I 

116TH CONGRESS 

1ST SESSION H. R. 4468 

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 

SEPTEMBER 24, 2019 

Mr. EVANS (for himself and Mr. ESTES) 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 shall, in consultation 

23 with such State, disapprove, for a period 

24 not to exceed two years, a nurse aide train25 ing and competency evaluation program or 


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1 a nurse aide competency evaluation pro2 gram offered by or in a skilled nursing fa3 cility if such facility— 

4 ‘‘(I) has been assessed a civil 

5 monetary penalty under subsection 

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

7 1919(h)(2)(A)(ii) of not less than 

8 $10,697 for providing substandard 

9 quality of care; and 

10 ‘‘(II) has not, in the determina11 tion of the Secretary, corrected the 

12 deficiencies in quality of care for 

13 which such civil monetary penalty was 

14 assessed. 

15 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

16 The Secretary shall rescind a disapproval 

17 under clause (i) upon demonstration by a 

18 skilled nursing facility that all deficiencies 

19 for which the civil monetary penalty de20 scribed in clause (i)(I) was assessed have 

21 been remedied. For purposes of rescinding 

22 disapproval under the previous sentence, 

23 the Secretary may require additional over24 sight of the skilled nursing facility for a 

25 period not to exceed the period of disVerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468

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1 approval imposed under clause (i) with re2 spect to such facility.’’; and 

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

4 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 

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

6 Act (42 U.S.C. 1396r) is amended— 

7 (1) in subsection (f)(2)— 

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

9 ‘‘(unless the facility is described in subpara10 graph (B)(iii)(I))’’; 

11 (B) in subparagraph (B)— 

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

13 after the semicolon; 

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

15 and inserting a period; 

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

17 (iv) by striking ‘‘A State may not del18 egate (through subcontract or otherwise) 

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

20 the nursing facility.’’; 

21 (C) by striking subparagraphs (C) and 

22 (D); and 

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

24 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN25 ING AND COMPETENCY EVALUATION PROGRAMS


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1 AND NURSE AIDE COMPETENCY EVALUATION

2 PROGRAMS.— 

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

4 State, the Secretary shall, in consultation 

5 with such State, disapprove, for a period 

6 not to exceed two years, a nurse aide train7 ing and competency evaluation program or 

8 a nurse aide competency evaluation pro9 gram offered by or in a nursing facility if 

10 such facility— 

11 ‘‘(I) has been assessed a civil 

12 monetary penalty under section 

13 1819(h)(2)(B)(ii) or subsection 

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

15 for providing substandard quality of 

16 care; and 

17 ‘‘(II) has not, in the determina18 tion of the Secretary, corrected the 

19 deficiencies in quality of care for 

20 which such civil monetary penalty was 

21 assessed. 

22 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

23 The Secretary shall rescind a disapproval 

24 under clause (i) upon demonstration by a 

25 nursing facility that all deficiencies for 


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1 which the civil monetary penalty described 

2 in clause (i)(I) was assessed have been 

3 remedied. For purposes of rescinding dis4 approval under the previous sentence, the 

5 Secretary may require additional oversight 

6 of the nursing facility for a period not to 

7 exceed the period of disapproval imposed 

8 under clause (i) with respect to such facil9 ity.’’; and 

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

11 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 

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

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

14 and Human Services shall promulgate regulations as nec15 essary to implement the amendments made by this section. 

16 (d) APPLICABILITY.— 

17 (1) IN GENERAL.— 

18 (A) TIMING OF DETERMINATIONS.—The 

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

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

21 civil monetary penalty if the relevant covered 

22 determination was made on or after the date of 

23 enactment of this Act. 

24 (B) COVERED DETERMINATION DE25 FINED.—The term ‘‘covered determination’’ 


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1 means, with respect to a skilled nursing facility 

2 or a nursing facility in a State, a determination 

3 by the State or the Secretary of Health and 

4 Human Services that the facility has provided 

5 a substandard quality of care for which a civil 

6 monetary penalty described in section 

7 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 

8 Social Security Act (as such sections have been 

9 amended by this Act) may be assessed. 

10 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 

11 (A) WAIVER.—With respect to a skilled 

12 nursing facility or a nursing facility subject, on 

13 the day before the date of enactment of this 

14 Act, to a prohibition under item (a) of either 

15 section 1819(f)(2)(B)(iii)(I) or section 

16 1919(f)(2)(B)(iii)(I) of the Social Security Act 

17 (as in effect on the day before such date of en18 actment), such prohibition shall no longer apply 

19 to the facility on or after such date of enact20 ment. 

21 (B) SURVEY OR CIVIL MONETARY PEN22 ALTY.—With respect to a skilled nursing facil23 ity or a nursing facility subject, on the day be24 fore the date of enactment of this Act, to a pro25 hibition under item (b) or (c) of either section 


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1 1819(f)(2)(B)(iii)(I) or section 

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

3 (as in effect on the day before such date of en4 actment), such prohibition shall no longer apply 

5 to the facility on or after such date of enact6 ment upon a determination by the Secretary of 

7 Health and Human Services that the facility 

8 has corrected the issue that resulted in such 

9 prohibition. 

Æ 


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