I 

108TH CONGRESS 

2D SESSION H. R. 4967

To amend titles XVIII and XIX of the Social Security Act to require automatic fire sprinkler systems in all nursing facilities participating in 

the Medicare or Medicaid Programs. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 22, 2004

Mr. LARSON of Connecticut 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 require automatic fire sprinkler systems in all nursing 

facilities participating in the Medicare or Medicaid Programs.

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; FINDINGS. 

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

5 ‘‘Nursing Home Fire Safety Act of 2004’’. 

6 (b) FINDINGS.—Congress finds the following: 
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1 (1) On February 26, 2003, a fire at a Hart2 ford, Connecticut, nursing facility without an auto3 matic fire sprinkler system claimed the lives of 16 

4 patients. 

5 (2) On September 27, 2003, a fire at a Nash6 ville, Tennessee, nursing facility without an auto7 matic fire sprinkler system claimed the lives of 15 

8 patients. 

9 (3) The National Fire Protection Association 

10 finds no record of a multiple death fire in a nursing 

11 facility equipped with an automatic fire sprinkler 

12 system. 

13 (4) An estimated 1.5 million of the nation’s el14 derly population reside in nursing facilities. 

15 (5) The Centers for Medicare and Medicaid 

16 Services estimates that of the approximate 17,000 

17 nursing facilities nationwide, about 25 percent do 

18 not have an automatic fire sprinkler system. 

19 (6) Many State governments lack requirements 

20 for their nursing facilities that were not originally 

21 equipped with automatic fire sprinkler systems to be 

22 retrofitted with such systems. 

23 (7) Automatic fire sprinkler systems greatly im24 prove the chances of survival for older adults in the 

25 event of a fire. 
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1 SEC. 2. REQUIRING AUTOMATIC FIRE SPRINKLER SYSTEMS 

2 IN MEDICARE AND MEDICAID FUNDED NURS3 ING FACILITIES. 

4 (a) REQUIREMENT FOR MEDICARE SKILLED NURS5 ING FACILITIES.—

6 (1) IN GENERAL.—Section 1819(d)(2) of the 

7 Social Security Act (42 U.S.C. 1395i–3(d)(2)) is 

8 amended—

9 (A) in subparagraph (B), by inserting ‘‘, 

10 subject to subparagraph (C)’’ after ‘‘except 

11 that’’; and 

12 (B) by adding at the end the following new 

13 subparagraph: 

14 ‘‘(C) AUTOMATIC FIRE SPRINKLER SYS15 TEM.—

16 ‘‘(i) IN GENERAL.—A skilled nursing 

17 facility shall be equipped with an oper18 ational automatic fire sprinkler system 

19 that meets the requirements for such a 

20 system under the National Fire Protection 

21 Association’s Standard for the Installation 

22 of Sprinkler Systems (1999 edition), or, at 

23 the option of a facility, such later edition 

24 of standard as the Secretary may recog25 nize. 
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1 ‘‘(ii) PERIOD FOR COMPLIANCE AND

2 DISCLOSURE OF COMPLIANCE FOR CUR3 RENT FACILITIES.—In the case of a skilled 

4 nursing facility that is providing extended 

5 care services for which payment is made 

6 under this title as of the date of the enact7 ment of this subparagraph and that was 

8 not in compliance with the requirement of 

9 clause (i) as of such date—

10 ‘‘(I) the requirement of clause (i) 

11 shall not apply until such date, not 

12 earlier than 3 years and not later 

13 than 5 years after the date of the en14 actment of this subparagraph, as the 

15 Secretary shall specify; and 

16 ‘‘(II) the facility shall provide for 

17 public disclosure, in a form and man18 ner specified by the Secretary, of 

19 whether the facility is in compliance 

20 with the standard described in clause 

21 (i). 

22 ‘‘(iii) TREATMENT OF EARLIER STATE

23 DEADLINE.—Nothing in clause (ii)(I) shall 

24 be construed to prevent a State from es25 tablishing a deadline for the installation of 
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1 automatic fire sprinkler systems for skilled 

2 nursing facilities that is earlier than the 

3 deadline specified by the Secretary under 

4 such clause.’’. 

5 (2) REIMBURSEMENT OF ADDITIONAL COSTS.—

6 Section 1888(e) of such Act (42 U.S.C. 1395yy(e)) 

7 is amended—

8 (A) in paragraph (1) by striking ‘‘and 

9 (12)’’ and inserting ‘‘(12), and (13)’’; and 

10 (B) by adding at the end the following new 

11 paragraph: 

12 ‘‘(13) ADDITIONAL AMOUNT TO AMORTIZE FOR

13 COSTS OF INSTALLING AUTOMATIC FIRE SPRINKLER

14 SYSTEM.—

15 ‘‘(A) IN GENERAL.—In the case of a 

16 skilled nursing facility that, as of a date that is 

17 on or after September 11, 2003, is participating 

18 in the program under this title, is not partici19 pating in the program under title XIX, and 

20 does not have installed an automatic fire sprin21 kler system that met the requirements de22 scribed in section 1819(d)(2)(C), and which 

23 subsequently incurs expenses in order to meet 

24 such requirements, in addition to any other 

25 payments made to the facility under this sub-
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1 section, there shall be paid, in an amortized 

2 manner over a five year period, an amount 

3 equal to the reasonable amount incurred by the 

4 facility in meeting such requirements, less the 

5 amount of any payment made before October 1, 

6 2004, under this title or title XIX that is di7 rectly attributable (such as through deprecia8 tion) to such expenses. Such payments shall be 

9 made by the Secretary in such form and man10 ner as the Secretary shall specify and based 

11 upon the presentation of such information as 

12 the Secretary requires. 

13 ‘‘(B) NO EFFECT ON OTHER PAYMENTS.—

14 The additional payment under subparagraph 

15 (A) shall not affect the amount of any other 

16 payment made under this subsection and the in17 curred expenses described in subparagraph (A) 

18 shall not be taken into account in making any 

19 other payments to a facility under this title.’’. 

20 (b) REQUIREMENT FOR MEDICAID NURSING FACILI21 TIES.—

22 (1) IN GENERAL.—Section 1919(d)(2) of the 

23 Social Security Act (42 U.S.C. 1396r(d)(2)) is 

24 amended—
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1 (A) in subparagraph (B), by inserting ‘‘, 

2 subject to subparagraph (C)’’ after ‘‘except 

3 that’’; and 

4 (B) by adding at the end the following new 

5 subparagraph: 

6 ‘‘(C) AUTOMATIC FIRE SPRINKLER SYS7 TEM.—

8 ‘‘(i) IN GENERAL.—A nursing facility 

9 shall be equipped with an operational auto10 matic fire sprinkler system that meets the 

11 requirements for such a system under the 

12 National Fire Protection Association’s 

13 Standard for the Installation of Sprinkler 

14 Systems (1999 edition), or, at the option 

15 of a facility, such later edition of standard 

16 as the Secretary may recognize. 

17 ‘‘(ii) PERIOD FOR COMPLIANCE AND

18 DISCLOSURE OF COMPLIANCE FOR CUR19 RENT FACILITIES.—In the case of a nurs20 ing facility that is providing nursing facil21 ity services for which payment is made 

22 under this title as of the date of the enact23 ment of this subparagraph and that was 

24 not in compliance with the requirement of 

25 clause (i) as of such date—
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1 ‘‘(I) the requirement of clause (i) 

2 shall not apply until such date, not 

3 earlier than 3 years and not later 

4 than 5 years after the date of the en5 actment of this subparagraph, as the 

6 Secretary shall specify; and 

7 ‘‘(II) the facility shall provide for 

8 public disclosure, in a form and man9 ner specified by the Secretary, of 

10 whether the facility is in compliance 

11 with the standard described in clause 

12 (i). 

13 ‘‘(iii) TREATMENT OF EARLIER STATE

14 DEADLINE.—Nothing in clause (ii)(I) shall 

15 be construed to prevent a State from es16 tablishing a deadline for the installation of 

17 automatic fire sprinkler systems for nurs18 ing facilities that is earlier than the dead19 line specified by the Secretary under such 

20 clause.’’. 

21 (2) REIMBURSEMENT OF ADDITIONAL COSTS.—

22 Section 1902(a)(13)(A) of such Act (42 U.S.C. 

23 1396a(a)(13)(A)) is amended—

24 (A) by striking ‘‘and’’ at the end of clause 

25 (iii); 
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1 (B) by striking ‘‘; and’’ at the end of 

2 clause (iv) and inserting ‘‘, and’’; and 

3 (C) by adding at the end the following new 

4 clause: 

5 ‘‘(v) in the case of nursing facility 

6 services furnished by a nursing facility 

7 that, as of a date that is on or after Sep8 tember 11, 2003, is participating in the 

9 program under this title but does not have 

10 installed an automatic fire sprinkler sys11 tem that met the requirements described in 

12 section 1919(d)(2)(C), and that subse13 quently incurs expenses in order to meet 

14 such requirements, such rates shall provide 

15 for the payment, in an amortized manner 

16 over a five year period and in addition to 

17 the payment amounts otherwise provided, 

18 of an amount equal to the reasonable 

19 amount incurred by the facility in meeting 

20 such requirements, less the payment 

21 amounts under this title or title XVIII 

22 made before October 1, 2004, that are di23 rectly attributable (such as through depre24 ciation) to such expenses, and the payment 

25 rates otherwise provided shall not take into 
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1 account such costs incurred in meeting 

2 such requirements; and’’. 

3 (3) FULL FEDERAL PAYMENT.—

4 (A) IN GENERAL.—The third sentence of 

5 section 1905 of such Act (42 U.S.C. 1396d) is 

6 amended by inserting before the period at the 

7 end the following: ‘‘and with respect to amounts 

8 expended as medical assistance in providing the 

9 payment amounts required under section 

10 1902(a)(13)(A)(v)’’. 

11 (B) CONFORMING AMENDMENT TO APPLY

12 TO TERRITORIES.—Section 1108 of such Act 

13 (42 U.S.C. 1308) is amended—

14 (i) in subsection (f), by striking ‘‘sub15 section (g)’’ and inserting ‘‘subsections (g) 

16 and (h)’’; and 

17 (ii) by adding at the end the following 

18 new subsection: 

19 ‘‘(h) EXCEPTION FOR PAYMENT FOR AUTOMATIC

20 FIRE SPRINKLER SYSTEMS.—The limitations on pay21 ments under subsection (f) shall not apply to payments 

22 that are attributable to payments for medical assistance 

23 for expenditures made under section 1902(a)(13)(A)(v).’’. 

24 (c) REDUCTION IN TAX BASIS.—Section 1016(a) of 

25 the Internal Revenue Code of 1986 is amended by striking 
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1 ‘‘and’’ at the end of paragraph (27), by striking the period 

2 at the end of paragraph (28) and inserting ‘‘, and’’, and 

3 by adding at the end the following new paragraph: 

4 ‘‘(29) in the case of property with respect to 

5 which any payment is made under section 

6 1888(e)(13) or 1902(a)(13)(A)(v) of the Social Se7 curity Act, by reducing the basis of such property by 

8 the amount of such payment.’’. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 this section shall take effect on the date of the enactment 

11 of this Act, except that the amendments made by sub12 sections (a)(2) and (b)(2) shall apply to payments to facili13 ties for periods beginning on or after October 1, 2004, 

14 regardless of whether the payments are for expenses in15 curred before, on, or after such date.

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