during an 

10 infectious disease outbreak (as defined 

11 in section 1819(d)(3)(C)).’’. 

12 SEC. 4. PROHIBITION ON WAIVING SUBMISSIONS OF DI13 RECT CARE STAFFING INFORMATION. 

14 Section 1128I(g) of the Social Security Act (42 

15 U.S.C. 1320a–7j(g)) is amended— 

16 (1) in paragraph (3), by striking ‘‘and’’ at the 

17 end; 

18 (2) in paragraph (4), by striking the period and 

19 inserting ‘‘; and’’; 

20 (3) by inserting after paragraph (4) the fol21 lowing new paragraph: 

22 ‘‘(5) shall be submitted not less frequently than 

23 quarterly, on a schedule specified by the Secretary.’’; 

24 and 


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1 (4) by adding at the end the following new sen2 tence: ‘‘The Secretary shall not waive the require3 ments of this subsection in the case of an infectious 

4 disease outbreak (as defined in section 

5 1819(d)(3)(C)).’’. 

6 SEC. 5. GAO STUDY AND REPORT. 

7 Not later than one year after the end of the COVID– 

8 19 emergency period (as described in section 

9 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 

10 1320b–5(g)(1)(B))), the Comptroller General of the 

11 United States shall submit to the Committee on Ways and 

12 Means of the House of Representatives and the Committee 

13 on Finance of the Senate a report analyzing deficiencies 

14 during such period in infection control measures and di15 rect care staffing requirements for skilled nursing facilities 

16 (as defined in section 1819(a) of the Social Security Act 

17 (42 U.S.C. 1395i–3(a))), as reported by the Administrator 

18 under section 2(d). 

19 SEC. 6. EFFECTIVE DATE. 

20 The amendments made by this Act shall apply with 

21 respect to skilled nursing facilities and nursing facilities 

22 beginning on the date of the enactment of this Act. 

Æ 


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