I 

116TH CONGRESS 

2D SESSION H. R. 8568 

To amend title XVIII and title 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, to prohibit the waiver of certain reporting requirements, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 9, 2020 

Mr. PASCRELL (for himself, Ms. SHERRILL, Mrs. WATSON COLEMAN, Mr. 

BEYER, Mr. PAYNE, Mr. DOGGETT, Ms. SHALALA, Ms. JUDY CHU of 

California, and Mr. KILDEE) 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 title XVIII and title 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, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Promoting Restoration 

3 of Emergency Preparedness and Advancing Response to 

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

5 LTC Act’’. 

6 SEC. 2. CODIFYING INFECTION CONTROL AND EMERGENCY 

7 PREPAREDNESS REGULATIONS FOR SKILLED 

8 NURSING FACILITIES AND NURSING FACILI9 TIES AS A REQUIREMENT FOR PARTICIPA10 TION UNDER THE MEDICARE AND MEDICAID 

11 PROGRAMS. 

12 (a) INFECTION CONTROL REGULATIONS.— 

13 (1) MEDICARE.—Section 1819(d)(3) of the So14 cial Security Act (42 U.S.C. 1395i–3(d)(3)) is 

15 amended— 

16 (A) by redesignating subparagraphs (A) 

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

18 moving such clauses 2 ems to the right; 

19 (B) by striking ‘‘ENVIRONMENT.— A 

20 skilled nursing facility must—’’ and inserting 

21 ‘‘ENVIRONMENT.— 

22 ‘‘(A) IN GENERAL.—A skilled nursing fa23 cility must—’’; and 

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

25 subparagraph: 


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1 ‘‘(B) APPLICATION STATEMENT.—For pur2 poses of carrying out this paragraph, the Sec3 retary shall apply by reference the provisions of 

4 section 483.80 of title 42, Code of Federal Reg5 ulations (as in effect on the date of the enact6 ment of the Promoting Restoration of Emer7 gency Preparedness and Advancing Response to 

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

9 applying subsection (g) of such regulation— 

10 ‘‘(i) any reference to COVID-19 shall 

11 be treated as a reference to an infectious 

12 disease outbreak, as defined in subpara13 graph (C); and 

14 ‘‘(ii) any reference to ventilator capac15 ity shall be treated as a reference to med16 ical equipment and supplies critical to the 

17 infectious disease outbreak, including ven18 tilator capacity. 

19 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE20 FINED.—For purposes of subparagraph (B), 

21 the term ‘infectious disease outbreak’ means 

22 any of the following periods: 

23 ‘‘(i) COVID-19 EMERGENCY PERIOD.— 

24 The emergency period described in section 


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1 1135(g)(1)(B) of the Social Security Act 

2 (42 U.S.C. 1320b–5(g)(1)(B)). 

3 ‘‘(ii) OTHER INFECTIOUS DISEASE

4 OUTBREAK PERIODS.— 

5 ‘‘(I) The period beginning on the 

6 date a nationwide emergency related 

7 to a public health emergency is de8 clared pursuant to the Stafford Act, a 

9 Major Disaster Declaration, or the 

10 National Emergencies Act and ending 

11 on the date that is 6 months after the 

12 date on which the declaration pursu13 ant to the Stafford Act, a Major Dis14 aster Declaration, or the National 

15 Emergencies Act, as applicable, ends, 

16 whichever is the latest. 

17 ‘‘(II) The period during which 

18 there exists a public health emergency 

19 related to an infectious disease out20 break declared by the Secretary pur21 suant to section 319 of the Public 

22 Health Service Act. 

23 ‘‘(III) With respect to a skilled 

24 nursing facility in a State with respect 

25 to which the Governor has declared an 


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1 emergency or major disaster (as de2 fined by the State) with respect to an 

3 infectious disease outbreak, the period 

4 for which such declaration is in effect 

5 with respect to such State.’’. 

6 (2) MEDICAID.—Section 1919(d)(3) of the So7 cial Security Act (42 U.S.C. 1396r(d)(3)) is amend8 ed— 

9 (A) by redesignating subparagraphs (A) 

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

11 moving such clauses 2 ems to the right; 

12 (B) by striking ‘‘ENVIRONMENT.— A nurs13 ing facility must—’’ and inserting ‘‘ENVIRON14 MENT.— 

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

16 must—’’; and 

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

18 subparagraph: 

19 ‘‘(B) APPLICATION STATEMENT.—For pur20 poses of carrying out this paragraph, the Sec21 retary shall apply by reference the provisions of 

22 section 483.80 of title 42, Code of Federal Reg23 ulations (as in effect on the date of the enact24 ment of the Promoting Restoration of Emer25 gency Preparedness and Advancing Response to 


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

2 applying subsection (g) of such regulation— 

3 ‘‘(i) any reference to COVID-19 shall 

4 be treated as a reference to an infectious 

5 disease outbreak, as defined in subpara6 graph (C); and 

7 ‘‘(ii) any reference to ventilator capac8 ity shall be treated as a reference to med9 ical equipment and supplies critical to the 

10 infectious disease outbreak, including ven11 tilator capacity. 

12 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE13 FINED.—The term ‘infectious disease outbreak’ 

14 has the meaning given such term in section 

15 1819(d)(3)(C).’’. 

16 (b) EMERGENCY PREPAREDNESS REGULATIONS.— 

17 (1) MEDICARE.—Section 1819(d) is amended 

18 by adding at the end the following new paragraph: 

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

20 nursing facility shall meet the requirements applica21 ble to skilled nursing facilities under the provisions 

22 of section 483.73 of title 42, Code of Federal Regu23 lations (as in effect on the date of the enactment of 

24 the Restoring Safety and Transparency for Long25 Term Care Residents Act).’’. 


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1 (2) MEDICAID.—Section 1919(d) is amended by 

2 adding at the end the following new paragraph: 

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

4 facility shall meet the requirements applicable to 

5 nursing facilities under the provisions of section 

6 483.73 of title 42, Code of Federal Regulations (as 

7 in effect on the date of the enactment of the Pro8 moting Restoration of Emergency Preparedness and 

9 Advancing Response to Epidemics in Long-Term 

10 Care Act).’’. 

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

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

13 the Secretary of Health and Human Services shall issue 

14 guidance to carry out the amendments made by this sec15 tion. 

16 (d) PUBLIC AVAILABILITY OF DATA ON DEFI17 CIENCIES IN INFECTION CONTROL AND DIRECT CARE

18 STAFFING IN SKILLED NURSING FACILITIES.—Not later 

19 than 2 weeks after the beginning of a period of an infec20 tious disease outbreak (as defined in subparagraph (C) of 

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

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

23 (or, in the case of the COVID-19 emergency period de24 scribed in section 1135(g)(1)(B) of such Act (42 U.S.C. 

25 1320b–5(g)(1)(B)), not later than 60 days after the date 


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

2 Centers for Medicare & Medicaid Services shall make pub3 licly available on the internet website of the Centers for 

4 Medicare & Medicaid Services data on deficiencies identi5 fied during the survey process described under subsection 

6 (g) of such section, with respect to infection control and 

7 direct care staffing in a skilled nursing facility (as defined 

8 in subsection (a) of such section). Such data so posted, 

9 with respect to an infectious disease outbreak (as defined 

10 in subparagraph (C) of such subsection (d)(3)), shall be 

11 updated every two weeks until the end of the period of 

12 such outbreak. 

13 SEC. 3. PROHIBITION ON REDUCING FREQUENCY OF 

14 STANDARD SURVEYS. 

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

16 amended by adding at the end the following new sub17 clause: 

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) is amend2 ed by adding at the end the following new subclause: 

3 ‘‘(I) PROHIBITION ON REDUCING

4 FREQUENCY OF SURVEYS CONDUCTED

5 DURING AN INFECTIOUS DISEASE

6 OUTBREAK.—The Secretary shall not 

7 reduce the frequency of surveys con8 ducted under this section during an 

9 infectious disease outbreak (as defined 

10 in section 1819(d)(3)(C)).’’. 

11 SEC. 4. PROHIBITION ON WAIVING SUBMISSIONS OF DI12 RECT CARE STAFFING INFORMATION. 

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

14 U.S.C. 1320a–7j(g)) is amended— 

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

16 end; 

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

18 inserting ‘‘; and’’; 

19 (3) by inserting after paragraph (4) the fol20 lowing new paragraph: 

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

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

23 and 

24 (4) by adding at the end the following new sen25 tence: ‘‘The Secretary shall not waive the requireVerDate Sep 11 2014 23:16 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8568.IH H8568

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1 ments of this subsection in the case of an infectious 

2 disease outbreak (as defined in section 

3 1819(d)(3)(C)).’’. 

4 SEC. 5. GAO STUDY AND REPORT. 

5 Not later than one year after the end of the COVID6 19 emergency period (as described in section 

7 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 

8 1320b–5(g)(1)(B)), the Comptroller General of the United 

9 States shall submit to the Committee on Ways and Means 

10 of the House of Representatives and the Committee on 

11 Finance of the Senate a report analyzing deficiencies dur12 ing such period in infection control measures and direct 

13 care staffing requirements for skilled nursing facilities (as 

14 defined in section 1819(a) of the Social Security Act (42 

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

16 under section 2(d)(1). 

17 SEC. 6. EFFECTIVE DATE. 

18 The amendments made by this Act shall apply with 

19 respect to skilled nursing facilities and nursing facilities 

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

Æ 


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