I 

113TH CONGRESS 

2D SESSION H. R. 5373 

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

a minimum direct care registered nurse staffing requirement at nursing 

facilities and skilled nursing facilities under Medicare and Medicaid and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2014 

Ms. SCHAKOWSKY (for herself, Ms. MATSUI, Ms. ROYBAL-ALLARD, Mr. 

PAYNE, and Mr. RANGEL) 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 establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing 

facilities under Medicare and Medicaid 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 ‘‘Put a Registered 

5 Nurse in the Nursing Home Act of 2014’’. 


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1 SEC. 2. ESTABLISHMENT OF MINIMUM DIRECT CARE REG2 ISTERED NURSE STAFFING REQUIREMENT AT 

3 NURSING FACILITIES AND SKILLED NURSING 

4 FACILITIES UNDER MEDICARE AND MED5 ICAID. 

6 (a) MEDICARE SKILLED NURSING FACILITIES.—Sec7 tion 1819(b)(4)(C) of the Social Security Act (42 U.S.C. 

8 1395i–3(b)(4)(C)) is amended— 

9 (1) in clause (i)— 

10 (A) by striking ‘‘Except as provided in 

11 clause (ii), a’’ and inserting ‘‘A’’; and 

12 (B) by striking all that follows ‘‘residents’’ 

13 and inserting a period; and 

14 (2) by striking clause (ii) and inserting the fol15 lowing: 

16 ‘‘(ii) USE OF DIRECT CARE REG17 ISTERED NURSE.—A skilled nursing facil18 ity must use the services of at least 1 reg19 istered professional nurse to provide as20 sessment, surveillance, and direct care to 

21 residents 24 hours a day, 7 days a week. 

22 In the preceding sentence, the term ‘sur23 veillance’ means the purposeful and ongo24 ing acquisition, interpretation, and syn25 thesis of residents’ data for clinical deci26 sion making.’’. 


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•HR 5373 IH

1 (b) MEDICAID NURSING FACILITIES.—Subparagraph 

2 (C) of section 1919(b)(4)(C) of the Social Security Act 

3 (42 U.S.C. 1396r(b)(4)(C)) is amended— 

4 (1) in the heading, by striking ‘‘; FACILITY

5 WAIVERS’’; 

6 (2) in clause (i)— 

7 (A) by striking ‘‘With respect to’’ and all 

8 that follows through ‘‘clause (ii), must provide’’ 

9 and inserting ‘‘A nursing facility must provide’’; 

10 and 

11 (B) by striking all that follows ‘‘residents’’ 

12 and inserting a period; and 

13 (3) by striking clauses (ii) and (iii) and insert14 ing the following: 

15 ‘‘(ii) USE OF DIRECT CARE REG16 ISTERED NURSE.—A nursing facility must 

17 use the services of at least 1 registered 

18 professional nurse to provide assessment, 

19 surveillance, and direct care to residents 

20 24 hours a day, 7 days a week. In the pre21 ceding sentence, the term ‘surveillance’ 

22 means the purposeful and ongoing acquisi23 tion, interpretation, and synthesis of resi24 dents’ data for clinical decisionmaking.’’. 


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

2 this section shall apply with respect to payments made for 

3 items and services furnished on or after the first day of 

4 the first calendar quarter beginning on the date that is 

5 1 year after the date of the enactment of this Act. 

Æ 


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