I 

110TH CONGRESS 

2D SESSION H. R. 5799 

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

the transparency of information on skilled nursing facilities and nursing 

facilities and to clarify and improve the targeting of the enforcement 

of requirements with respect to such facilities. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 15, 2008 

Ms. EDDIE BERNICE JOHNSON of Texas 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 the transparency of information on skilled 

nursing facilities and nursing facilities and to clarify 

and improve the targeting of the enforcement of requirements with respect to such facilities. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Nursing Home Transparency and Improvement Act of 

6 2008’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVING TRANSPARENCY OF INFORMATION ON 

SKILLED NURSING FACILITIES AND NURSING FACILITIES 

Sec. 101. Required disclosure of ownership and affiliated parties information. 

Sec. 102. Accountability requirements. 

Sec. 103. Nursing home compare Medicare website. 

Sec. 104. Reporting of expenditures. 

Sec. 105. Standardized complaint form. 

Sec. 106. Ensuring staffing accountability. 

TITLE II—TARGETING ENFORCEMENT 

Sec. 201. Civil money penalties. 

Sec. 202. GAO study and report on the relative financial status and performance of special focus facilities. 

Sec. 203. National independent monitor program. 

Sec. 204. GAO studies and reports on temporary management and barriers to 

purchasing facilities with a record of poor care. 

Sec. 205. Notification of facility closure. 

Sec. 206. National demonstration projects on culture change and use of information technology in nursing homes. 

TITLE III—IMPROVING STAFF TRAINING 

Sec. 301. Dementia and abuse prevention training. 

Sec. 302. Study and report on training required for certified nurse aides and 

supervisory staff. 

3 TITLE I—IMPROVING TRANS4 PARENCY OF INFORMATION 

5 ON SKILLED NURSING FACILI6 TIES AND NURSING FACILI7 TIES 

8 SEC. 101. REQUIRED DISCLOSURE OF OWNERSHIP AND AF9 FILIATED PARTIES INFORMATION. 

10 (a) SKILLED NURSING FACILITIES.—Section 

11 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i– 


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1 3(d)(1)) is amended by adding at the end the following 

2 new subparagraphs: 

3 ‘‘(D) AVAILABILITY OF OWNERSHIP AND

4 AFFILIATED PARTIES INFORMATION.— 

5 ‘‘(i) IN GENERAL.—Beginning on the 

6 date of enactment of this subparagraph, a 

7 skilled nursing facility must have the infor8 mation described in clause (ii) available for 

9 submission to the Secretary, the Inspector 

10 General of the Department of Health and 

11 Human Services, the State, the State long12 term care ombudsman, a resident of a fa13 cility, and the legal representative of such 

14 a resident or other responsible party in the 

15 case where the Secretary, the Inspector 

16 General, the State, the State long-term 

17 care ombudsman, the resident, or the legal 

18 representative or responsible party re19 quests such information (and, beginning on 

20 the effective date of the regulations pro21 mulgated under subparagraph (E)(i), for 

22 reporting such information in accordance 

23 with such regulations). The facility shall 

24 certify to the Secretary and the Inspector 

25 General of the Department of Health and 


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1 Human Services, as a condition of partici2 pation and payment under the program 

3 under this title, that the information sub4 mitted upon such request is accurate and 

5 current. 

6 ‘‘(ii) INFORMATION DESCRIBED.—The 

7 following information is described in this 

8 clause: 

9 ‘‘(I) The identity of individuals 

10 with an ownership or control interest 

11 (as defined in section 1124(a)(3)) in 

12 the facility. 

13 ‘‘(II) Information on the mem14 bers of the governing body of the 

15 skilled nursing facility, including the 

16 names, titles, and dates of service of 

17 such members. 

18 ‘‘(III) Information describing the 

19 organizational structure of any affili20 ated or related parties, including prin21 cipal officers and directors of affili22 ated or related companies, or mem23 bers in the case of a limited liability 

24 company. 


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1 To the extent that information reported by 

2 a facility to the Internal Revenue Service 

3 on Form 990, information submitted by a 

4 facility to the Securities and Exchange 

5 Commission, or information otherwise sub6 mitted to the Secretary contains the infor7 mation described in subclauses (I), (II), 

8 and (III), the facility may provide such 

9 Form or such information submitted to 

10 meet the requirements of clause (i) and 

11 subparagraph (E)(i). 

12 ‘‘(iii) DEFINITION OF AFFILIATED OR

13 RELATED PARTIES.—In this subparagraph, 

14 the term ‘affiliated or related parties’ 

15 means companies or individuals that serve 

16 as operators, landlords, management com17 panies or advisors, real estate or consulting 

18 companies, members of a limited liability 

19 company, administrative services compa20 nies, lenders and companies providing fi21 nancial guarantees, captive or affiliated li22 ability insurance companies, and such 

23 other entities as the Secretary determines 

24 appropriate. 

25 ‘‘(E) REPORTING.— 


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1 ‘‘(i) IN GENERAL.—Not later than 2 

2 years after the date of enactment of this 

3 subparagraph, the Secretary shall promul4 gate regulations requiring skilled nursing 

5 facilities to report the information de6 scribed in clause (ii) of subparagraph (D) 

7 to the Secretary in a standardized format, 

8 and such other regulations as are nec9 essary to carry out such subparagraph. 

10 Such regulations shall ensure that the fa11 cility certifies, as a condition of participa12 tion and payment under the program 

13 under this title, that the information re14 ported is accurate and current. 

15 ‘‘(ii) GUIDANCE.—The Secretary shall 

16 provide guidance and technical assistance 

17 to States on how to adopt the standardized 

18 format under clause (i).’’. 

19 (b) NURSING FACILITIES.—Section 1919(d)(1) of the 

20 Social Security Act (42 U.S.C. 1396r(d)(1)) is amended 

21 by adding at the end the following new subparagraph: 

22 ‘‘(D) AVAILABILITY OF OWNERSHIP AND

23 AFFILIATED PARTIES INFORMATION.— 

24 ‘‘(i) IN GENERAL.—Beginning on the 

25 date of enactment of this subparagraph, a 


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1 nursing facility must have the information 

2 described in clause (ii) available for sub3 mission to the Secretary, the Inspector 

4 General of the Department of Health and 

5 Human Services, the State, the State long6 term care ombudsman, a resident of a fa7 cility, and the legal representative of such 

8 a resident or other responsible party in the 

9 case where the Secretary, the Inspector 

10 General, the State, the State long-term 

11 care ombudsman, the resident, or the legal 

12 representative or responsible party re13 quests such information (and, beginning on 

14 the effective date of the regulations pro15 mulgated under subparagraph (E)(i), for 

16 reporting such information in accordance 

17 with such regulations). The facility shall 

18 certify to the Secretary and the Inspector 

19 General of the Department of Health and 

20 Human Services, as a condition of partici21 pation and payment under the program 

22 under this title, that the information sub23 mitted upon such request is accurate and 

24 current. 


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1 ‘‘(ii) INFORMATION DESCRIBED.—The 

2 following information is described in this 

3 clause: 

4 ‘‘(I) The identity of individuals 

5 with an ownership or control interest 

6 (as defined in section 1124(a)(3)) in 

7 the facility. 

8 ‘‘(II) Information on the mem9 bers of the governing body of the 

10 nursing facility, including the names, 

11 titles, and dates of service of such 

12 members. 

13 ‘‘(III) Information describing the 

14 organizational structure of any affili15 ated or related parties, including prin16 cipal officers and directors of affili17 ated or related companies, or mem18 bers in the case of a limited liability 

19 company. 

20 To the extent that information reported by 

21 a facility to the Internal Revenue Service 

22 on Form 990, information submitted by a 

23 facility to the Securities and Exchange 

24 Commission, or information otherwise sub25 mitted to the Secretary contains the inforVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 mation described in subclauses (I), (II), 

2 and (III), the facility may provide such 

3 Form or such information submitted to 

4 meet the requirements of clause (i) and 

5 subparagraph (E)(i). 

6 ‘‘(iii) DEFINITION OF AFFILIATED OR

7 RELATED PARTIES.—In this subparagraph, 

8 the term ‘affiliated or related parties’ 

9 means companies or individuals that serve 

10 as operators, landlords, management com11 panies or advisors, real estate or consulting 

12 companies, members of a limited liability 

13 company, administrative services compa14 nies, lenders and companies providing fi15 nancial guarantees, captive or affiliated li16 ability insurance companies, and such 

17 other entities as the Secretary determines 

18 appropriate. 

19 ‘‘(E) REPORTING.— 

20 ‘‘(i) IN GENERAL.—Not later than 2 

21 years after the date of enactment of this 

22 subparagraph, the Secretary shall promul23 gate regulations requiring nursing facilities 

24 to report the information described in 

25 clause (ii) of subparagraph (D) to the SecVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 retary in a standardized format, and such 

2 other regulations as are necessary to carry 

3 out such subparagraph. Such regulations 

4 shall ensure that the facility certifies, as a 

5 condition of participation and payment 

6 under the program under this title, that 

7 the information reported is accurate and 

8 current. 

9 ‘‘(ii) GUIDANCE.—The Secretary shall 

10 provide guidance and technical assistance 

11 to States on how to adopt the standardized 

12 format under clause (i).’’. 

13 SEC. 102. ACCOUNTABILITY REQUIREMENTS. 

14 (a) SKILLED NURSING FACILITIES.—Section 

15 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i– 

16 3(d)(1)), as amended by section 101, is amended by add17 ing at the end the following new subparagraph: 

18 ‘‘(F) ACCOUNTABILITY REQUIREMENTS.— 

19 ‘‘(i) IN GENERAL.—On or after the 

20 date that is 2 years after the date of enact21 ment of this subparagraph, any skilled 

22 nursing facility or chain of such facilities 

23 must meet standards for being an account24 able entity by complying with the criteria 

25 developed under clause (ii). 


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1 ‘‘(ii) CRITERIA.—Not later than the 

2 date that is 2 years after such date of en3 actment, the Secretary, in consultation 

4 with the General Counsel of the Depart5 ment of Health and Human Services and 

6 the Inspector General of the Department 

7 of Health and Human Services, shall de8 velop criteria to define accountability re9 quirements applicable to facilities and 

10 chains of such facilities. Such criteria 

11 shall— 

12 ‘‘(I) include standards for sub13 mission of annual independent audits 

14 for facilities that are part of a group 

15 under common ownership or control, 

16 whether publicly or privately held and 

17 which have annual revenues of 

18 $50,000,000 or more in the aggregate 

19 as a group; and 

20 ‘‘(II) require new owners of a fa21 cility to provide proof of financial abil22 ity to operate the facility, including 

23 documentation of projected revenue 

24 and expenses for the first 12 months 

25 of operation of the facility. 


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1 ‘‘(iii) RULE OF CONSTRUCTION.—The 

2 criteria developed under clause (ii), and 

3 any requirements to submit information 

4 under such criteria, shall be in addition to 

5 any information the Secretary otherwise 

6 requires providers to submit on the owner7 ship and operation of skilled nursing facili8 ties (including information required to be 

9 submitted or reported under subparagraph 

10 (D) or (E)).’’. 

11 (b) NURSING FACILITIES.—Section 1919(d)(1) of the 

12 Social Security Act (42 U.S.C. 1396r(d)(1)), as amended 

13 by section 101, is amended by adding at the end the fol14 lowing new subparagraph: 

15 ‘‘(F) ACCOUNTABILITY REQUIREMENTS.— 

16 ‘‘(i) IN GENERAL.—On or after the 

17 date that is 2 years after the date of enact18 ment of this subparagraph, any nursing fa19 cility or chain of such facilities must meet 

20 standards for being an accountable entity 

21 by complying with the criteria developed 

22 under clause (ii). 

23 ‘‘(ii) CRITERIA.—Not later than the 

24 date that is 2 years after such date of en25 actment, the Secretary, in consultation 


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1 with the General Counsel of the Depart2 ment of Health and Human Services and 

3 the Inspector General of the Department 

4 of Health and Human Services, shall de5 velop criteria to define accountability re6 quirements applicable to facilities and 

7 chains of such facilities. Such criteria 

8 shall— 

9 ‘‘(I) include standards for sub10 mission of annual independent audits 

11 for facilities that are part of a group 

12 under common ownership or control, 

13 whether publicly or privately held and 

14 which have annual revenues of 

15 $50,000,000 or more in the aggregate 

16 as a group; and 

17 ‘‘(II) require new owners of a fa18 cility to provide proof of financial abil19 ity to operate the facility, including 

20 documentation of projected revenue 

21 and expenses for the first 12 months 

22 of operation of the facility. 

23 ‘‘(iii) RULE OF CONSTRUCTION.—The 

24 criteria developed under clause (ii), and 

25 any requirements to submit information 


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1 under such criteria, shall be in addition to 

2 any information the Secretary otherwise 

3 requires providers to submit on the owner4 ship and operation of nursing facilities (in5 cluding information required to be sub6 mitted or reported under subparagraph 

7 (D) or (E)).’’. 

8 SEC. 103. NURSING HOME COMPARE MEDICARE WEBSITE. 

9 (a) SKILLED NURSING FACILITIES.— 

10 (1) IN GENERAL.—Section 1819 of the Social 

11 Security Act (42 U.S.C. 1395i–3) is amended— 

12 (A) by redesignating subsection (i) as sub13 section (j); and 

14 (B) by inserting after subsection (h) the 

15 following new subsection: 

16 ‘‘(i) NURSING HOME COMPARE WEBSITE.— 

17 ‘‘(1) INCLUSION OF ADDITIONAL INFORMA18 TION.— 

19 ‘‘(A) IN GENERAL.—The Secretary shall 

20 ensure that the Department of Health and 

21 Human Services includes, as part of the infor22 mation provided for comparison of nursing 

23 homes on the official Internet website of the 

24 Federal Government for Medicare beneficiaries 

25 (commonly referred to as the ‘Nursing Home 


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1 Compare’ Medicare website) (or a successor 

2 website), the following information in a manner 

3 that is prominent, easily accessible, readily un4 derstandable to consumers of long-term care 

5 services, and searchable: 

6 ‘‘(i) Information that is reported to 

7 the Secretary under subparagraph (E) of 

8 subsection (d)(1) and information sub9 mitted with respect to accountability re10 quirements applicable to facilities and 

11 chains of facilities under subparagraph (F) 

12 of such subsection. 

13 ‘‘(ii) Information on the ‘Special 

14 Focus Facility program’ (or a successor 

15 program) established by the Centers for 

16 Medicare & Medicaid Services, according to 

17 procedures established by the Secretary. 

18 Such procedures shall provide for the in19 clusion of information with respect to, and 

20 the names and locations of, those facilities 

21 that— 

22 ‘‘(I) have been enrolled in the 

23 program; 

24 ‘‘(II) are enrolled in the program 

25 and have failed to make significant 


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1 progress within 18 months after such 

2 enrollment; and 

3 ‘‘(III) have closed voluntarily or 

4 whose participation under this title 

5 has been terminated by the Secretary. 

6 ‘‘(iii) Staffing data for each facility 

7 (including resident census data and data 

8 on the hours of care provided per resident 

9 per day) based on data submitted under 

10 subsection (b)(8)(C)(ii), including informa11 tion on staffing turnover and tenure, in a 

12 format that is clearly understandable to 

13 consumers of long-term care services and 

14 allows such consumers to compare dif15 ferences in staffing between facilities. 

16 ‘‘(iv) Links to State Internet websites 

17 with information regarding State survey 

18 and certification programs, links to Form 

19 2567 State inspection reports (or a suc20 cessor form) on such websites, information 

21 to guide consumers in how to interpret and 

22 understand such reports, and the facility 

23 plan of correction or other response to 

24 such report. 


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1 ‘‘(v) The standardized complaint form 

2 developed under subsection (f)(8), includ3 ing explanatory material on what com4 plaint forms are, how they are used, and 

5 how to file a complaint with the State sur6 vey and certification program and the 

7 State long-term care ombudsman program. 

8 ‘‘(vi) A summary of information on 

9 enforcement that includes remedies pro10 posed and imposed by the Secretary with 

11 respect to a skilled nursing facility during 

12 the preceding 3 years. 

13 ‘‘(B) DEADLINE FOR PROVISION OF INFOR14 MATION.— 

15 ‘‘(i) IN GENERAL.—Except as pro16 vided in clause (ii), the Secretary shall en17 sure that the information described in sub18 paragraph (A) is included on such website 

19 (or a successor website) not later than 1 

20 year after the date of enactment of this 

21 subsection. 

22 ‘‘(ii) EXCEPTIONS.— 

23 ‘‘(I) OWNERSHIP AND AFFILI24 ATED PARTIES AND ACCOUNTABILITY

25 REQUIREMENTS INFORMATION.—The 


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1 Secretary shall ensure that the infor2 mation described in subparagraph 

3 (A)(i) is included on such website (or 

4 a successor website) not later than the 

5 date on which the requirements under 

6 subparagraphs (E) and (F), respec7 tively, of subsection (d)(1) are imple8 mented. 

9 ‘‘(II) STAFFING DATA.—The Sec10 retary shall ensure that the informa11 tion described in subparagraph 

12 (A)(iii) is included on such website (or 

13 a successor website) not later than the 

14 date on which the requirement under 

15 subsection (b)(8)(C)(ii) is imple16 mented. 

17 ‘‘(2) REVIEW AND MODIFICATION OF

18 WEBSITE.— 

19 ‘‘(A) IN GENERAL.—The Secretary shall 

20 establish a process— 

21 ‘‘(i) to review the accuracy, clarity of 

22 presentation, timeliness, and comprehen23 siveness of information reported on such 

24 website as of the day before the date of en25 actment of this subsection; and 


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1 ‘‘(ii) not later than 1 year after the 

2 date of enactment of this subsection, to 

3 modify or revamp such website in accord4 ance with the review conducted under 

5 clause (i). 

6 ‘‘(B) CONSULTATION.—In conducting the 

7 review under subparagraph (A)(i), the Sec8 retary shall consult with— 

9 ‘‘(i) State long-term care ombudsman 

10 programs; 

11 ‘‘(ii) consumer advocacy groups; 

12 ‘‘(iii) provider stakeholder groups; and 

13 ‘‘(iv) any other representatives of pro14 grams or groups the Secretary determines 

15 appropriate.’’. 

16 (2) TIMELINESS OF SUBMISSION OF SURVEY

17 AND CERTIFICATION INFORMATION.— 

18 (A) IN GENERAL.—Section 1819(g)(5) of 

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

20 3(g)(5)) is amended by adding at the end the 

21 following new subparagraph: 

22 ‘‘(E) SUBMISSION OF SURVEY AND CER23 TIFICATION INFORMATION TO THE SEC24 RETARY.—In order to improve the timeliness of 

25 information made available to the public under 


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1 subparagraph (A) and provided on the Nursing 

2 Home Compare Medicare website under sub3 section (i), each State shall submit information 

4 respecting any survey or certification made re5 specting a skilled nursing facility (including any 

6 enforcement actions taken by the State) to the 

7 Secretary not later than the date on which the 

8 State sends such information to the facility. 

9 The Secretary shall use the information sub10 mitted under the preceding sentence to update 

11 the information provided on the Nursing Home 

12 Compare Medicare website as expeditiously as 

13 practicable.’’. 

14 (B) EFFECTIVE DATE.—The amendment 

15 made by this paragraph shall take effect 1 year 

16 after the date of enactment of this Act. 

17 (b) NURSING FACILITIES.— 

18 (1) IN GENERAL.—Section 1919 of the Social 

19 Security Act (42 U.S.C. 1396r) is amended— 

20 (A) by redesignating subsection (i) as sub21 section (j); and 

22 (B) by inserting after subsection (h) the 

23 following new subsection: 

24 ‘‘(i) NURSING HOME COMPARE WEBSITE.— 


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1 ‘‘(1) INCLUSION OF ADDITIONAL INFORMA2 TION.— 

3 ‘‘(A) IN GENERAL.—The Secretary shall 

4 ensure that the Department of Health and 

5 Human Services includes, as part of the infor6 mation provided for comparison of nursing 

7 homes on the official Internet website of the 

8 Federal Government for Medicare beneficiaries 

9 (commonly referred to as the ‘Nursing Home 

10 Compare’ Medicare website) (or a successor 

11 website), the following information in a manner 

12 that is prominent, easily accessible, readily un13 derstandable to consumers of long-term care 

14 services, and searchable: 

15 ‘‘(i) Information that is reported to 

16 the Secretary under subparagraph (E) of 

17 subsection (d)(1) and information sub18 mitted with respect to accountability re19 quirements applicable to facilities and 

20 chains of facilities under subparagraph (F) 

21 of such subsection. 

22 ‘‘(ii) Information on the ‘Special 

23 Focus Facility program’ (or a successor 

24 program) established by the Centers for 

25 Medicare & Medicaid Services, according to 


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1 procedures established by the Secretary. 

2 Such procedures shall provide for the in3 clusion of information with respect to, and 

4 the names and locations of, those facilities 

5 that— 

6 ‘‘(I) have been enrolled in the 

7 program; 

8 ‘‘(II) are enrolled in the program 

9 and have failed to make significant 

10 progress within 18 months after such 

11 enrollment; and 

12 ‘‘(III) have closed voluntarily or 

13 whose participation under this title 

14 has been terminated by the Secretary. 

15 ‘‘(iii) Staffing data for each facility 

16 (including resident census data and data 

17 on the hours of care provided per resident 

18 per day) based on data submitted under 

19 subsection (b)(8)(C)(ii), including informa20 tion on staffing turnover and tenure, in a 

21 format that is clearly understandable to 

22 consumers of long-term care services and 

23 allows such consumers to compare dif24 ferences in staffing between facilities. 


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1 ‘‘(iv) Links to State Internet websites 

2 with information regarding State survey 

3 and certification programs, links to Form 

4 2567 State inspection reports (or a suc5 cessor form) on such websites, information 

6 to guide consumers in how to interpret and 

7 understand such reports, and the facility 

8 plan of correction or other response to 

9 such report. 

10 ‘‘(v) The standardized complaint form 

11 developed under subsection (f)(10), includ12 ing explanatory material on what com13 plaint forms are, how they are used, and 

14 how to file a complaint with the State sur15 vey and certification program and the 

16 State long-term care ombudsman program. 

17 ‘‘(vi) A summary of information on 

18 enforcement that includes remedies pro19 posed and imposed by the Secretary or a 

20 State with respect to a nursing facility 

21 during the preceding 3 years. 

22 ‘‘(B) DEADLINE FOR PROVISION OF INFOR23 MATION.— 

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1 sure that the information described in sub2 paragraph (A) is included on such website 

3 (or a successor website) not later than 1 

4 year after the date of enactment of this 

5 subsection. 

6 ‘‘(ii) EXCEPTIONS.— 

7 ‘‘(I) OWNERSHIP AND AFFILI8 ATED PARTIES AND ACCOUNTABILITY

9 REQUIREMENTS INFORMATION.—The 

10 Secretary shall ensure that the infor11 mation described in subparagraph 

12 (A)(i) is included on such website (or 

13 a successor website) not later than the 

14 date on which the requirements under 

15 subparagraph (E) and (F), respec16 tively, of subsection (d)(1) are imple17 mented. 

18 ‘‘(II) STAFFING DATA.—The Sec19 retary shall ensure that the informa20 tion described in subparagraph 

21 (A)(iii) is included on such website (or 

22 a successor website) not later than the 

23 date on which the requirement under 

24 subsection (b)(8)(C)(ii) is imple25 mented. 


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1 ‘‘(2) REVIEW AND MODIFICATION OF

2 WEBSITE.— 

3 ‘‘(A) IN GENERAL.—The Secretary shall 

4 establish a process— 

5 ‘‘(i) to review the accuracy, clarity of 

6 presentation, timeliness, and comprehen7 siveness of information reported on such 

8 website as of the day before the date of en9 actment of this subsection; and 

10 ‘‘(ii) not later than 1 year after the 

11 date of enactment of this subsection, to 

12 modify or revamp such website in accord13 ance with the review conducted under 

14 clause (i). 

15 ‘‘(B) CONSULTATION.—In conducting the 

16 review under subparagraph (A)(i), the Sec17 retary shall consult with— 

18 ‘‘(i) State long-term care ombudsman 

19 programs; 

20 ‘‘(ii) consumer advocacy groups; 

21 ‘‘(iii) provider stakeholder groups; and 

22 ‘‘(iv) any other representatives of pro23 grams or groups the Secretary determines 

24 appropriate.’’. 


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1 (2) TIMELINESS OF SUBMISSION OF SURVEY

2 AND CERTIFICATION INFORMATION.— 

3 (A) IN GENERAL.—Section 1919(g)(5) of 

4 the Social Security Act (42 U.S.C. 1396r(g)(5)) 

5 is amended by adding at the end the following 

6 new subparagraph: 

7 ‘‘(E) SUBMISSION OF SURVEY AND CER8 TIFICATION INFORMATION TO THE SEC9 RETARY.—In order to improve the timeliness of 

10 information made available to the public under 

11 subparagraph (A) and provided on the Nursing 

12 Home Compare Medicare website under sub13 section (i), each State shall submit information 

14 respecting any survey or certification made re15 specting a nursing facility (including any en16 forcement actions taken by the State) to the 

17 Secretary not later than the date on which the 

18 State sends such information to the facility. 

19 The Secretary shall use the information sub20 mitted under the preceding sentence to update 

21 the information provided on the Nursing Home 

22 Compare Medicare website as expeditiously as 

23 practicable.’’. 


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1 (B) EFFECTIVE DATE.—The amendment 

2 made by this paragraph shall take effect 1 year 

3 after the date of enactment of this Act. 

4 (c) AVAILABILITY OF REPORTS ON SURVEYS, CER5 TIFICATIONS, AND COMPLAINT INVESTIGATIONS.— 

6 (1) SKILLED NURSING FACILITIES.—Section 

7 1819(d)(1) of the Social Security Act (42 U.S.C. 

8 1395i–3(d)(1)), as amended by section 102, is 

9 amended by adding at the end the following new 

10 subparagraph: 

11 ‘‘(G) AVAILABILITY OF SURVEY, CERTIFI12 CATION, AND COMPLAINT INVESTIGATION RE13 PORTS.—A skilled nursing facility must— 

14 ‘‘(i) have reports with respect to any 

15 surveys, certifications, and complaint in16 vestigations made respecting the facility 

17 during the 3 preceding years available for 

18 any individual to review upon request; and 

19 ‘‘(ii) post notice of the availability of 

20 such reports in areas of the facility that 

21 are prominent and accessible to the pub22 lic.’’. 

23 (2) NURSING FACILITIES.—Section 1919(d)(1) 

24 of the Social Security Act (42 U.S.C. 1396r(d)(1)), 


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1 as amended by section 102, is amended by adding 

2 at the end the following new subparagraph: 

3 ‘‘(G) AVAILABILITY OF SURVEY, CERTIFI4 CATION, AND COMPLAINT INVESTIGATION RE5 PORTS.—A nursing facility must— 

6 ‘‘(i) have reports with respect to any 

7 surveys, certifications, and complaint in8 vestigations made respecting the facility 

9 during the 3 preceding years available for 

10 any individual to review upon request; and 

11 ‘‘(ii) post notice of the availability of 

12 such reports in areas of the facility that 

13 are prominent and accessible to the pub14 lic.’’. 

15 (3) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect 1 year after the 

17 date of enactment of this Act. 

18 (d) GUIDANCE TO STATES ON FORM 2567 STATE IN19 SPECTION REPORTS AND COMPLAINT INVESTIGATION RE20 PORTS.— 

21 (1) GUIDANCE.—The Secretary shall provide 

22 guidance to States on how States can establish elec23 tronic links to Form 2567 State inspection reports 

24 (or a successor form), complaint investigation re25 ports, and a facility’s plan of correction or other reVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 sponse to such Form 2567 State inspection reports 

2 (or a successor form) on the Internet website of the 

3 State that provides information on skilled nursing 

4 facilities and nursing facilities. 

5 (2) DEFINITIONS.—In this subsection: 

6 (A) NURSING FACILITY.—The term ‘‘nurs7 ing facility’’ has the meaning given such term 

8 in section 1919(a) of the Social Security Act 

9 (42 U.S.C. 1396r(a)). 

10 (B) SECRETARY.—The term ‘‘Secretary’’ 

11 means the Secretary of Health and Human 

12 Services. 

13 (C) SKILLED NURSING FACILITY.—The 

14 term ‘‘skilled nursing facility’’ has the meaning 

15 given such term in section 1819(a) of the Social 

16 Security Act (42 U.S.C. 1395i–3(a)). 

17 SEC. 104. REPORTING OF EXPENDITURES. 

18 Section 1888 of the Social Security Act (42 U.S.C. 

19 1395yy) is amended by adding at the end the following 

20 new subsection: 

21 ‘‘(f) REPORTING OF EXPENDITURES.— 

22 ‘‘(1) IN GENERAL.—For cost reports submitted 

23 for cost reporting periods beginning on or after the 

24 date that is 1 year after the date of enactment of 

25 this subsection, skilled nursing facilities shall sepaVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 rately report expenditures for wages and benefits for 

2 nursing staff (by staff level, breaking out (at a min3 imum) registered nurses, licensed professional 

4 nurses, and certified nurse assistants). 

5 ‘‘(2) MODIFICATION OF FORM.—The Secretary, 

6 in consultation with private sector accountants expe7 rienced with Medicare and Medicaid nursing facility 

8 home cost reports, shall redesign such reports to 

9 meet the requirement of paragraph (1). 

10 ‘‘(3) CATEGORIZATION.—The Secretary, work11 ing in consultation with the Medicare Payment Advi12 sory Commission, the Inspector General of the De13 partment of Health and Human Services, and other 

14 expert parties the Secretary determines appropriate, 

15 shall take the expenditures listed on cost reports 

16 submitted by skilled nursing facilities and categorize 

17 such expenditures into the following categories on an 

18 annual basis: 

19 ‘‘(A) Spending on direct care services (in20 cluding nursing, therapy, and non-ancillary 

21 therapy services). 

22 ‘‘(B) Spending on indirect care (including 

23 housekeeping, dietary, and other related serv24 ices). 


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1 ‘‘(C) Capital costs (including building and 

2 land costs). 

3 ‘‘(D) Administrative costs. 

4 ‘‘(4) AVAILABILITY OF INFORMATION SUB5 MITTED.—The Secretary shall establish procedures 

6 to make information on expenditures submitted 

7 under this subsection readily available to interested 

8 parties upon request, subject to such requirements 

9 as the Secretary may specify under the procedures 

10 established under this paragraph.’’. 

11 SEC. 105. STANDARDIZED COMPLAINT FORM. 

12 (a) SKILLED NURSING FACILITIES.— 

13 (1) DEVELOPMENT BY THE SECRETARY.—Sec14 tion 1819(f) of the Social Security Act (42 U.S.C. 

15 1395i–3(f)) is amended by adding at the end the fol16 lowing new paragraph: 

17 ‘‘(8) STANDARDIZED COMPLAINT FORM.—The 

18 Secretary shall develop a standardized complaint 

19 form for use by a resident (or a person acting on the 

20 resident’s behalf) in filing a complaint with a State 

21 survey and certification agency and a State long22 term care ombudsman program with respect to a 

23 skilled nursing facility.’’. 

24 (2) STATE REQUIREMENTS.—Section 1819(e) 

25 of the Social Security Act (42 U.S.C. 1395i–3(e)) is 


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1 amended by adding at the end the following new 

2 paragraph: 

3 ‘‘(6) COMPLAINT FORMS AND RESOLUTION

4 PROCESSES.— 

5 ‘‘(A) COMPLAINT FORMS.—The State must 

6 make the standardized complaint form devel7 oped under subsection (f)(8) available upon re8 quest to— 

9 ‘‘(i) a resident of a skilled nursing fa10 cility; and 

11 ‘‘(ii) any person acting on the resi12 dent’s behalf. 

13 ‘‘(B) COMPLAINT RESOLUTION PROCESS.— 

14 The State must establish a complaint resolution 

15 process in order to ensure that the legal rep16 resentative of a resident of a skilled nursing fa17 cility or other responsible party is not denied 

18 access to such resident or otherwise retaliated 

19 against if they have complained about the qual20 ity of care provided by the facility or other 

21 issues relating to the facility. Such complaint 

22 resolution process shall include— 

23 ‘‘(i) procedures to assure accurate 

24 tracking of complaints received, including 


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1 notification to the complainant that a com2 plaint has been received; 

3 ‘‘(ii) procedures to determine the like4 ly severity of a complaint and for the in5 vestigation of the complaint; and 

6 ‘‘(iii) deadlines for responding to a 

7 complaint and for notifying the complain8 ant of the outcome of the investigation. 

9 ‘‘(C) RULE OF CONSTRUCTION.—Nothing 

10 in this paragraph shall be construed as pre11 venting a resident of a skilled nursing facility 

12 (or a person acting on the resident’s behalf) 

13 from submitting a complaint in a manner or 

14 format other than by using the standardized 

15 complaint form developed under subsection 

16 (f)(8) (including submitting a complaint oral17 ly).’’. 

18 (b) NURSING FACILITIES.— 

19 (1) DEVELOPMENT BY THE SECRETARY.—Sec20 tion 1919(f) of the Social Security Act (42 U.S.C. 

21 1395i–3(f)) is amended by adding at the end the fol22 lowing new paragraph: 

23 ‘‘(10) STANDARDIZED COMPLAINT FORM.—The 

24 Secretary shall develop a standardized complaint 

25 form for use by a resident (or a person acting on the 


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1 resident’s behalf) in filing a complaint with a State 

2 survey and certification agency and a State long3 term care ombudsman program with respect to a 

4 nursing facility.’’. 

5 (2) STATE REQUIREMENTS.—Section 1919(e) 

6 of the Social Security Act (42 U.S.C. 1395i–3(e)) is 

7 amended by adding at the end the following new 

8 paragraph: 

9 ‘‘(8) COMPLAINT FORMS AND RESOLUTION

10 PROCESSES.— 

11 ‘‘(A) COMPLAINT FORMS.—The State must 

12 make the standardized complaint form devel13 oped under subsection (f)(10) available upon re14 quest to— 

15 ‘‘(i) a resident of a nursing facility; 

16 and 

17 ‘‘(ii) any person acting on the resi18 dent’s behalf. 

19 ‘‘(B) COMPLAINT RESOLUTION PROCESS.— 

20 The State must establish a complaint resolution 

21 process in order to ensure that the legal rep22 resentative of a resident of a nursing facility or 

23 other responsible party is not denied access to 

24 such resident or otherwise retaliated against if 

25 they have complained about the quality of care 


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1 provided by the facility or other issues relating 

2 to the facility. Such complaint resolution proc3 ess shall include— 

4 ‘‘(i) procedures to assure accurate 

5 tracking of complaints received, including 

6 notification to the complainant that a com7 plaint has been received; 

8 ‘‘(ii) procedures to determine the like9 ly severity of a complaint and for the in10 vestigation of the complaint; and 

11 ‘‘(iii) deadlines for responding to a 

12 complaint and for notifying the complain13 ant of the outcome of the investigation. 

14 ‘‘(C) RULE OF CONSTRUCTION.—Nothing 

15 in this paragraph shall be construed as pre16 venting a resident of a nursing facility (or a 

17 person acting on the resident’s behalf) from 

18 submitting a complaint in a manner or format 

19 other than by using the standardized complaint 

20 form developed under subsection (f)(10) (in21 cluding submitting a complaint orally).’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall take effect 1 year after the date of enact24 ment of this Act. 


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1 SEC. 106. ENSURING STAFFING ACCOUNTABILITY. 

2 (a) SKILLED NURSING FACILITIES.—Section 

3 1819(b)(8) of the Social Security Act (42 U.S.C. 1395i– 

4 3(b)(8)) is amended by adding at the end the following 

5 new subparagraph: 

6 ‘‘(C) SUBMISSION OF STAFFING INFORMA7 TION BASED ON PAYROLL DATA IN A UNIFORM

8 FORMAT.— 

9 ‘‘(i) DESIGN PHASE.— 

10 ‘‘(I) IN GENERAL.—The Sec11 retary shall establish a program for 

12 skilled nursing facilities to report 

13 staffing information (including infor14 mation with respect to agency and 

15 contract staff) based on payroll data. 

16 Such program shall be conducted for 

17 a 1-year period beginning on the date 

18 of enactment of this subparagraph. 

19 ‘‘(II) REPORT.—Not later than 6 

20 months after the completion of the 

21 program established under subclause 

22 (I), the Secretary shall submit a re23 port to Congress containing the re24 sults of the program. 

25 ‘‘(ii) SUBMISSION OF STAFFING IN26 FORMATION.—Beginning not later than 1 


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1 year after the completion of the program 

2 established under clause (i)(I), the Sec3 retary shall require a skilled nursing facil4 ity to electronically submit to the Secretary 

5 nurse staffing information (including infor6 mation with respect to agency and contract 

7 staff) based on payroll data in a uniform 

8 format (according to specifications estab9 lished by the Secretary). Such specifica10 tions shall require that the information 

11 submitted under the preceding sentence— 

12 ‘‘(I) specify the category of work 

13 a certified employee performs (such as 

14 whether the employee is a registered 

15 nurse, licensed practical nurse, li16 censed vocational nurse, or certified 

17 nursing assistant); 

18 ‘‘(II) include resident census 

19 data; 

20 ‘‘(III) include a regular reporting 

21 schedule; and 

22 ‘‘(IV) include information on em23 ployee turnover and tenure and on the 

24 hours of care provided by each catVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 egory of certified employees referenced 

2 in subclause (I) per resident per day.’’ 

3 (b) NURSING FACILITIES.—Section 1919(b)(8) of the 

4 Social Security Act (42 U.S.C. 1396r(b)(8)) is amended 

5 by adding at the end the following new subparagraph: 

6 ‘‘(C) SUBMISSION OF STAFFING INFORMA7 TION BASED ON PAYROLL DATA IN A UNIFORM

8 FORMAT.— 

9 ‘‘(i) DESIGN PHASE.— 

10 ‘‘(I) IN GENERAL.—The Sec11 retary shall establish a program for 

12 nursing facilities to report staffing in13 formation (including information with 

14 respect to agency and contract staff) 

15 based on payroll data. Such program 

16 shall be conducted for a 1-year period 

17 beginning on the date of enactment of 

18 this subparagraph. 

19 ‘‘(II) REPORT.—Not later than 6 

20 months after the completion of the 

21 program established under subclause 

22 (I), the Secretary shall submit a re23 port to Congress containing the re24 sults of the program. 


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1 ‘‘(ii) SUBMISSION OF STAFFING IN2 FORMATION.—Beginning not later than 1 

3 year after the completion of the program 

4 established under clause (i)(I), the Sec5 retary shall require a nursing facility to 

6 electronically submit to the Secretary 

7 nurse staffing information (including infor8 mation with respect to agency and contract 

9 staff) based on payroll data in a uniform 

10 format (according to specifications estab11 lished by the Secretary). Such specifica12 tions shall require that the information 

13 submitted under the preceding sentence— 

14 ‘‘(I) specify the category of work 

15 a certified employee performs (such as 

16 whether the employee is a registered 

17 nurse, licensed practical nurse, li18 censed vocational nurse, or certified 

19 nursing assistant); 

20 ‘‘(II) include resident census 

21 data; 

22 ‘‘(III) include a regular reporting 

23 schedule; and 

24 ‘‘(IV) include information on em25 ployee turnover and tenure and on the 


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1 hours of care provided by each cat2 egory of certified employees referenced 

3 in subclause (I) per resident per day.’’ 

4 TITLE II—TARGETING 

5 ENFORCEMENT 

6 SEC. 201. CIVIL MONEY PENALTIES. 

7 (a) SKILLED NURSING FACILITIES.— 

8 (1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of 

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

10 3(h)(2)(B)(ii)) is amended to read as follows: 

11 ‘‘(ii) AUTHORITY WITH RESPECT TO

12 CIVIL MONEY PENALTIES.— 

13 ‘‘(I) AMOUNT.—Subject to sub14 clause (III), the Secretary may impose 

15 a civil money penalty in the applicable 

16 amount (as defined in subclause (II)) 

17 for each day or each instance of non18 compliance (as determined appro19 priate by the Secretary). 

20 ‘‘(II) APPLICABLE AMOUNT.—In 

21 this clause, the term ‘applicable 

22 amount’ means— 

23 ‘‘(aa) in the case where the 

24 deficiency results in the death of 


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•HR 5799 IH

1 a resident of the facility, an 

2 amount not to exceed $100,000; 

3 ‘‘(bb) in the case of a defi4 ciency where the facility is cited 

5 for actual harm or immediate 

6 jeopardy, an amount not less 

7 than $3,000 and not more than 

8 $25,000; and 

9 ‘‘(cc) in the case of any 

10 other deficiency, an amount not 

11 to exceed $3,000. 

12 ‘‘(III) REDUCTION OF CIVIL

13 MONEY PENALTIES IN CERTAIN CIR14 CUMSTANCES.—Subject to subclause 

15 (IV), in the case where a facility self16 reports and promptly corrects a defi17 ciency for which a penalty was im18 posed under this clause not later than 

19 10 calendar days after the date of 

20 such imposition, the Secretary may 

21 reduce the amount of the penalty im22 posed by not more than 50 percent. 

23 ‘‘(IV) PROHIBITIONS ON REDUC24 TION FOR CERTAIN DEFICIENCIES.— 


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1 ‘‘(aa) REPEAT DEFI2 CIENCIES.—The Secretary may 

3 not reduce the amount of a pen4 alty under subclause (III) if the 

5 Secretary had reduced a penalty 

6 imposed on the facility in the 

7 preceding year under such sub8 clause with respect to a repeat 

9 deficiency. 

10 ‘‘(bb) CERTAIN OTHER DE11 FICIENCIES.—The Secretary may 

12 not reduce the amount of a pen13 alty under subclause (III) if the 

14 penalty is imposed for a defi15 ciency described in subclause 

16 (II)(bb) and the actual harm is 

17 found to result in a pattern of 

18 harm or widespread harm that 

19 immediately jeopardizes the 

20 health or safety of a resident or 

21 residents of the facility, or if the 

22 penalty is imposed for a defi23 ciency described in subclause 

24 (II)(aa). 


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1 ‘‘(V) COLLECTION OF CIVIL

2 MONEY PENALTIES.—In the case of a 

3 civil money penalty imposed under 

4 this clause for a deficiency described 

5 in item (aa) or (bb) of subclause (II), 

6 the Secretary— 

7 ‘‘(aa) subject to item (bb), 

8 shall provide the opportunity for 

9 the facility to participate in an 

10 informal dispute resolution proc11 ess prior to the collection of such 

12 penalty; 

13 ‘‘(bb) may provide for the 

14 collection of such civil money 

15 penalty and the placement of 

16 such amounts collected in an es17 crow account on the earlier of the 

18 date on which the informal dis19 pute resolution process under 

20 item (aa) is completed or the 

21 date that is 90 days after the 

22 date of the imposition of the pen23 alty; 

24 ‘‘(cc) may provide that such 

25 amounts collected are kept in 


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1 such account pending the resolu2 tion of any appeals; 

3 ‘‘(dd) in the case where the 

4 facility successfully appeals the 

5 penalty, may provide for the re6 turn of such amounts collected 

7 (plus interest) to the facility; and 

8 ‘‘(ee) in the case where all 

9 such appeals are unsuccessful, 

10 may provide that some portion of 

11 such amounts collected may be 

12 used to support activities that 

13 benefit residents, including as14 sistance to support and protect 

15 residents who reside in a facility 

16 that closes (voluntarily or invol17 untarily) or is decertified (includ18 ing offsetting costs of relocating 

19 residents to home and commu20 nity-based settings or another fa21 cility), and projects that support 

22 resident and family councils and 

23 other consumer involvement in 

24 assuring quality care in facilities. 


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1 ‘‘(VI) PROCEDURE.—The provi2 sions of section 1128A (other than 

3 subsections (a) and (b) and except to 

4 the extent that such provisions require 

5 a hearing prior to the imposition of a 

6 civil money penalty in the case de7 scribed in subclause (V)) shall apply 

8 to a civil money penalty under this 

9 clause in the same manner as such 

10 provisions apply to a penalty or pro11 ceeding under section 1128A(a).’’. 

12 (2) CONFORMING AMENDMENT.—The second 

13 sentence of section 1819(h)(5) of the Social Security 

14 Act (42 U.S.C. 1395i–3(h)(5)) is amended by insert15 ing ‘‘(ii)(V),’’ after ‘‘(i),’’. 

16 (b) NURSING FACILITIES.— 

17 (1) PENALTIES IMPOSED BY THE STATE.— 

18 (A) IN GENERAL.—Section 1919(h)(2) of 

19 the Social Security Act (42 U.S.C. 1396r(h)(2)) 

20 is amended— 

21 (i) in subparagraph (A)(ii), by strik22 ing the first sentence and inserting the fol23 lowing: ‘‘A civil money penalty in accord24 ance with subparagraph (G).’’; and 


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1 (ii) by adding at the end the following 

2 new subparagraph: 

3 ‘‘(G) CIVIL MONEY PENALTIES.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (iii), the State may impose a civil money 

6 penalty under subparagraph (A)(ii) in the 

7 applicable amount for each day or each in8 stance of noncompliance (as determined 

9 appropriate by the State). 

10 ‘‘(ii) DEFINITION OF APPLICABLE

11 AMOUNT.—In this subparagraph, the term 

12 ‘applicable amount’ means— 

13 ‘‘(I) in the case where the defi14 ciency results in the death of a resi15 dent of the facility, an amount not to 

16 exceed $100,000; 

17 ‘‘(II) in the case of a deficiency 

18 where the facility is cited for actual 

19 harm or immediate jeopardy, an 

20 amount not less than $3,000 and not 

21 more than $25,000; and 

22 ‘‘(III) in the case of any other 

23 deficiency, an amount not to exceed 

24 $3,000. 


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1 ‘‘(iii) REDUCTION OF CIVIL MONEY

2 PENALTIES IN CERTAIN CIR3 CUMSTANCES.—Subject to clause (iv), in 

4 the case where a facility self-reports and 

5 promptly corrects a deficiency for which a 

6 penalty was imposed under subparagraph 

7 (A)(ii) not later than 10 calendar days 

8 after the date of such imposition, the State 

9 may reduce the amount of the penalty im10 posed by not more than 50 percent. 

11 ‘‘(iv) PROHIBITION ON REDUCTION

12 FOR CERTAIN DEFICIENCIES.— 

13 ‘‘(I) REPEAT DEFICIENCIES.— 

14 The State may not reduce the amount 

15 of a penalty under clause (iii) if the 

16 State had reduced a penalty imposed 

17 on the facility in the preceding year 

18 under such clause with respect to a 

19 repeat deficiency. 

20 ‘‘(II) CERTAIN OTHER DEFI21 CIENCIES.—The State may not reduce 

22 the amount of a penalty under clause 

23 (iii) if the penalty is imposed for a de24 ficiency described in clause (ii)(II) 

25 and the actual harm is found to result 


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1 in a pattern of harm or widespread 

2 harm that immediately jeopardizes the 

3 health or safety of a resident or resi4 dents of the facility, or if the penalty 

5 is imposed for a deficiency described 

6 in clause (ii)(I). 

7 ‘‘(v) COLLECTION OF CIVIL MONEY

8 PENALTIES.—In the case of a civil money 

9 penalty imposed under subparagraph 

10 (A)(ii) for a deficiency described in sub11 clause (I) or (II) of clause (ii), the State— 

12 ‘‘(I) subject to subclause (II), 

13 shall provide the opportunity for the 

14 facility to participate in an informal 

15 dispute resolution process prior to the 

16 collection of such penalty; 

17 ‘‘(II) may provide for the collec18 tion of such civil money penalty and 

19 the placement of such amounts col20 lected in an escrow account on the 

21 earlier of the date on which the infor22 mal dispute resolution process under 

23 subclause (I) is completed or the date 

24 that is 90 days after the date of the 

25 imposition of the penalty; 


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1 ‘‘(III) may provide that such 

2 amounts collected are kept in such ac3 count pending the resolution of any 

4 appeals; 

5 ‘‘(IV) in the case where the facil6 ity successfully appeals the penalty, 

7 may provide for the return of such 

8 amounts collected (plus interest) to 

9 the facility; and 

10 ‘‘(V) in the case where all such 

11 appeals are unsuccessful, may provide 

12 that such funds collected shall be used 

13 for the purposes described in the sec14 ond sentence of subparagraph 

15 (A)(ii).’’. 

16 (B) CONFORMING AMENDMENT.—The sec17 ond sentence of section 1919(h)(2)(A)(ii) is 

18 amended by inserting ‘‘, and some portion of 

19 such funds may be used to support activities 

20 that benefit residents, including assistance to 

21 support and protect residents who reside in a 

22 facility that closes (voluntarily or involuntarily) 

23 or is decertified (including offsetting costs of re24 locating residents to home and community25 based settings or another facility), and projects 


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•HR 5799 IH

1 that support resident and family councils and 

2 other consumer involvement in assuring quality 

3 care in facilities’’ before the period at the end. 

4 (2) PENALTIES IMPOSED BY THE SEC5 RETARY.— 

6 (A) IN GENERAL.—Section 

7 1919(h)(3)(C)(ii) of the Social Security Act (42 

8 U.S.C. 1396r(h)(3)(C)) is amended to read as 

9 follows: 

10 ‘‘(ii) AUTHORITY WITH RESPECT TO

11 CIVIL MONEY PENALTIES.— 

12 ‘‘(I) AMOUNT.—Subject to sub13 clause (III), the Secretary may impose 

14 a civil money penalty in the applicable 

15 amount (as defined in subclause (II)) 

16 for each day or each instance of non17 compliance (as determined appro18 priate by the Secretary). 

19 ‘‘(II) APPLICABLE AMOUNT.—In 

20 this clause, the term ‘applicable 

21 amount’ means— 

22 ‘‘(aa) in the case where the 

23 deficiency results in the death of 

24 a resident of the facility, an 

25 amount not to exceed $100,000; 


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1 ‘‘(bb) in the case of a defi2 ciency where the facility is cited 

3 for actual harm or immediate 

4 jeopardy, an amount not less 

5 than $3,000 and not more than 

6 $25,000; and 

7 ‘‘(cc) in the case of any 

8 other deficiency, an amount not 

9 to exceed $3,000. 

10 ‘‘(III) REDUCTION OF CIVIL

11 MONEY PENALTIES IN CERTAIN CIR12 CUMSTANCES.—Subject to subclause 

13 (IV), in the case where a facility self14 reports and promptly corrects a defi15 ciency for which a penalty was im16 posed under this clause not later than 

17 10 calendar days after the date of 

18 such imposition, the Secretary may 

19 reduce the amount of the penalty im20 posed by not more than 50 percent. 

21 ‘‘(IV) PROHIBITIONS ON REDUC22 TION FOR CERTAIN DEFICIENCIES.— 

23 ‘‘(aa) REPEAT DEFI24 CIENCIES.—The Secretary may 

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1 alty under subclause (III) if the 

2 Secretary had reduced a penalty 

3 imposed on the facility in the 

4 preceding year under such sub5 clause with respect to a repeat 

6 deficiency. 

7 ‘‘(bb) CERTAIN OTHER DE8 FICIENCIES.—The Secretary may 

9 not reduce the amount of a pen10 alty under subclause (III) if the 

11 penalty is imposed for a defi12 ciency described in subclause 

13 (II)(bb) and the actual harm is 

14 found to result in a pattern of 

15 harm or widespread harm that 

16 immediately jeopardizes the 

17 health or safety of a resident or 

18 residents of the facility, or if the 

19 penalty is imposed for a defi20 ciency described in subclause 

21 (II)(aa). 

22 ‘‘(V) COLLECTION OF CIVIL

23 MONEY PENALTIES.—In the case of a 

24 civil money penalty imposed under 

25 this clause for a deficiency described 


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•HR 5799 IH

1 in item (aa) or (bb) of subclause (II), 

2 the Secretary— 

3 ‘‘(aa) subject to item (bb), 

4 shall provide the opportunity for 

5 the facility to participate in an 

6 informal dispute resolution proc7 ess prior to the collection of such 

8 penalty; 

9 ‘‘(bb) may provide for the 

10 collection of such civil money 

11 penalty and the placement of 

12 such amounts collected in an es13 crow account on the earlier of the 

14 date on which the informal dis15 pute resolution process under 

16 item (aa) is completed or the 

17 date that is 90 days after the 

18 date of the imposition of the pen19 alty; 

20 ‘‘(cc) may provide that such 

21 amounts collected are kept in 

22 such account pending the resolu23 tion of any appeals; 

24 ‘‘(dd) in the case where the 

25 facility successfully appeals the 


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1 penalty, may provide for the re2 turn of such amounts collected 

3 (plus interest) to the facility; and 

4 ‘‘(ee) in the case where all 

5 such appeals are unsuccessful, 

6 may provide that some portion of 

7 such amounts collected may be 

8 used to support activities that 

9 benefit residents, including as10 sistance to support and protect 

11 residents who reside in a facility 

12 that closes (voluntarily or invol13 untarily) or is decertified (includ14 ing offsetting costs of relocating 

15 residents to home and commu16 nity-based settings or another fa17 cility), and projects that support 

18 resident and family councils and 

19 other consumer involvement in 

20 assuring quality care in facilities. 

21 ‘‘(VI) PROCEDURE.—The provi22 sions of section 1128A (other than 

23 subsections (a) and (b) and except to 

24 the extent that such provisions require 

25 a hearing prior to the imposition of a 


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1 civil money penalty in the case de2 scribed in subclause (V)) shall apply 

3 to a civil money penalty under this 

4 clause in the same manner as such 

5 provisions apply to a penalty or pro6 ceeding under section 1128A(a).’’. 

7 (B) CONFORMING AMENDMENT.—Section 

8 1919(h)(5)(8) of the Social Security Act (42 

9 U.S.C. 1396r(h)(5)(8)) is amended by inserting 

10 ‘‘(ii)(V),’’ after ‘‘(i),’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall take effect 1 year after the date of enact13 ment of this Act. 

14 SEC. 202. GAO STUDY AND REPORT ON THE RELATIVE FI15 NANCIAL STATUS AND PERFORMANCE OF 

16 SPECIAL FOCUS FACILITIES. 

17 (a) STUDY.— 

18 (1) IN GENERAL.—The Comptroller General of 

19 the United States shall conduct a study on the fi20 nancial status, resident care, and performance of 

21 skilled nursing facilities and nursing facilities in the 

22 Special Focus Facility program (or a successor pro23 gram) established by the Centers for Medicare & 

24 Medicaid Services relative to a comparable sample of 

25 facilities that are not in such program. Such study 


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1 shall include an examination of the ownership and 

2 control interests, and any affiliated parties, of the 

3 facilities studied (as applicable). 

4 (2) DEFINITIONS.—In this section: 

5 (A) NURSING FACILITY.—The term ‘‘nurs6 ing facility’’ has the meaning given such term 

7 in section 1919(a) of the Social Security Act 

8 (42 U.S.C. 1396r(a)). 

9 (B) SECRETARY.—The term ‘‘Secretary’’ 

10 means the Secretary of Health and Human 

11 Services. 

12 (C) SKILLED NURSING FACILITY.—The 

13 term ‘‘skilled nursing facility’’ has the meaning 

14 given such term in section 1819(a) of the Social 

15 Security Act (42 U.S.C. 1395(a)). 

16 (b) REPORT.—Not later than 1 year after the date 

17 of enactment of this Act, the Comptroller General of the 

18 United States shall submit a report to Congress and the 

19 Secretary containing the results of the study conducted 

20 under subsection (a), together with recommendations for 

21 such legislation and administrative action as the Comp22 troller General determines appropriate. 


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1 SEC. 203. NATIONAL INDEPENDENT MONITOR PROGRAM. 

2 (a) SKILLED NURSING FACILITIES.—Section 

3 1819(h) of the Social Security Act (42 U.S.C. 1395i– 

4 3(h)(2) is amended— 

5 (1) by redesignating paragraphs (5) and (6) as 

6 paragraphs (6) and (7), respectively; and 

7 (2) by inserting after paragraph (4) the fol8 lowing new paragraph: 

9 ‘‘(5) NATIONAL INDEPENDENT MONITOR PRO10 GRAM.— 

11 ‘‘(A) IN GENERAL.—Not later than 1 year 

12 after the date of enactment of this paragraph, 

13 the Secretary, in consultation with the Inspec14 tor General of the Department of Health and 

15 Human Services, shall develop, test, and imple16 ment a protocol for the establishment of an 

17 independent monitoring program to oversee 

18 interstate and large intrastate chains of skilled 

19 nursing facilities. Such program shall be de20 signed to analyze such chains in 1 or more of 

21 the following instances: 

22 ‘‘(i) Where 3 or more facilities of the 

23 chain were enrolled in the ‘Special Focus 

24 Facility program’ (or a successor program) 

25 established by the Centers for Medicare & 


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1 Medicaid Services during the preceding 3 

2 years. 

3 ‘‘(ii) Where the chain has been experi4 encing financial problems that may be 

5 linked to serious quality deficiencies. 

6 ‘‘(iii) Where the chain has a record of 

7 chronic poor performance. 

8 ‘‘(B) RESPONSIBILITIES.—The inde9 pendent monitoring program established under 

10 subparagraph (A) shall include the following re11 sponsibilities: 

12 ‘‘(i) Conducting periodic reviews and 

13 preparing root-cause quality and deficiency 

14 analyses of a chain described in such sub15 paragraph to assess compliance by the 

16 chain with State and Federal laws and reg17 ulations. 

18 ‘‘(ii) Conducting oversight of efforts 

19 by such a chain, whether publicly or pri20 vately held, to achieve compliance with 

21 State and Federal laws and regulations. 

22 ‘‘(iii) Analyzing the management 

23 structure, distribution of expenditures, and 

24 nurse staffing levels of facilities of such a 


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1 chain in relation to resident census, staff 

2 turnover rates, and tenure. 

3 ‘‘(iv) Reporting findings and rec4 ommendations with respect to such re5 views, analyses, and oversight to the chain 

6 and facilities of the chain, to the Secretary, 

7 and to relevant States. 

8 ‘‘(v) Publishing the results of such re9 views, analyses, and oversight. 

10 ‘‘(C) IMPLEMENTATION OF RECOMMENDA11 TIONS.— 

12 ‘‘(i) RECEIPT OF FINDING BY

13 CHAIN.—Not later than 10 days after re14 ceipt of a finding reported under subpara15 graph (B)(iv), the chain shall submit a re16 port to the independent monitor— 

17 ‘‘(I) outlining corrective actions 

18 to be taken by the chain to implement 

19 the recommendations in such report; 

20 or 

21 ‘‘(II) indicating that the chain 

22 will not implement such recommenda23 tions, and why it will not do so. 

24 ‘‘(ii) RECEIPT OF REPORT BY INDE25 PENDENT MONITOR.—Not later than 10 


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1 days after receipt of the report submitted 

2 by the chain under clause (i), the inde3 pendent monitor shall finalize its rec4 ommendations and submit a report to the 

5 chain and facilities of the chain, the Sec6 retary, and the State or States, as appro7 priate, containing such final recommenda8 tions. 

9 ‘‘(iii) CIVIL MONEY PENALTY.—The 

10 Secretary may impose a civil money pen11 alty under subsection (h)(2)(B)(ii) on a 

12 chain that fails to respond to or to take 

13 corrective actions to implement the rec14 ommendations of the independent monitor 

15 in accordance with this subparagraph. 

16 ‘‘(D) COST OF APPOINTMENT.—A chain 

17 shall be responsible for all costs associated with 

18 the appointment of independent monitors under 

19 the program under this paragraph. The chain 

20 shall pay such costs to the Secretary (in accord21 ance with procedures established by the Sec22 retary). 

23 ‘‘(E) EVALUATION AND REPORT.— 

24 ‘‘(i) EVALUATION.—The Inspector 

25 General of the Department of Health and 


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1 Human Services shall evaluate the inde2 pendent monitoring program under this 

3 paragraph. 

4 ‘‘(ii) REPORT.—Not later than 2 

5 years after the implementation of such pro6 gram under subparagraph (A), the Inspec7 tor General shall submit a report to Con8 gress containing the results of the evalua9 tion conducted under clause (i), together 

10 with recommendations for such legislation 

11 and administrative action as the Inspector 

12 General determines appropriate. 

13 ‘‘(F) INTERMEDIATE REMEDY.—The ap14 pointment of an independent monitor shall be 

15 an intermediate remedy that may be in addition 

16 to or in lieu of other remedies under this sub17 section.’’. 

18 (b) NURSING FACILITIES.—Section 1919(h) of the 

19 Social Security Act (42 U.S.C. 1396r(h)) is amended— 

20 (1) by redesignating paragraphs (8) and (9) as 

21 paragraphs (9) and (10), respectively; and 

22 (2) by inserting after paragraph (7) the fol23 lowing new paragraph: 

24 ‘‘(8) NATIONAL INDEPENDENT MONITOR PRO25 GRAM.— 


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1 ‘‘(A) IN GENERAL.—Not later than 1 year 

2 after the date of enactment of this paragraph, 

3 the Secretary, in consultation with the Inspec4 tor General of the Department of Health and 

5 Human Services, shall develop, test, and imple6 ment a protocol for the establishment of an 

7 independent monitoring program to oversee 

8 interstate and large intrastate chains of nursing 

9 facilities. Such program shall be designed to 

10 analyze such chains in 1 or more of the fol11 lowing instances: 

12 ‘‘(i) Where 3 or more facilities of the 

13 chain were enrolled in the ‘Special Focus 

14 Facility program’ (or a successor program) 

15 established by the Centers for Medicare & 

16 Medicaid Services during the preceding 3 

17 years. 

18 ‘‘(ii) Where the chain has been experi19 encing financial problems that may be 

20 linked to serious quality deficiencies. 

21 ‘‘(iii) Where the chain has a record of 

22 chronic poor performance. 

23 ‘‘(B) RESPONSIBILITIES.—The inde24 pendent monitoring program established under 


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1 subparagraph (A) shall include the following re2 sponsibilities: 

3 ‘‘(i) Conducting periodic reviews and 

4 preparing root-cause quality and deficiency 

5 analyses of a chain described in such sub6 paragraph to assess compliance by the 

7 chain with State and Federal laws and reg8 ulations. 

9 ‘‘(ii) Conducting oversight of efforts 

10 by such a chain, whether publicly or pri11 vately held, to achieve compliance with 

12 State and Federal laws and regulations. 

13 ‘‘(iii) Analyzing the management 

14 structure, distribution of expenditures, and 

15 nurse staffing levels of facilities of such a 

16 chain in relation to resident census, staff 

17 turnover rates, and tenure. 

18 ‘‘(iv) Reporting findings and rec19 ommendations with respect to such re20 views, analyses, and oversight to the chain 

21 and facilities of the chain, to the Secretary, 

22 and to relevant States. 

23 ‘‘(v) Publishing the results of such re24 views, analyses, and oversight. 


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1 ‘‘(C) IMPLEMENTATION OF RECOMMENDA2 TIONS.— 

3 ‘‘(i) RECEIPT OF FINDING BY

4 CHAIN.—Not later than 10 days after re5 ceipt of a finding reported under subpara6 graph (B)(iv), the chain shall submit a re7 port to the independent monitor— 

8 ‘‘(I) outlining corrective actions 

9 to be taken by the chain to implement 

10 the recommendations in such report; 

11 or 

12 ‘‘(II) indicating that the chain 

13 will not implement such recommenda14 tions, and why it will not do so. 

15 ‘‘(ii) RECEIPT OF REPORT BY INDE16 PENDENT MONITOR.—Not later than 10 

17 days after receipt of the report submitted 

18 by the chain under clause (i), the inde19 pendent monitor shall finalize its rec20 ommendations and submit a report to the 

21 chain and facilities of the chain, the Sec22 retary, and the State or States, as appro23 priate, containing such final recommenda24 tions. 


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1 ‘‘(iii) CIVIL MONEY PENALTY.—A 

2 State or the Secretary may impose a civil 

3 money penalty under subsection 

4 (h)(2)(A)(ii), or (h)(3)(C)(ii), respectively, 

5 on a chain that fails to respond to or to 

6 take corrective actions to implement the 

7 recommendations of the independent mon8 itor in accordance with this subparagraph. 

9 ‘‘(D) COST OF APPOINTMENT.—A chain 

10 shall be responsible for all costs associated with 

11 the appointment of independent monitors under 

12 the program under this paragraph. The chain 

13 shall pay such costs to the Secretary (in accord14 ance with procedures established by the Sec15 retary). 

16 ‘‘(E) EVALUATION AND REPORT.— 

17 ‘‘(i) EVALUATION.—The Inspector 

18 General of the Department of Health and 

19 Human Services shall evaluate the inde20 pendent monitoring program under this 

21 paragraph. 

22 ‘‘(ii) REPORT.—Not later than 2 

23 years after the implementation of such pro24 gram under subparagraph (A), the Inspec25 tor General shall submit a report to ConVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 gress containing the results of the evalua2 tion conducted under clause (i), together 

3 with recommendations for such legislation 

4 and administrative action as the Inspector 

5 General determines appropriate. 

6 ‘‘(F) INTERMEDIATE REMEDY.—The ap7 pointment of an independent monitor shall be 

8 an intermediate remedy that may be in addition 

9 to or in lieu of other remedies under this sub10 section.’’. 

11 SEC. 204. GAO STUDIES AND REPORTS ON TEMPORARY 

12 MANAGEMENT AND BARRIERS TO PUR13 CHASING FACILITIES WITH A RECORD OF 

14 POOR CARE. 

15 (a) STUDY AND REPORT ON TEMPORARY MANAGE16 MENT.— 

17 (1) IN GENERAL.—The Comptroller General of 

18 the United States (in this section referred to as the 

19 ‘‘Comptroller General’’) shall conduct a study on— 

20 (A) best practices for the appointment of 

21 temporary management under sections 

22 1819(h)(2)(B)(iii), 1919(h)(2)(A)(iii), and 

23 1919(h)(3)(C)(iii) of the Social Security Act 

24 (42 U.S.C. 1395i–3(h)(2)(B)(iii); 

25 1396r(h)(2)(A)(iii); 1396r(h)(3)(C)(iii)); and 


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1 (B) barriers to the appointment of such 

2 temporary management. 

3 (2) REPORT.—Not later than 1 year after the 

4 date of enactment of this Act, the Comptroller Gen5 eral shall submit a report to Congress containing the 

6 results of the study conducted under paragraph (1), 

7 together with recommendations for such legislation 

8 and administrative action as the Comptroller Gen9 eral determines appropriate. 

10 (3) GUIDANCE TO STATES.—The Secretary of 

11 Health and Human Services shall issue guidance to 

12 States based on the recommendations contained in 

13 the report submitted under paragraph (2). 

14 (b) STUDY AND REPORT ON BARRIERS TO PUR15 CHASING FACILITIES WITH A RECORD OF POOR CARE.— 

16 (1) STUDY.—The Comptroller General of the 

17 United States shall conduct a study on the extent 

18 and the nature of any barriers for new owners who 

19 purchase, and potential owners who wish to pur20 chase, skilled nursing facilities and nursing facilities 

21 with a record of poor care. 

22 (2) REPORT.—Not later than 1 year after the 

23 date of enactment of this Act, the Comptroller Gen24 eral shall submit a report to Congress containing the 

25 results of the study conducted under paragraph (1), 


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1 together with recommendations for such legislation 

2 and administrative action as the Comptroller Gen3 eral determines appropriate to address any barriers 

4 identified in such study. 

5 (3) DEFINITIONS.—In this subsection: 

6 (A) NURSING FACILITY.—The term ‘‘nurs7 ing facility’’ has the meaning given such term 

8 in section 1919(a) of the Social Security Act 

9 (42 U.S.C. 1396r(a)). 

10 (B) SKILLED NURSING FACILITY.—The 

11 term ‘‘skilled nursing facility’’ has the meaning 

12 given such term in section 1819(a) of the Social 

13 Security Act (42 U.S.C. 1395(a)). 

14 SEC. 205. NOTIFICATION OF FACILITY CLOSURE. 

15 (a) SKILLED NURSING FACILITIES.— 

16 (1) IN GENERAL.—Section 1819(c) of the So17 cial Security Act (42 U.S.C. 1395i–3(c)) is amended 

18 by adding at the end the following new paragraph: 

19 ‘‘(7) NOTIFICATION OF FACILITY CLOSURE.— 

20 ‘‘(A) IN GENERAL.—Any individual who is 

21 the administrator of a skilled nursing facility 

22 must— 

23 ‘‘(i) submit to the Secretary, the State 

24 long-term care ombudsman, residents of 

25 the facility, and the legal representatives of 


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1 such residents or other responsible parties, 

2 written notification of an impending clo3 sure— 

4 ‘‘(I) subject to subclause (II), not 

5 later than the date that is 60 days 

6 prior to the date of such closure; and 

7 ‘‘(II) in the case of a facility 

8 where the Secretary terminates the fa9 cility’s participation under this title, 

10 not later than the date that the Sec11 retary determines appropriate; 

12 ‘‘(ii) ensure that the facility does not 

13 admit any new residents on or after the 

14 date on which such written notification is 

15 submitted; and 

16 ‘‘(iii) include in the notice a plan for 

17 the transfer and adequate relocation of the 

18 residents of the facility by a specified date 

19 prior to closure that has been approved by 

20 the State, including assurances that the 

21 residents will be transferred to the most 

22 appropriate facility or other setting in 

23 terms of quality, services, and location, 

24 taking into consideration the needs and 

25 best interests of each resident. 


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1 ‘‘(B) RELOCATION.— 

2 ‘‘(i) IN GENERAL.—The State shall 

3 ensure that, before a facility closes, all 

4 residents of the facility have been success5 fully relocated to another facility or an al6 ternative home and community-based set7 ting. 

8 ‘‘(ii) CONTINUATION OF PAYMENTS

9 UNTIL RESIDENTS RELOCATED.—The Sec10 retary may, as the Secretary determines 

11 appropriate, continue to make payments 

12 under this title with respect to residents of 

13 a facility that has submitted a notification 

14 under subparagraph (A) during the period 

15 beginning on the date such notification is 

16 submitted and ending on the date on which 

17 the resident is successfully relocated.’’. 

18 (2) CONFORMING AMENDMENTS.—Section 

19 1819(h)(4) of the Social Security Act (42 U.S.C. 

20 1395i–3(h)(4)) is amended— 

21 (A) in the first sentence, by striking ‘‘the 

22 Secretary shall terminate’’ and inserting ‘‘the 

23 Secretary, subject to subsection (c)(7), shall 

24 terminate’’; and 


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1 (B) in the second sentence, by striking 

2 ‘‘subsection (c)(2)’’ and inserting ‘‘paragraphs 

3 (2) and (7) of subsection (c)’’. 

4 (b) NURSING FACILITIES.— 

5 (1) IN GENERAL.—Section 1919(c) of the So6 cial Security Act (42 U.S.C. 1396r(c)) is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(9) NOTIFICATION OF FACILITY CLOSURE.— 

9 ‘‘(A) IN GENERAL.—Any individual who is 

10 an administrator of a nursing facility must— 

11 ‘‘(i) submit to the Secretary, the State 

12 long-term care ombudsman, residents of 

13 the facility, and the legal representatives of 

14 such residents or other responsible parties, 

15 written notification of an impending clo16 sure— 

17 ‘‘(I) subject to subclause (II), not 

18 later than the date that is 60 days 

19 prior to the date of such closure; and 

20 ‘‘(II) in the case of a facility 

21 where the Secretary terminates the fa22 cility’s participation under this title, 

23 not later than the date that the Sec24 retary determines appropriate; 


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1 ‘‘(ii) ensure that the facility does not 

2 admit any new residents on or after the 

3 date on which such written notification is 

4 submitted; and 

5 ‘‘(iii) include in the notice a plan for 

6 the transfer and adequate relocation of the 

7 residents of the facility by a specified date 

8 prior to closure that has been approved by 

9 the State, including assurances that the 

10 residents will be transferred to the most 

11 appropriate facility or other setting in 

12 terms of quality, services, and location, 

13 taking into consideration the needs and 

14 best interests of each resident. 

15 ‘‘(B) RELOCATION.— 

16 ‘‘(i) IN GENERAL.—The State shall 

17 ensure that, before a facility closes, all 

18 residents of the facility have been success19 fully relocated to another facility or an al20 ternative home and community-based set21 ting. 

22 ‘‘(ii) CONTINUATION OF PAYMENTS

23 UNTIL RESIDENTS RELOCATED.—The Sec24 retary may, as the Secretary determines 

25 appropriate, continue to make payments 


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1 under this title with respect to residents of 

2 a facility that has submitted a notification 

3 under subparagraph (A) during the period 

4 beginning on the date such notification is 

5 submitted and ending on the date on which 

6 the resident is successfully relocated.’’. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall take effect 1 year after the date of enact9 ment of this Act. 

10 SEC. 206. NATIONAL DEMONSTRATION PROJECTS ON CUL11 TURE CHANGE AND USE OF INFORMATION 

12 TECHNOLOGY IN NURSING HOMES. 

13 (a) IN GENERAL.—The Secretary shall conduct 2 

14 demonstration projects, 1 for the development of best 

15 practices in skilled nursing facilities and nursing facilities 

16 that are involved in the culture change movement (includ17 ing the development of resources for facilities to find and 

18 access funding in order to undertake culture change) and 

19 1 for the development of best practices in skilled nursing 

20 facilities and nursing facilities for the use of information 

21 technology to improve resident care. 

22 (b) CONDUCT OF DEMONSTRATION PROJECTS.— 

23 (1) GRANT AWARD.—Under each demonstration 

24 project conducted under this section, the Secretary 

25 shall award 1 or more grants to facility-based setVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 tings for the development of best practices described 

2 in subsection (a) with respect to the demonstration 

3 project involved. Such award shall be made on a 

4 competitive basis and may be allocated in 1 lump5 sum payment. 

6 (2) CONSIDERATION OF SPECIAL NEEDS OF

7 RESIDENTS.—Each demonstration project conducted 

8 under this section shall take into consideration the 

9 special needs of residents of skilled nursing facilities 

10 and nursing facilities who have cognitive impair11 ment, including dementia. 

12 (c) IMPLEMENTATION AND DURATION.— 

13 (1) IMPLEMENTATION.—The demonstration 

14 projects shall each be implemented not later than 1 

15 year after the date of enactment of this Act. 

16 (2) IN GENERAL.—The demonstration projects 

17 shall each be conducted for a period not to exceed 

18 3 years. 

19 (d) DEFINITIONS.—In this section: 

20 (1) NURSING FACILITY.—The term ‘‘nursing 

21 facility’’ has the meaning given such term in section 

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

23 1396r(a)). 

24 (2) SECRETARY.—The term ‘‘Secretary’’ means 

25 the Secretary of Health and Human Services. 


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1 (3) SKILLED NURSING FACILITY.—The term 

2 ‘‘skilled nursing facility’’ has the meaning given such 

3 term in section 1819(a) of the Social Security Act 

4 (42 U.S.C. 1395(a)). 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated such sums as are nec7 essary to carry out this section. 

8 (f) REPORT.—Not later than 9 months after the com9 pletion of the demonstration project, the Secretary shall 

10 submit a report to Congress on such project, together with 

11 recommendations for such legislation and administrative 

12 action as the Secretary determines appropriate. 

13 TITLE III—IMPROVING STAFF 

14 TRAINING 

15 SEC. 301. DEMENTIA AND ABUSE PREVENTION TRAINING. 

16 (a) SKILLED NURSING FACILITIES.—Section 

17 1819(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 

18 1395i–3(f)(2)(A)(i)(I)) is amended by inserting ‘‘(includ19 ing, in the case of initial training and, if the Secretary 

20 determines appropriate, in the case of ongoing training, 

21 dementia management training, and patient abuse preven22 tion training’’ before ‘‘, (II)’’. 

23 (b) NURSING FACILITIES.—Section 

24 1919(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 

25 1396r(f)(2)(A)(i)(I)) is amended by inserting ‘‘(including, 


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1 in the case of initial training and, if the Secretary deter2 mines appropriate, in the case of ongoing training, demen3 tia management training, and patient abuse prevention’’ 

4 before ‘‘, (II)’’. 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall take effect 1 year after the date of enact7 ment of this Act. 

8 SEC. 302. STUDY AND REPORT ON TRAINING REQUIRED 

9 FOR CERTIFIED NURSE AIDES AND SUPER10 VISORY STAFF. 

11 (a) STUDY.— 

12 (1) IN GENERAL.—The Secretary shall conduct 

13 a study on the content of training for certified nurse 

14 aides and supervisory staff of skilled nursing facili15 ties and nursing facilities. The study shall include an 

16 analysis of the following: 

17 (A) Whether the number of initial training 

18 hours for certified nurse aides required under 

19 sections 1819(f)(2)(A)(i)(II) and 

20 1919(f)(2)(A)(i)(II) of the Social Security Act 

21 (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 

22 1396r(f)(2)(A)(i)(II)) should be increased from 

23 75 and, if so, what the required number of ini24 tial training hours should be, including any recVerDate Aug 31 2005 05:14 Apr 17, 2008 Jkt 069200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H5799.IH H5799

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1 ommendations for the content of such training 

2 (including training related to dementia). 

3 (B) Whether requirements for ongoing 

4 training under such sections 

5 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) 

6 should be increased from 12 hours per year, in7 cluding any recommendations for the content of 

8 such training. 

9 (2) CONSULTATION.—In conducting the anal10 ysis under paragraph (1)(A), the Secretary shall 

11 consult with States that currently (as of the date of 

12 enactment of this Act) require more than 75 hours 

13 of training for certified nurse aides. 

14 (3) DEFINITIONS.—In this section: 

15 (A) NURSING FACILITY.—The term ‘‘nurs16 ing facility’’ has the meaning given such term 

17 in section 1919(a) of the Social Security Act 

18 (42 U.S.C. 1396r(a)). 

19 (B) SECRETARY.—The term ‘‘Secretary’’ 

20 means the Secretary of Health and Human 

21 Services, acting through the Assistant Secretary 

22 for Planning and Evaluation. 

23 (C) SKILLED NURSING FACILITY.—The 

24 term ‘‘skilled nursing facility’’ has the meaning 


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1 given such term in section 1819(a) of the Social 

2 Security Act (42 U.S.C. 1395(a)). 

3 (b) REPORT.—Not later than 2 years after the date 

4 of enactment of this Act, the Secretary shall submit a re5 port to Congress containing the results of the study con6 ducted under subsection (a), together with recommenda7 tions for such legislation and administrative action as the 

8 Secretary determines appropriate. 

Æ 


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