II 

117TH CONGRESS 

2D SESSION S. 4381 

To amend titles XVIII and XIX of the Social Security Act with respect 

to nursing facility requirements, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 13, 2022 

Mr. WARNER (for himself and Mr. SCOTT of South Carolina) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

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 ‘‘Ensuring Seniors’ Ac5 cess to Quality Care Act’’. 

6 SEC. 2. TRAINING AND COMPETENCY EVALUATION PRO7 GRAMS. 

8 (a) MEDICARE.—Section 1819(f)(2) of the Social Se9 curity Act (42 U.S.C. 1395i–3(f)(2)) is amended— 


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

2 ‘‘(unless the facility is described in subparagraph 

3 (B)(iii)(I))’’; 

4 (2) in subparagraph (B)— 

5 (A) in clause (i)— 

6 (i) by striking ‘‘(subject to clause 

7 (iii))’’; and 

8 (ii) by inserting ‘‘and’’ after the semi9 colon; 

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

11 inserting a period; and 

12 (C) by striking clause (iii); 

13 (3) by striking ‘‘A State may not delegate 

14 (through subcontract or otherwise) its responsibility 

15 under clause (iii)(II) to the skilled nursing facility.’’; 

16 (4) by striking subparagraphs (C) and (D); and 

17 (5) by adding at the end the following: 

18 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN19 ING AND COMPETENCY EVALUATION PROGRAMS

20 AND NURSE AIDE COMPETENCY EVALUATION

21 PROGRAMS.— 

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

23 State, the Secretary shall, in consultation 

24 with such State, disapprove, for a period 

25 not to exceed 2 years, a nurse aide trainVerDate Sep 11 2014 02:08 Jun 17, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4381.IS S4381

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1 ing and competency evaluation program or 

2 a nurse aide competency evaluation pro3 gram offered by or in a skilled nursing fa4 cility if such facility— 

5 ‘‘(I) has been assessed a civil 

6 monetary penalty under subsection 

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

8 1919(h)(2)(A)(ii) of not less than 

9 $10,697 for providing substandard 

10 quality of care; and 

11 ‘‘(II) has not, in the determina12 tion of the Secretary, corrected the 

13 deficiencies in quality of care for 

14 which such civil monetary penalty was 

15 assessed. 

16 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

17 The Secretary shall rescind a disapproval 

18 under clause (i) upon demonstration by a 

19 skilled nursing facility that— 

20 ‘‘(I) all deficiencies for which the 

21 civil monetary penalty described in 

22 clause (i)(I) was assessed have been 

23 remedied; 

24 ‘‘(II) the facility has not received 

25 deficiencies related to direct patient 


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1 harm for substandard quality of care 

2 deficiencies in the prior 2 years; and 

3 ‘‘(III) the Secretary certifies that 

4 the civil monetary penalty assessed 

5 under clause (i)(I) did not result in 

6 immediate jeopardy for direct patient 

7 harm or injury related to an abuse or 

8 neglect deficiency. 

9 For purposes of rescinding disapproval 

10 under this clause, the Secretary may re11 quire additional oversight of the skilled 

12 nursing facility for a period not to exceed 

13 the period of disapproval imposed under 

14 clause (i) with respect to such facility.’’. 

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

17 (1) in subparagraph (A)(iv)(I), by striking 

18 ‘‘(unless the facility is described in subparagraph 

19 (B)(iii)(I))’’; 

20 (2) in subparagraph (B)— 

21 (A) in clause (i), by inserting ‘‘and’’ after 

22 the semicolon; 

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

24 inserting a period; 

25 (C) by striking clause (iii); and 


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1 (D) by striking ‘‘A State may not delegate 

2 (through subcontract or otherwise) its responsi3 bility under clause (iii)(II) to the nursing facil4 ity.’’; 

5 (3) by striking subparagraphs (C) and (D); and 

6 (4) by adding at the end the following: 

7 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN8 ING AND COMPETENCY EVALUATION PROGRAMS

9 AND NURSE AIDE COMPETENCY EVALUATION

10 PROGRAMS.— 

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

12 State, the Secretary shall, in consultation 

13 with such State, disapprove, for a period 

14 not to exceed 2 years, a nurse aide train15 ing and competency evaluation program or 

16 a nurse aide competency evaluation pro17 gram offered by or in a nursing facility if 

18 such facility— 

19 ‘‘(I) has been assessed a civil 

20 monetary penalty under section 

21 1819(h)(2)(B)(ii) or subsection 

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

23 for providing substandard quality of 

24 care; and 


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1 ‘‘(II) has not, in the determina2 tion of the Secretary, corrected the 

3 deficiencies in quality of care for 

4 which such civil monetary penalty was 

5 assessed. 

6 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 

7 The Secretary shall rescind a disapproval 

8 under clause (i) upon demonstration by a 

9 nursing facility that— 

10 ‘‘(I) all deficiencies for which the 

11 civil monetary penalty described in 

12 clause (i)(I) was assessed have been 

13 remedied; 

14 ‘‘(II) the facility has not received 

15 deficiencies related to direct patient 

16 harm for substandard quality of care 

17 deficiencies in the prior 2 years; and 

18 ‘‘(III) the Secretary certifies that 

19 the civil monetary penalty assessed 

20 under clause (i)(I) did not result in 

21 immediate jeopardy for direct patient 

22 harm or injury related to an abuse or 

23 neglect deficiency. 

24 For purposes of rescinding disapproval 

25 under this clause, the Secretary may reVerDate Sep 11 2014 02:08 Jun 17, 2022 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4381.IS S4381

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1 quire additional oversight of the nursing 

2 facility for a period not to exceed the pe3 riod of disapproval imposed under clause 

4 (i) with respect to such facility.’’. 

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

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

7 and Human Services shall promulgate regulations as nec8 essary to implement the amendments made by this section. 

9 (d) APPLICABILITY.— 

10 (1) IN GENERAL.— 

11 (A) TIMING OF DETERMINATIONS.—The 

12 amendments made by subsections (a)(4) and 

13 (b)(4) of this section shall apply only to a civil 

14 monetary penalty if the relevant covered deter15 mination was made on or after the date of en16 actment of this Act. 

17 (B) COVERED DETERMINATION DE18 FINED.—The term ‘‘covered determination’’ 

19 means, with respect to a skilled nursing facility 

20 or a nursing facility in a State, a determination 

21 by the State or the Secretary of Health and 

22 Human Services that the facility has provided 

23 a substandard quality of care for which a civil 

24 monetary penalty described in section 

25 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 


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1 Social Security Act (as such sections have been 

2 amended by this Act) may be assessed. 

3 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 

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

5 nursing facility or a nursing facility subject, on 

6 the day before the date of enactment of this 

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

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

9 1919(f)(2)(B)(iii)(I) of the Social Security Act 

10 (as in effect on the day before such date of en11 actment), such prohibition shall no longer apply 

12 to the facility on or after such date of enact13 ment. 

14 (B) SURVEY OR CIVIL MONETARY PEN15 ALTY.—With respect to a skilled nursing facil16 ity or a nursing facility subject, on the day be17 fore the date of enactment of this Act, to a pro18 hibition under item (b) or (c) of either section 

19 1819(f)(2)(B)(iii)(I) or section 

20 1919(f)(2)(B)(iii)(I) of the Social Security Act 

21 (as in effect on the day before such date of en22 actment), such prohibition shall no longer apply 

23 to the facility on or after such date of enact24 ment upon a determination by the Secretary of 

25 Health and Human Services that the facility 


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1 has corrected the issue that resulted in such 

2 prohibition. 

3 SEC. 3. PERMITTING MEDICARE AND MEDICAID PRO4 VIDERS TO ACCESS THE NATIONAL PRACTI5 TIONER DATA BANK TO CONDUCT EMPLOYEE 

6 BACKGROUND CHECKS. 

7 Section 1921(b)(6) of the Social Security Act (42 

8 U.S.C. 1396r–2(b)(6)) is amended— 

9 (1) by striking ‘‘and other health care entities 

10 (as defined in section 431 of the Health Care Qual11 ity Improvement Act of 1986)’’ and inserting ‘‘, 

12 other health care entities (as defined in section 431 

13 of the Health Care Quality Improvement Act of 

14 1986), providers of services (as defined in section 

15 1861(u)), suppliers (as defined in section 1861(d)), 

16 and providers of items or services under a State plan 

17 under this title (or a waiver of such a plan)’’; and 

18 (2) by striking ‘‘such hospitals or other health 

19 care entities’’ and inserting ‘‘such hospitals, health 

20 care entities, providers, or suppliers’’. 

Æ 


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