I

107TH CONGRESS

1ST SESSION H. R. 118

To establish a program to provide grants to States to test innovative ways

to increase nursing home staff levels, reduce turnover, and improve

quality of care for residents in nursing homes, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 3, 2001

Mr. HOLT introduced the following bill; which was referred to the Committee

on Energy and Commerce, and in addition to the Committee on Ways

and Means, 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 establish a program to provide grants to States to test

innovative ways to increase nursing home staff levels,

reduce turnover, and improve quality of care for residents in nursing homes, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Nursing Home Staff5 ing and Quality Improvement Act of 2001’’.
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1 SEC. 2. GRANTS TO STATES FOR IMPROVEMENTS IN NURS2 ING HOME STAFFING AND QUALITY.

3 (a) SECRETARY’S AUTHORITY TO AWARD GRANTS.—

4 The Secretary of Health and Human Services shall estab5 lish a program of competitive grants to States, in accord6 ance with the provisions of this section, for the purpose

7 of improving the quality of care furnished in nursing

8 homes operating in the State.

9 (b) APPLICATIONS AND ELIGIBILITY FOR GRANTS.—

10 (1) INITIAL APPLICATION.—A State seeking a

11 grant to conduct a project under this section shall

12 submit an application containing such information

13 and assurances as the Secretary of Health and

14 Human Services may require, including—

15 (A) a commitment to submit annual re16 ports describing the State’s progress in increas17 ing staffing levels and making other quality im18 provements in nursing homes in the State; and

19 (B) a description of a plan for evaluation

20 of the activities carried out under the grant, in21 cluding a plan for measurement of progress to22 ward the goals and objectives of the program,

23 consistent with the principles of the Govern24 ment Performance and Results Act.

25 (2) CONSULTATION WITH PUBLIC.—Before sub26 mitting an application for a grant under this section,
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1 a State shall solicit and consider the views of mem2 bers of the public, nursing home residents or their

3 representatives, and other persons concerned with

4 the administration of nursing homes within the

5 State with respect to the design of the proposed

6 State program.

7 (3) ELIGIBILITY.—

8 (A) INITIAL ELIGIBILITY.—A State shall

9 not be eligible for a grant award under this sec10 tion unless it makes assurances satisfactory to

11 the Secretary of Health and Human Services

12 that the skilled nursing facilities (as defined in

13 section 1819(a) of the Social Security Act (42

14 U.S.C. 1395i–3(a))) and nursing facilities (as

15 defined in section 1919(a) of such Act (42

16 U.S.C. 1396r(a))) within the State will reach or

17 exceed the minimum staff level described in

18 subsection (d)(2) within two years after the

19 date of the enactment of this Act and will main20 tain such level throughout the remainder of the

21 grant program.

22 (B) CONTINUING ELIGIBILITY.—A State

23 shall not be eligible for the continuation of

24 grant funding under a multi-year grant under

25 this section unless the State demonstrates to
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1 the satisfaction of the Secretary of Health and

2 Human Services that it continues to meet the

3 requirement described in subparagraph (A) and

4 has made sufficient progress in meeting the

5 goals described in its grant application.

6 (c) USE OF GRANT FUNDS.—Funds received by a

7 State under this section may be provided to entities in8 cluding nursing homes, labor management partnerships,

9 and educational institutions, and may be used for any or

10 all of the following purposes:

11 (1) To enable a nursing home to recruit addi12 tional nursing staff or to retain existing nursing

13 staff (including through the use of reasonable finan14 cial incentives or reasonable benefit enhancements).

15 (2) To increase education and training of nurs16 ing staff (including designing or implementing pro17 grams to promote the career advancement of cer18 tified nurse aides).

19 (3) To provide bonuses to nursing homes meet20 ing State quality standards or avoiding serious qual21 ity violations for a period of one or more years.

22 (4) Such other nursing home staffing and qual23 ity improvement initiatives as the Secretary of

24 Health and Human Services may approve.

25 (d) DISTRIBUTION OF FUNDS.—
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1 (1) IN GENERAL.—Subject to subsection (b), in

2 awarding grants under this section, the Secretary of

3 Health and Human Services shall award no more

4 than 25 percent of the funds to States in which, as

5 of the date of the enactment of this section, skilled

6 nursing facilities and nursing facilities have reached

7 or exceeded the minimum staff level specified in

8 paragraph (2) (as determined by the Secretary).

9 (2) MINIMUM NURSING HOME STAFF LEVEL.—

10 (A) IN GENERAL.—Subject to subpara11 graph (B), for purposes of subsection (b) and

12 paragraph (1), the level specified in this para13 graph for a skilled nursing facility or nursing

14 facility is a staff level sufficient to ensure that

15 each resident receives from a certified nurse

16 aide at least two hours per day of direct care

17 (including repositioning the resident and chang18 ing wet clothes, assisting with feeding, exercise,

19 and toileting, and working to enhance a resi20 dent’s independence with respect to activities of

21 daily living).

22 (B) SECRETARY’S AUTHORITY TO IN23 CREASE MINIMUM STAFF LEVEL.—The Sec24 retary of Health and Human Services may es25 tablish a minimum staff level that is higher
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1 than that specified in subparagraph (A). Any

2 such revised staff level shall be effective no ear3 lier than six months after the date on which

4 Secretary provides notice to States of the new

5 requirement.

6 (3) MULTI-YEAR GRANT FUNDS.—The Sec7 retary of Health and Human Services shall award

8 any multi-year grant under this section from

9 amounts appropriated (or available pursuant to sub10 section (e)(2)) for the first fiscal year of the grant.

11 (e) APPROPRIATIONS AND AVAILABILITY OF CIVIL

12 MONEY PENALTY (CMP) COLLECTIONS.—

13 (1) APPROPRIATIONS.—There are appropriated

14 to the Secretary of Health and Human Services, out

15 of any money in the Treasury not otherwise appro16 priated, for all costs for carrying out the program

17 under this section $200,000,000 for each of fiscal

18 years 2001 through 2005, such funds to remain

19 available to the Secretary through the end of the

20 first succeeding fiscal year.

21 (2) AVAILABILITY OF CMP COLLECTIONS.—In

22 addition to the amounts appropriated pursuant to

23 paragraph (1), there shall be available to the Sec24 retary of Health and Human Services for such costs

25 for such fiscal years any amounts deposited in the
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1 Nursing Facility Civil Money Penalties Collection

2 Account established under section 4.

3 SEC. 3. ENHANCED NURSING FACILITY REPORTING RE4 QUIREMENTS.

5 (a) MEDICARE.—

6 (1) SUBMISSION OF NURSING STAFF LEVEL

7 DATA TO THE SECRETARY.—Section 1819(b) of the

8 Social Security Act (42 U.S.C. 1395i–3(b)), as

9 amended by section 941(a) of the Medicare, Med10 icaid, and SCHIP Benefits Improvement and Pro11 tection Act of 2000 (as enacted into law by section

12 1(a)(6) of Public Law 106–554), is amended by add13 ing at the end the following new paragraph:

14 ‘‘(9) DATA ON STAFFING LEVELS.—

15 ‘‘(A) SUBMISSION TO SECRETARY.—A

16 skilled nursing facility shall submit to the Sec17 retary, in such form and manner and at such

18 intervals as the Secretary may require, data

19 with respect to nursing staff of the facility.

20 Such data shall include the total number of

21 nursing staff hours furnished during the period

22 specified by the Secretary (including totals for

23 each shift worked during such period) by the

24 facility to residents for which payment is made

25 under section 1888(e), broken down by total
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1 certified nurse aide hours, total licensed prac2 tical or vocational nurse hours, and total reg3 istered nurse hours, and shall also include the

4 average wage rate for each class of nursing

5 staff employed by the facility.

6 ‘‘(B) PUBLICATION.—The Secretary shall

7 provide for the publication on the Internet site

8 of the Department of Health and Human Serv9 ices known as Nursing Home Compare the fa10 cility-specific nursing staff information collected

11 pursuant to subparagraph (A). The Secretary

12 shall update such information periodically.’’.

13 (2) POSTING OF INFORMATION ON NURSING FA14 CILITY STAFFING.—Section 1819(b)(8)(A) of the So15 cial Security Act (42 U.S.C. 1395i–3(b)(8)(A)), as

16 added by such section 941(a), is amended by strik17 ing ‘‘for each shift’’ and inserting ‘‘for each nursing

18 unit of the facility and for each shift’’.

19 (3) INFORMATION CONCERNING PATIENT CLAS20 SIFICATION.—Section 1819(b)(4)(C) of the Social

21 Security Act (42 U.S.C. 1395i–3(b)(4)(C)) is

22 amended by adding at the end the following new

23 clause:

24 ‘‘(iii) INFORMATION CONCERNING

25 RESIDENTS.—The skilled nursing facility
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1 shall provide the Secretary, in such form

2 and manner and at such intervals as the

3 Secretary may require, a classification of

4 all residents of the skilled nursing facility

5 that accords with the patient classification

6 system described in section

7 1888(e)(4)(G)(i), or such successor system

8 as the Secretary may identify.’’.

9 (b) MEDICAID.—

10 (1) IN GENERAL.—Section 1919(b) of the So11 cial Security Act (42 U.S.C. 1396r(b)), as amended

12 by section 941(b) of the Medicare, Medicaid, and

13 SCHIP Benefits Improvement and Protection Act of

14 2000 (as enacted into law by section 1(a)(6) of Pub15 lic Law 106–554), is amended by adding at the end

16 the following new paragraph:

17 ‘‘(9) DATA ON STAFFING LEVELS.—

18 ‘‘(A) SUBMISSION TO SECRETARY.—A

19 nursing facility shall submit to the Secretary, in

20 such form and manner and at such intervals as

21 the Secretary may require, data with respect to

22 nursing staff of the facility. Such data shall in23 clude the total number of nursing staff hours

24 furnished during the period specified by the

25 Secretary (including totals for each shift
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1 worked during such period) by the facility to

2 residents for which payment is made under this

3 title, broken down by total certified nurse aide

4 hours, total licensed practical or vocational

5 nurse hours, and total registered nurse hours,

6 and shall also include the average wage rate for

7 each class of nursing staff employed by the fa8 cility.

9 ‘‘(B) PUBLICATION.—The Secretary shall

10 provide for the publication on the Internet Site

11 of the Department of Health and Human Serv12 ices known as Nursing Home Compare the fa13 cility-specific nursing staff information collected

14 pursuant to subparagraph (A). The Secretary

15 shall update such information periodically.’’.

16 (2) POSTING OF INFORMATION ON NURSING FA17 CILITY STAFFING.—Section 1919(b)(8)(A) of the So18 cial Security Act (42 U.S.C. 1396r(b)(8)(A)), as

19 added by such section 941(b), is amended by strik20 ing ‘‘for each shift’’ and inserting ‘‘for each nursing

21 unit of the facility and for each shift’’.

22 (3) INFORMATION CONCERNING PATIENT CLAS23 SIFICATION.—Section 1919(b)(4)(C) of the Social

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

25 by adding at the end the following new clause:
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1 ‘‘(iv) INFORMATION CONCERNING

2 RESIDENTS.—The nursing facility shall

3 provide the Secretary, in such form and

4 manner and at such intervals as the Sec5 retary may require, a classification of all

6 residents of the nursing facility that ac7 cords with the patient classification system

8 described in section 1888(e)(4)(G)(i), or

9 such successor system as the Secretary

10 may identify.’’.

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

12 this section shall take effect on the date that is one year

13 after the date of the enactment of this Act.

14 SEC. 4. NURSING FACILITY CIVIL MONEY PENALTY COL15 LECTIONS.

16 (a) ESTABLISHMENT OF NURSING FACILITY CIVIL

17 MONEY PENALTY COLLECTIONS ACCOUNT.—Section

18 1128A of the Social Security Act (42 U.S.C. 1320a–7a)

19 is amended by adding at the end the following new sub20 section:

21 ‘‘(o) ESTABLISHMENT OF NURSING FACILITY CIVIL

22 MONEY PENALTY COLLECTIONS ACCOUNT.—There is

23 hereby established an account to be known as the ‘Nursing

24 Facility Civil Money Penalties Collection Account’ (here25 after in this subsection referred to as the ‘Account’). Not-
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1 withstanding any other provision of law, there shall be de2 posited into the Account the Secretary’s share of any civil

3 monetary penalties collected under sections 1819 and

4 1919, all such amounts to be available without fiscal year

5 limitation for repaying the Secretary’s share of amounts

6 owed to skilled nursing facilities or nursing facilities pur7 suant to the final sentence of sections 1819(h)(2)(B)(ii)

8 and 1919(h)(2)(B)(ii), and for awarding grants under sec9 tion 2 of the Nursing Home Staffing and Quality Improve10 ment Act of 2000.’’.

11 (b) AUTHORITY TO COLLECT CMPS IMME12 DIATELY.—

13 (1) MEDICARE.—Section 1819(h)(2)(B)(ii) of

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

15 3(h)(2)(B)(ii)) is amended by inserting before the

16 final period ‘‘, except that, notwithstanding section

17 1128A(c)(2) or any other provision of law, the Sec18 retary, upon determining that a civil money penalty

19 should be imposed against a skilled nursing facility

20 pursuant to this paragraph, shall take immediate ac21 tion to collect such penalty (except where the Sec22 retary finds that such action could jeopardize the

23 health or welfare of residents of the skilled nursing

24 facility). In collecting such penalty, the Secretary

25 may deduct the amount of the penalty from amounts
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1 otherwise payable to the facility under this title or

2 take such other actions as the Secretary considers

3 appropriate. If the Secretary’s imposition of a pen4 alty under this paragraph is set aside, in whole or

5 in part, as a result of a hearing under section

6 1128A(c)(2) (or an appeal therefrom) or by a court

7 of competent jurisdiction, and the Secretary elects

8 not to pursue an appeal of such judgment; or has

9 exhausted all appeals, the Secretary shall repay any

10 amount owed to the skilled nursing facility with ac11 crued interest’’.

12 (2) MEDICAID.—Section 1919(h)(3)(B)(ii) of

13 the Social Security Act (42 U.S.C.

14 1396r(h)(3)(B)(ii)) is amended by inserting before

15 the final period ‘‘, except that, notwithstanding sec16 tion 1128A(c)(2) or any other provision of law, the

17 Secretary, upon determining that a civil money pen18 alty should be imposed against a nursing facility

19 pursuant to this paragraph, shall take immediate ac20 tion to collect the penalty (except where the Sec21 retary finds that such action could jeopardize the

22 health or welfare of residents of the nursing facility).

23 In collecting such penalty, the Secretary may direct

24 the State to deduct the amount of the penalty from

25 amounts otherwise payable to the nursing facility
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1 under this title or take such other actions as the

2 Secretary, in consultation with the State, considers

3 appropriate. If the Secretary’s imposition of a pen4 alty under this paragraph is set aside, in whole or

5 in part, as a result of a hearing under section

6 1128A(c)(2) (or an appeal therefrom) or by a court

7 of competent jurisdiction, and the Secretary elects

8 not to pursue an appeal of such judgment, or has

9 exhausted all appeals, the Secretary shall repay, or

10 shall direct the State to repay, any amount owed to

11 the nursing facility with accrued interest’’.

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