I 

112TH CONGRESS 

1ST SESSION H. R. 2522 

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

oversight of nursing facilities under the Medicare and Medicaid programs 

by preventing inappropriate influence over surveyors, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 13, 2011 

Ms. ROYBAL-ALLARD 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 oversight of nursing facilities under the Medicare and Medicaid programs by preventing inappropriate 

influence over surveyors, 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 Patient 

5 Protection and Standards Act of 2011’’. 


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1 SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SUR2 VEYORS. 

3 (a) MEDICARE.—Section 1819(g)(2)(E)(iii) of the 

4 Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)(iii)) is 

5 amended by adding the following at the end: ‘‘The testing 

6 program must be sufficiently rigorous (as determined by 

7 the Secretary) to ensure that surveyors are adequately 

8 prepared to survey and certify facilities in a consistent and 

9 accurate manner.’’ 

10 (b) MEDICAID.—Section 1919(g)(2)(E)(iii) of the So11 cial Security Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is 

12 amended by adding the following at the end: ‘‘The testing 

13 program must be sufficiently rigorous (as determined by 

14 the Secretary) to ensure that surveyors are adequately 

15 prepared to survey and certify facilities in a consistent and 

16 accurate manner.’’ 

17 SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING 

18 FOR STATE SURVEYS OF NURSING HOMES. 

19 (a) MEDICARE.—Section 1819(g)(2)(E) of the Social 

20 Security Act (42 U.S.C. 1395i–3(g)(2)(E)) is amended by 

21 adding at the end the following: 

22 ‘‘(iv) ADEQUATE QUALIFIED STAFF

23 FOR SURVEY TEAMS.—The Secretary, in 

24 consultation with the advisory committee 

25 under subparagraph (F), shall establish re26 quirements for the qualifications and comVerDate Mar 15 2010 04:16 Jul 14, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2522.IH H2522

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1 pensation of members of a survey team 

2 under this subsection and require that a 

3 State employs an adequate number of indi4 viduals as members of survey teams to en5 sure adequate oversight of skilled nursing 

6 facilities. 

7 ‘‘(v) CONTINUING EDUCATION.—In 

8 addition to the training and testing pro9 gram required under clause (iii), the Sec10 retary shall require that State and Federal 

11 surveyors regularly complete an adequate 

12 amount (as determined by the Secretary) 

13 of continuing education courses that meet 

14 requirements determined by the Secretary 

15 for content and the rigor of the material 

16 covered by such courses. An individual 

17 shall not serve as a member of a survey 

18 team unless the individual is in compliance 

19 with the requirements of this clause.’’. 

20 (b) MEDICAID.—Section 1919(g)(2)(E) of the Social 

21 Security Act (42 U.S.C. 1396r(g)(2)(E)) is amended by 

22 adding at the end the following: 

23 ‘‘(iv) ADEQUATE QUALIFED STAFF

24 FOR SURVEY TEAMS.—The Secretary, in 

25 consultation with the advisory committee 


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1 under subparagraph (F), shall establish re2 quirements for the qualifications and com3 pensation of members of a survey team 

4 under this subsection and require that a 

5 State employs an adequate number of indi6 viduals as members of survey teams to en7 sure adequate oversight of skilled nursing 

8 facilities. 

9 ‘‘(v) CONTINUING EDUCATION.—In 

10 addition to the training and testing pro11 gram required under clause (iii), the Sec12 retary shall require that State and Federal 

13 surveyors regularly complete an adequate 

14 amount (as determined by the Secretary) 

15 of continuing education courses that meet 

16 requirements determined by the Secretary 

17 for content and the rigor of the material 

18 covered by such courses. No individual 

19 shall serve as a member of a survey team 

20 unless the individual is in compliance with 

21 the requirements of this clause.’’. 

22 SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY 

23 OF SURVEYORS. 

24 (a) IN GENERAL.— 


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1 (1) MEDICARE.—Section 1819(g) of the Social 

2 Security Act (42 U.S.C. 1395i–3(g)) is amended by 

3 adding the following at the end: 

4 ‘‘(6) REPORTING OF INACCURACIES.— 

5 ‘‘(A) COVERED INDIVIDUAL DEFINED.— 

6 For purposes of this paragraph, the term ‘cov7 ered individual’ means an individual— 

8 ‘‘(i) who is a member of a State sur9 vey team under this subsection; or 

10 ‘‘(ii) who is an employee of the State 

11 department or agency that conducts sur12 veys under this section. 

13 ‘‘(B) REPORTING REQUIREMENT.—A cov14 ered individual shall report to the Secretary any 

15 instance in which the individual suspects that— 

16 ‘‘(i) a survey under this subsection 

17 fails to report or under reports an issue in 

18 a facility that could impact the safety or 

19 quality of care of the residents in such fa20 cility; or 

21 ‘‘(ii) a member of the survey team or 

22 an employee of the State survey agency 

23 was inappropriately influenced (through 

24 the offering of monetary awards or 


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1 through undue pressure) to alter the re2 sults of the survey. 

3 ‘‘(C) RESPONSE TO REPORT.—If the Sec4 retary receives a report under subparagraph 

5 (B), the Secretary shall take appropriate action, 

6 as determined by the Secretary, to ensure the 

7 accuracy of the survey. 

8 ‘‘(D) PENALTIES FOR INAPPROPRIATELY

9 INFLUENCING A SURVEYOR.—Subject to sub10 paragraph (H), any individual (including an 

11 employee of a skilled nursing facility or any af12 filiated corporate entity, a representative of the 

13 skilled nursing facility industry, a member of a 

14 State survey team, an employee of the State de15 partment or agency that conducts surveys 

16 under this section, or an elected official) who 

17 attempts to inappropriately influence (as de18 fined by the Secretary through regulations) the 

19 results of a survey under this subsection, or the 

20 actions of a member of a survey team or an em21 ployee of a survey agency, shall be subject to a 

22 civil money penalty not to exceed $10,000. The 

23 provisions of section 1128A (other than sub24 sections (a) and (b)) shall apply to a civil 

25 money penalty under the previous sentence in 


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1 the same manner as such provisions apply to a 

2 penalty or proceeding under section 1128A(a). 

3 ‘‘(E) WHISTLEBLOWER PROTECTIONS.— 

4 With respect to a covered individual, any officer 

5 or employee of the State may not— 

6 ‘‘(i) discharge, demote, suspend, 

7 threaten, harass, or deny a promotion or 

8 other employment-related benefit to such 

9 individual, or in any other manner dis10 criminate against an individual in the 

11 terms and conditions of employment be12 cause the individual submitted a report 

13 under subparagraph (B); or 

14 ‘‘(ii) file a complaint or a report 

15 against the individual with the appropriate 

16 State professional disciplinary agency be17 cause the individual submitted a report 

18 under subparagraph (B). 

19 ‘‘(F) PENALTIES FOR VIOLATING WHIS20 TLEBLOWER PROTECTIONS.—Subject to sub21 paragraph (H), any officer or employee of a 

22 State who engages in an activity that is prohib23 ited by subparagraph (E) shall be subject to a 

24 civil money penalty not to exceed $50,000. The 

25 provisions of section 1128A (other than subVerDate Mar 15 2010 04:16 Jul 14, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2522.IH H2522

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1 sections (a) and (b)) shall apply to a civil 

2 money penalty under the previous sentence in 

3 the same manner as such provisions apply to a 

4 penalty or proceeding under section 1128A(a). 

5 ‘‘(G) REQUIREMENT TO POST NOTICE.— 

6 Each State shall post conspicuously in an ap7 propriate location a sign (in a form specified by 

8 the Secretary) specifying the rights of covered 

9 individuals under this section. Such sign shall 

10 include— 

11 ‘‘(i) a statement that a covered indi12 vidual may file a complaint with the Sec13 retary describing any violations of the pro14 visions of this paragraph by an employee 

15 or officer of a State; and 

16 ‘‘(ii) information concerning the form 

17 and manner in which such a complaint 

18 should be filed. 

19 ‘‘(H) CONSTRUCTION RELATED TO LEGIS20 LATIVE OVERSIGHT.—For purposes of this 

21 paragraph, to the extent that a member of a 

22 State legislature requests that a covered indi23 vidual appear at a hearing of a committee of 

24 such legislature or asks questions of such indi25 vidual during such a hearing, the actions of 


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1 such member shall not be construed in a man2 ner that would subject such member to a pen3 alty under this paragraph.’’. 

4 (2) MEDICAID.—Section 1919(g) of the Social 

5 Security Act (42 U.S.C. 1396r(g)) is amended by 

6 adding the following at the end: 

7 ‘‘(6) REPORTING OF INACCURACIES.— 

8 ‘‘(A) COVERED INDIVIDUAL DEFINED.— 

9 For purposes of this paragraph, the term ‘cov10 ered individual’ means an individual— 

11 ‘‘(i) who is a member of a State sur12 vey team under this subsection; or 

13 ‘‘(ii) who is an employee of the State 

14 department or agency that conducts sur15 veys under this section. 

16 ‘‘(B) REPORTING REQUIREMENT.—A cov17 ered individual shall report to the Secretary any 

18 instance in which the individual suspects that— 

19 ‘‘(i) a survey under this subsection 

20 fails to report or under reports an issue in 

21 a facility that could impact the safety or 

22 quality of care of the residents in such fa23 cility; or 

24 ‘‘(ii) a member of the survey team or 

25 an employee of the State survey agency 


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1 was inappropriately influenced (through 

2 the offering of monetary awards or 

3 through undue pressure) to alter the re4 sults of the survey. 

5 ‘‘(C) RESPONSE TO REPORT.—If the Sec6 retary receives a report under subparagraph 

7 (B), the Secretary shall take appropriate action, 

8 as determined by the Secretary, to ensure the 

9 accuracy of the survey. 

10 ‘‘(D) PENALTIES FOR INAPPROPRIATELY

11 INFLUENCING A SURVEYOR.—Subject to sub12 paragraph (H), any individual (including an 

13 employee of a skilled nursing facility or any af14 filiated corporate entity, a representative of the 

15 skilled nursing facility industry, a member of a 

16 State survey team, an employee of the State de17 partment or agency that conducts surveys 

18 under this section, or an elected official) who 

19 attempts to inappropriately influence (as de20 fined by the Secretary through regulations) the 

21 results of a survey under this subsection, or the 

22 actions of a member of a survey team or an em23 ployee of a survey agency, shall be subject to a 

24 civil money penalty not to exceed $10,000. The 

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1 sections (a) and (b)) shall apply to a civil 

2 money penalty under the previous sentence in 

3 the same manner as such provisions apply to a 

4 penalty or proceeding under section 1128A(a). 

5 ‘‘(E) WHISTLEBLOWER PROTECTIONS.— 

6 With respect to a covered individual, any officer 

7 or employee of the State may not— 

8 ‘‘(i) discharge, demote, suspend, 

9 threaten, harass, or deny a promotion or 

10 other employment-related benefit to such 

11 individual, or in any other manner dis12 criminate against an individual in the 

13 terms and conditions of employment be14 cause the individual submitted a report 

15 under subparagraph (B); or 

16 ‘‘(ii) file a complaint or a report 

17 against the individual with the appropriate 

18 State professional disciplinary agency be19 cause the individual submitted a report 

20 under subparagraph (B). 

21 ‘‘(F) PENALTIES FOR VIOLATING WHIS22 TLEBLOWER PROTECTIONS.—Subject to sub23 paragraph (H), any officer or employee of a 

24 State who engages in an activity that is prohib25 ited by subparagraph (E) shall be subject to a 


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1 civil money penalty not to exceed $50,000. The 

2 provisions of section 1128A (other than sub3 sections (a) and (b)) shall apply to a civil 

4 money penalty under the previous sentence in 

5 the same manner as such provisions apply to a 

6 penalty or proceeding under section 1128A(a). 

7 ‘‘(G) REQUIREMENT TO POST NOTICE.— 

8 Each State shall post conspicuously in an ap9 propriate location a sign (in a form specified by 

10 the Secretary) specifying the rights of covered 

11 individuals under this section. Such sign shall 

12 include— 

13 ‘‘(i) a statement that a covered indi14 vidual may file a complaint with the Sec15 retary describing any violations of the pro16 visions of this paragraph by an employee 

17 or officer of a State; and 

18 ‘‘(ii) information concerning the form 

19 and manner in which such a complaint 

20 should be filed. 

21 ‘‘(H) CONSTRUCTION RELATED TO LEGIS22 LATIVE OVERSIGHT.—For purposes of this 

23 paragraph, to the extent that a member of a 

24 State legislature requests that a covered indi25 vidual appear at a hearing of a committee of 


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1 such legislature or asks questions of such indi2 vidual during such a hearing, the actions of 

3 such member shall not be construed in a man4 ner that would subject such member to a pen5 alty under this paragraph.’’. 

6 (b) CONFORMING AMENDMENTS.— 

7 (1) Section 1819(f)(2)(B)(iii)(I)(c) of the Social 

8 Security Act is amended by inserting ‘‘, a civil mone9 tary penalty described in section 1919(g)(6)(D) of 

10 not less than $10,000’’ after ‘‘of not less than 

11 $5,000’’. 

12 (2) Section 1919(f)(2)(B)(iii)(I)(c) of the Social 

13 Security Act is amended by inserting ‘‘, a civil mone14 tary penalty described in (g)(6)(D) of not less than 

15 $10,000’’ after ‘‘of not less than $5,000’’. 

16 SEC. 5. ADVISORY COMMITTEE. 

17 (a) MEDICARE.—Section 1819(g)(2) of the Social Se18 curity Act (42 U.S.C. 1395i–3(g)(2)) is amended by add19 ing at the end the following: 

20 ‘‘(F) ADVISORY COMMITTEE.— 

21 ‘‘(i) ESTABLISHMENT.—The Secretary 

22 shall establish an advisory committee on 

23 surveys under this paragraph. 

24 ‘‘(ii) MEMBERSHIP.—The membership 

25 of the advisory committee under clause (i) 


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1 shall include advocates for residents of 

2 skilled nursing facilities, members of sur3 vey teams under this subsection, and nurs4 ing home administrators. 

5 ‘‘(iii) RECOMMENDED STANDARDS.— 

6 The advisory committee under clause (i) 

7 shall make recommendations to the Sec8 retary on standards for— 

9 ‘‘(I) the adequate staffing of sur10 vey teams under this subsection; 

11 ‘‘(II) the training of members of 

12 such teams; and 

13 ‘‘(III) disclosing any contact be14 tween such members and individuals 

15 associated with skilled nursing facili16 ties, and limiting such contact to pre17 vent inappropriate influence of such 

18 members by such individuals. 

19 ‘‘(iv) OTHER RECOMMENDATIONS.— 

20 The advisory committee under clause (i) 

21 may also make recommendations to the 

22 Secretary on any other issue that would 

23 improve the survey process under this 

24 paragraph.’’. 


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1 (b) MEDICAID.—Section 1919(g)(2) of the Social Se2 curity Act (42 U.S.C. 1396r(g)(2)) is amended by adding 

3 at the end the following: 

4 ‘‘(F) ADVISORY COMMITTEE.— 

5 ‘‘(i) ESTABLISHMENT.—The Secretary 

6 shall establish an advisory committee on 

7 surveys under this paragraph. 

8 ‘‘(ii) MEMBERSHIP.—The membership 

9 of the advisory committee under clause (i) 

10 shall include advocates for residents of 

11 nursing facilities, members of survey teams 

12 under this subsection, and nursing home 

13 administrators. 

14 ‘‘(iii) RECOMMENDED STANDARDS.— 

15 The advisory committee under clause (i) 

16 shall make recommendations to the Sec17 retary on standards for— 

18 ‘‘(I) the adequate staffing of sur19 vey teams under this subsection; 

20 ‘‘(II) the training of members of 

21 such teams; and 

22 ‘‘(III) disclosing any contact be23 tween such members and individuals 

24 associated with nursing facilities, and 

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1 propriate influence of such members 

2 by such individuals. 

3 ‘‘(iv) OTHER RECOMMENDATIONS.— 

4 The advisory committee under clause (i) 

5 may also make recommendations to the 

6 Secretary on any other issue that would 

7 improve the survey process under this 

8 paragraph.’’. 

9 SEC. 6. REVIEW OF SURVEYS. 

10 (a) MEDICARE.—Section 1819(g)(2)(D) of the Social 

11 Security Act (42 U.S.C. 1395i–3(g)(2)(D)) is amended— 

12 (1) by striking ‘‘Each State’’ and inserting the 

13 following: 

14 ‘‘(i) IN GENERAL.—Each State’’; and 

15 (2) by adding at the end the following new 

16 clause: 

17 ‘‘(ii) REVIEW OF SURVEYS.—The su18 pervisor of the survey team shall review 

19 each survey conducted under this sub20 section to ensure that any issues that im21 pact quality of care that are identified by 

22 such surveys are consistently and appro23 priately described and rated by the survey 

24 team.’’. 


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1 (b) MEDICAID.—Section 1919(g)(2)(D) of the Social 

2 Security Act (42 U.S.C. 1396r(g)(2)(D)) is amended— 

3 (1) by striking ‘‘Each State’’ and inserting the 

4 following: 

5 ‘‘(i) IN GENERAL.—Each State’’; and 

6 (2) by adding at the end the following new 

7 clause: 

8 ‘‘(ii) REVIEW OF SURVEYS.—The su9 pervisor of the survey team shall review 

10 each survey conducted under this sub11 section to ensure that any issues that im12 pact quality of care that are identified by 

13 such surveys are consistently and appro14 priately described and rated by the survey 

15 team.’’. 

Æ 


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