I 

111TH CONGRESS 

2D SESSION H. R. 6261 

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

oversight of nursing facilities under the Medicare and Medicaid programs 

by ensuring adequate, trained surveyors, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 29, 2010 

Ms. ROYBAL-ALLARD 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 

to improve oversight of nursing facilities under the Medicare and Medicaid programs by ensuring adequate, 

trained surveyors, 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 Patient 

5 Protection and Standards Act’’. 


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1 SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SUR2 VEYORS. 

3 (a) MEDICARE.—Section 1819(g)(2)(E)(iii) of the 

4 Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)(iii)) is 

5 amended by adding the following at the end: ‘‘The testing 

6 program must be sufficiently rigorous (as determined by 

7 the Secretary) to ensure that surveyors are adequately 

8 prepared to survey and certify facilities in a consistent and 

9 accurate manner.’’ 

10 (b) MEDICAID.—Section 1919(g)(2)(E)(iii) of the So11 cial Security Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is 

12 amended by adding the following at the end: ‘‘The testing 

13 program must be sufficiently rigorous (as determined by 

14 the Secretary) to ensure that surveyors are adequately 

15 prepared to survey and certify facilities in a consistent and 

16 accurate manner.’’ 

17 SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING 

18 FOR STATE SURVEYS OF NURSING HOMES. 

19 (a) MEDICARE.—Section 1819(g)(2)(E) of the Social 

20 Security Act (42 U.S.C. 1395i–3(g)(2)(E)) is amended by 

21 adding at the end the following: 

22 ‘‘(iv) ADEQUATE QUALIFIED STAFF

23 FOR SURVEY TEAMS.—The Secretary, in 

24 consultation with the advisory committee 

25 under subparagraph (F), shall establish re26 quirements— 


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1 ‘‘(I) for the qualifications and 

2 compensation of members of a survey 

3 team under this subsection; and 

4 ‘‘(II) that a State employs an 

5 adequate number of individuals as 

6 members of survey teams to ensure 

7 adequate oversight of skilled nursing 

8 facilities. 

9 ‘‘(v) CONTINUING EDUCATION.—In 

10 addition to the training and testing pro11 gram required under clause (iii), the Sec12 retary shall require that State and Federal 

13 surveyors regularly complete an adequate 

14 amount (as determined by the Secretary) 

15 of continuing education courses that meet 

16 requirements determined by the Secretary 

17 for content and the rigor of the material 

18 covered by such courses. An individual 

19 shall not serve as a member of a survey 

20 team unless the individual is in compliance 

21 with the requirements of this clause.’’. 

22 (b) MEDICAID.—Section 1919(g)(2)(E) of the Social 

23 Security Act (42 U.S.C. 1396r(g)(2)(E)) is amended by 

24 adding at the end the following: 


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1 ‘‘(iv) ADEQUATE QUALIFED STAFF

2 FOR SURVEY TEAMS.—The Secretary, in 

3 consultation with the advisory committee 

4 under subparagraph (F), shall establish re5 quirements— 

6 ‘‘(I) for the qualifications and 

7 compensation of members of a survey 

8 team under this subsection; and 

9 ‘‘(II) that a State employs an 

10 adequate number of individuals as 

11 members of survey teams to ensure 

12 adequate oversight of nursing facili13 ties. 

14 ‘‘(v) CONTINUING EDUCATION.—In 

15 addition to the training and testing pro16 gram required under clause (iii), the Sec17 retary shall require that State and Federal 

18 surveyors regularly complete an adequate 

19 amount (as determined by the Secretary) 

20 of continuing education courses that meet 

21 requirements determined by the Secretary 

22 for content and the rigor of the material 

23 covered by such courses. No individual 

24 shall serve as a member of a survey team 


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1 unless the individual is in compliance with 

2 the requirements of this clause.’’. 

3 SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY 

4 OF SURVEYORS. 

5 (a) WHISTLE BLOWER PROTECTIONS.— 

6 (1) MEDICARE.—Section 1819(g) of the Social 

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

8 adding the following at the end: 

9 ‘‘(6) REPORTING OF INACCURACIES.— 

10 ‘‘(A) REPORTING REQUIREMENT.—A cov11 ered individual shall report to the Secretary any 

12 instance in which the individual suspects that— 

13 ‘‘(i) a survey under this subsection 

14 fails to report or under reports an issue in 

15 a facility that could impact the safety or 

16 quality of care of the residents in such fa17 cility; or 

18 ‘‘(ii) a member of the survey team or 

19 an employee of the State survey agency 

20 was inappropriately induced (through the 

21 offering of monetary awards or through 

22 undue pressure) to alter the results of the 

23 survey. 

24 ‘‘(B) RESPONSES TO REPORT.—If the Sec25 retary receives a report under subparagraph 


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1 (A), the Secretary shall take appropriate action, 

2 as determined by the Secretary, to ensure the 

3 accuracy of the survey. 

4 ‘‘(C) WHISTLE BLOWER PROTECTIONS.— 

5 With respect to a covered individual, a State 

6 may not— 

7 ‘‘(i) discharge, demote, suspend, 

8 threaten, harass, or deny a promotion or 

9 other employment-related benefit to such 

10 individual, or in any other manner dis11 criminate against an individual in the 

12 terms and conditions of employment be13 cause the individual submitted a report 

14 under subparagraph (A); or 

15 ‘‘(ii) file a complaint or a report 

16 against the individual with the appropriate 

17 State professional disciplinary agency be18 cause the individual submitted a report 

19 under subparagraph (A). 

20 ‘‘(D) REMEDY FOR VIOLATIONS.—If the 

21 Secretary finds that a State has violated the 

22 prohibitions under subparagraph (C), the Sec23 retary shall provide for an appropriate remedy. 

24 ‘‘(E) REQUIREMENT TO POST NOTICE.— 

25 Each State shall post conspicuously in an apVerDate Mar 15 2010 01:40 Oct 08, 2010 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6261.IH H6261

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1 propriate location a sign (in a form specified by 

2 the Secretary) specifying the rights of covered 

3 individuals under this section. Such sign shall 

4 include a statement that a covered individual 

5 may file a complaint with the Secretary against 

6 the State for violating the provisions of this 

7 paragraph and information with respect to the 

8 manner of filing such a complaint. 

9 ‘‘(F) COVERED INDIVIDUAL DEFINED.— 

10 For purposes of this paragraph, the term ‘cov11 ered individual’ means an individual— 

12 ‘‘(i) who is a member of a State sur13 vey team under this subsection; or 

14 ‘‘(ii) who is an employee of the State 

15 department or agency that conducts sur16 veys under this section.’’. 

17 (2) MEDICAID.—Section 1919(g) of the Social 

18 Security Act (42 U.S.C. 1396r(g)) is amended by 

19 adding the following at the end: 

20 ‘‘(6) REPORTING OF INACCURACIES.— 

21 ‘‘(A) REPORTING REQUIREMENT.—A cov22 ered individual shall report to the Secretary any 

23 instance in which the individual suspects that— 

24 ‘‘(i) a survey under this subsection 

25 fails to report or under reports an issue in 


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1 a facility that could impact the safety or 

2 quality of care of the residents in such fa3 cility; or 

4 ‘‘(ii) a member of the survey team or 

5 an employee of the State survey agency 

6 was inappropriately induced (through the 

7 offering of monetary awards or through 

8 undue pressure) to alter the results of the 

9 survey. 

10 ‘‘(B) RESPONSE TO REPORTS.—If the Sec11 retary receives a report under subparagraph 

12 (A), the Secretary shall take appropriate action, 

13 as determined by the Secretary, to ensure the 

14 accuracy of the survey. 

15 ‘‘(C) WHISTLE BLOWER PROTECTIONS.— 

16 With respect to a covered individual, a State 

17 may not— 

18 ‘‘(i) discharge, demote, suspend, 

19 threaten, harass, or deny a promotion or 

20 other employment-related benefit to such 

21 individual, or in any other manner dis22 criminate against an individual in the 

23 terms and conditions of employment be24 cause the individual submitted a report 

25 under subparagraph (A); or 


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1 ‘‘(ii) file a complaint or a report 

2 against the individual with the appropriate 

3 State professional disciplinary agency be4 cause the individual submitted a report 

5 under subparagraph (A). 

6 ‘‘(D) PENALTIES FOR RETALIATION.—If 

7 the Secretary finds that a State has violated the 

8 prohibitions under subparagraph (C), the Sec9 retary shall provide for a reduction of the pay10 ment otherwise made to the State under section 

11 1903(a)(7), with respect to a quarter, equal to 

12 5 percent. A State that is dissatisfied with the 

13 Secretary’s findings under this subparagraph 

14 may obtain reconsideration and review of the 

15 findings under section 1116 in the same man16 ner as a State may seek reconsideration and re17 view under that section of the Secretary’s deter18 mination under section 1116(a)(1). 

19 ‘‘(E) REQUIREMENT TO POST NOTICE.— 

20 Each State shall post conspicuously in an ap21 propriate location a sign (in a form specified by 

22 the Secretary) specifying the rights of covered 

23 individuals under this section. Such sign shall 

24 include a statement that a covered individual 

25 may file a complaint with the Secretary against 


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1 the State for violating the provisions of this 

2 paragraph and information with respect to the 

3 manner of filing such a complaint. 

4 ‘‘(F) COVERED INDIVIDUAL DEFINED.— 

5 For purposes of this paragraph, the term ‘cov6 ered individual’ means an individual— 

7 ‘‘(i) who is a member of a State sur8 vey team under this subsection; or 

9 ‘‘(ii) who is an employee of the State 

10 department or agency that conducts sur11 veys under this section.’’. 

12 (b) PENALTIES FOR INAPPROPRIATELY INFLU13 ENCING A SURVEYOR.— 

14 (1) MEDICARE.—Section 1819(g)(2)(E) of the 

15 Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)), 

16 as amended by section 3(a), is further amended by 

17 adding the following at the end: 

18 ‘‘(vi) PENALTIES FOR INAPPROPRI19 ATELY INFLUENCING A SURVEYOR.—Any 

20 individual (including an employee of a 

21 skilled nursing facility or any affiliated 

22 corporate entity, a representative of the 

23 skilled nursing facility industry, a member 

24 of a State survey team, an employee of the 

25 State department or agency that conducts 


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1 surveys under this section, or an elected 

2 official) who attempts to inappropriately 

3 influence, as determined by the Secretary 

4 through regulations, the results of a survey 

5 under this subsection or the actions of a 

6 member of a survey team or an employee 

7 of a survey agency under this subsection 

8 shall be subject to a civil money penalty 

9 not to exceed $10,000. The provisions of 

10 section 1128A (other than subsections (a) 

11 and (b)) shall apply to a civil money pen12 alty under the previous sentence in the 

13 same manner as such provisions apply to a 

14 penalty or proceeding under section 

15 1128A(a).’’. 

16 (2) MEDICAID.—Section 1919(g)(2)(E) of the 

17 Social Security Act (42 U.S.C. 1396r(g)(2)(E)), as 

18 amended by section 3(b), is further amended by add19 ing at the end the following: 

20 ‘‘(vi) PENALTIES FOR INAPPROPRI21 ATELY INFLUENCING A SURVEYOR.—Any 

22 individual (including an employee of a 

23 nursing facility or any affiliated corporate 

24 entity, a representative of the nursing fa25 cility industry, a member of a State survey 


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1 team, an employee of the State department 

2 or agency that conducts surveys under this 

3 section, or an elected official) who at4 tempts to inappropriately influence, as de5 termined by the Secretary through regula6 tions, the results of a survey under this 

7 subsection or the actions of a member of a 

8 survey team or an employee of a survey 

9 agency under this subsection shall be sub10 ject to a civil money penalty not to exceed 

11 $10,000. The provisions of section 1128A 

12 (other than subsections (a) and (b)) shall 

13 apply to a civil money penalty under the 

14 previous sentence in the same manner as 

15 such provisions apply to a penalty or pro16 ceeding under section 1128A(a).’’. 

17 (3) CONFORMING AMENDMENTS.— 

18 (A) Section 1819(f)(2)(B)(iii)(I)(c) of the 

19 Social Security Act is amended by inserting ‘‘, 

20 a civil monetary penalty described in section 

21 1919(g)(2)(E)(vi) of not less than $10,000’’ 

22 after ‘‘of not less than $5,000’’. 

23 (B) Section 1919(f)(2)(B)(iii)(I)(c) of the 

24 Social Security Act is amended by inserting ‘‘, 

25 a civil monetary penalty described in 


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1 (g)(2)(E)(vi) of not less than $10,000’’ after 

2 ‘‘of not less than $5,000’’. 

3 SEC. 5. ADVISORY COMMITTEE. 

4 (a) MEDICARE.—Section 1819(g)(2) of the Social Se5 curity Act (42 U.S.C. 1395i–3(g)(2)) is amended by add6 ing at the end the following: 

7 ‘‘(F) ADVISORY COMMITTEE.— 

8 ‘‘(i) ESTABLISHMENT.—The Secretary 

9 shall establish an advisory committee on 

10 surveys under this paragraph. 

11 ‘‘(ii) MEMBERSHIP.—The membership 

12 of the advisory committee under clause (i) 

13 shall include advocates for residents of 

14 skilled nursing facilities, members of sur15 vey teams under this subsection, and nurs16 ing home administrators, directors of nurs17 ing, registered nurses, and other skilled 

18 nursing facility stakeholders. 

19 ‘‘(iii) RECOMMENDED STANDARDS.— 

20 The advisory committee under clause (i) 

21 shall make recommendations to the Sec22 retary on standards for— 

23 ‘‘(I) the adequate staffing of sur24 vey teams under this subsection; 


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1 ‘‘(II) the training of members of 

2 such teams; and 

3 ‘‘(III) disclosing any contact be4 tween such members and individuals 

5 associated with skilled nursing facili6 ties, and limiting such contact to pre7 vent inappropriate influence of such 

8 members by such individuals. 

9 ‘‘(iv) OTHER RECOMMENDATIONS.— 

10 The advisory committee under clause (i) 

11 may also make recommendations to the 

12 Secretary on any other issue that would 

13 improve the survey process under this 

14 paragraph.’’. 

15 (b) MEDICAID.—Section 1919(g)(2) of the Social Se16 curity Act (42 U.S.C. 1396r(g)(2)) is amended by adding 

17 at the end the following: 

18 ‘‘(F) ADVISORY COMMITTEE.— 

19 ‘‘(i) ESTABLISHMENT.—The Secretary 

20 shall establish an advisory committee on 

21 surveys under this paragraph. 

22 ‘‘(ii) MEMBERSHIP.—The membership 

23 of the advisory committee under clause (i) 

24 shall include advocates for residents of 

25 nursing facilities, members of survey teams 


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1 under this subsection, and nursing home 

2 administrators. 

3 ‘‘(iii) RECOMMENDED STANDARDS.— 

4 The advisory committee under clause (i) 

5 shall make recommendations to the Sec6 retary on standards for— 

7 ‘‘(I) the adequate staffing of sur8 vey teams under this subsection; 

9 ‘‘(II) the training of members of 

10 such teams; and 

11 ‘‘(III) disclosing any contact be12 tween such members and individuals 

13 associated with nursing facilities, and 

14 limiting such contact to prevent inap15 propriate influence of such members 

16 by such individuals. 

17 ‘‘(iv) OTHER RECOMMENDATIONS.— 

18 The advisory committee under clause (i) 

19 may also make recommendations to the 

20 Secretary on any other issue that would 

21 improve the survey process under this 

22 paragraph.’’. 

23 SEC. 6. REVIEW OF SURVEYS. 

24 (a) MEDICARE.—Section 1819(g)(2)(D) of the Social 

25 Security Act (42 U.S.C. 1395i–3(g)(2)(D)) is amended— 


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1 (1) by striking ‘‘Each State’’ and inserting the 

2 following: 

3 ‘‘(i) IN GENERAL.—Each State’’; and 

4 (2) by adding at the end the following new 

5 clause: 

6 ‘‘(ii) REVIEW OF SURVEYS.—The su7 pervisors of the survey teams shall review 

8 each survey conducted under this sub9 section to ensure that any issues that im10 pact quality of care that are identified by 

11 such surveys are consistently and appro12 priately described and rated by the survey 

13 teams.’’. 

14 (b) MEDICAID.—Section 1919(g)(2)(D) of the Social 

15 Security Act (42 U.S.C. 1396r(g)(2)(D)) is amended— 

16 (1) by striking ‘‘Each State’’ and inserting the 

17 following: 

18 ‘‘(i) IN GENERAL.—Each State’’; and 

19 (2) by adding at the end the following new 

20 clause: 

21 ‘‘(ii) REVIEW OF SURVEYS.—The su22 pervisors of the survey teams shall review 

23 each survey conducted under this sub24 section to ensure that any issues that im25 pact quality of care that are identified by 


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1 such surveys are consistently and appro2 priately described and rated by the survey 

3 teams.’’. 

Æ 


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