I 

111TH CONGRESS 

1ST SESSION H. R. 2937 

To prevent health care facility-acquired infections. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2009 

Ms. SPEIER (for herself, Ms. SCHAKOWSKY, Mrs. CAPPS, and Ms. ESHOO) 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 prevent health care facility-acquired infections. 

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 ‘‘MRSA Infection Pre5 vention and Patient Protection Act’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 

8 (1) ACUTE CARE HOSPITAL.—The term ‘‘acute 

9 care hospital’’ means a hospital that maintains and 

10 operates an emergency room (including a trauma or 


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1 burn center), surgical unit, birthing facility, and 

2 such other unit that is highly susceptible to acquir3 ing or transmitting infections, as determined by the 

4 Secretary through regulations. 

5 (2) HOSPITAL.—The term ‘‘hospital’’ has the 

6 meaning given such term in section 1861(e) of the 

7 Social Security Act (42 U.S.C. 1395x(e)) and in8 cludes critical access hospitals (as defined in section 

9 1861(mm) of such Act) and other entities deter10 mined to be hospitals by the Secretary. 

11 (3) MRSA.—The term ‘‘MRSA’’ means 

12 Methicillin-resistant Staphylococcus aureus. 

13 (4) OTHER INFECTION.—The term ‘‘other in14 fection’’ means an infection that the Secretary, after 

15 consultation with the Director of the Centers for 

16 Disease Control and Prevention and other public 

17 health officials, as appropriate, and after public 

18 hearing, determines to be, or to have the potential 

19 to become, a serious source of morbidity and mor20 tality in health care facilities. 

21 (5) SECRETARY.—The term ‘‘Secretary’’ means 

22 the Secretary of Health and Human Services. 

23 SEC. 3. HOSPITAL INFECTION PREVENTION PROGRAMS. 

24 (a) REGULATIONS.— 


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1 (1) IN GENERAL.—Not later than 150 days 

2 after the date of enactment of this Act, the Sec3 retary, in consultation with the Director of the Cen4 ters for Disease Control and Prevention and such 

5 independent experts as the Secretary determines ap6 propriate, shall promulgate regulations that— 

7 (A) provide a list of best practices for pre8 venting MRSA infections and such other anti9 biotic resistant pathogens as the Secretary de10 termines appropriate; 

11 (B) define the term ‘‘high risk hospital de12 partments’’ for purposes of applying the best 

13 practices provided for under subparagraph (A), 

14 which may include surgical, burn, neonatal, and 

15 such other departments as the Secretary deter16 mines; 

17 (C) define the term ‘‘serious source of 

18 morbidity and mortality’’ in quantitative terms 

19 for purposes of determining the applicability of 

20 this Act to other infections, except that such 

21 definition shall not require morbidity and mor22 tality rates of more than 1 percent of the esti23 mated patient population at risk for a par24 ticular infection in order for an infection to 


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1 qualify as a serious source of morbidity and 

2 mortality; and 

3 (D) provide screening, recordkeeping, and 

4 other requirements as they relate to reductions 

5 in MRSA infections. 

6 (2) CONSISTENCY.—The regulations promul7 gated under this subsection shall be consistent with 

8 the requirements of this Act. 

9 (3) EFFECTIVE DATE.—The regulations pro10 mulgated under paragraph (1) shall take effect on 

11 the date that is 30 days after the date on which 

12 such regulations are published in the Federal Reg13 ister, but in no case later than 180 days after the 

14 date of enactment of this Act. 

15 (b) SCREENING REQUIREMENTS.— 

16 (1) IN GENERAL.—Not later than 180 days 

17 after the date of enactment of this Act, each acute 

18 care hospital shall screen each patient entering an 

19 intensive care unit or other high risk hospital de20 partment (as defined in the regulations promulgated 

21 under subsection (a)(1)(B)). 

22 (2) EXTENSION OF REQUIREMENTS.— 

23 (A) IN GENERAL.—The Secretary, in con24 sultation with the Director of the Centers for 

25 Disease Control and Prevention, shall establish 


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1 a process and a timetable for extending the 

2 screening requirements of paragraph (1) to all 

3 patients admitted to all hospitals. 

4 (B) REQUIREMENTS FULLY APPLIED.— 

5 The timetable established under subparagraph 

6 (A), shall require that all patients be covered by 

7 the screening requirements under paragraph (1) 

8 by not later than January 1, 2014. 

9 (C) WAIVER.—The Secretary may waive 

10 the requirements of this paragraph if the Sec11 retary determines, at the recommendation of 

12 the Director of the Centers for Disease Control 

13 and Prevention and after public hearing, that 

14 the rate of MRSA infections or other infections 

15 has declined to a level at which further screen16 ing is no longer needed. 

17 (3) MEDICARE.— 

18 (A) REQUIREMENT.— 

19 (i) IN GENERAL.—Section 1866(a)(1) 

20 of the Social Security Act (42 U.S.C. 

21 1395cc(a)(1)) is amended— 

22 (I) by striking ‘‘and’’ at the end 

23 of subparagraph (U); 


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1 (II) by striking the period at the 

2 end of subparagraph (V) and insert3 ing ‘‘, and’’; and 

4 (III) by inserting after subpara5 graph (V) the following: 

6 ‘‘(W) in the case of an acute care hospital (as 

7 defined in section 2(1) of the MRSA Infection Pre8 vention and Patient Protection Act), to comply with 

9 the screening requirements described in section 3 of 

10 such Act.’’. 

11 (ii) EFFECTIVE DATE.—The amend12 ments made by clause (i) shall apply to 

13 agreements entered into or renewed on or 

14 after the date that is 180 days after the 

15 enactment of this Act. 

16 (B) MEDICARE PAYMENT ADJUSTMENTS.— 

17 Not later than January 1, 2011, the Secretary 

18 shall submit to the appropriate committees of 

19 Congress, a report on whether payment adjust20 ments should be made under title XVIII of the 

21 Social Security Act (42 U.S.C. 1395 et seq.) to 

22 assist certain hospitals in defraying the cost of 

23 screening for, and the subsequent treatment of, 

24 MRSA infections (or other infections). In pre25 paring such report, the Secretary shall give speVerDate Nov 24 2008 06:13 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2937.IH H2937

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1 cial consideration to the needs of rural, critical 

2 access, sole community, and Medicare depend3 ent hospitals, and disproportionate share hos4 pitals and other hospitals with a dispropor5 tionate share of immune compromised patients. 

6 (c) BEST PRACTICES.—In addition to any other best 

7 practices contained in the regulations promulgated under 

8 subsection (a)(1)(A), each hospital shall comply with the 

9 following: 

10 (1) A hospital shall require contact (barrier) 

11 precautions, as determined by the Secretary, be 

12 taken when treating patients who test positive for 

13 MRSA colonization (as defined by the Centers for 

14 Disease Control and Prevention). 

15 (2) Where possible, a hospital shall isolate, with 

16 the same staffing ratio per bed as in the non-iso17 lated beds of the hospital, or cohort patients colo18 nized or infected with MRSA, or notify patients in 

19 which the infected patient may room with that such 

20 patient has tested positive for MRSA, control and 

21 monitor the movements of such patients within the 

22 hospital, and take whatever steps are needed to stop 

23 the transmission of MRSA bacteria to patients who 

24 did not come into the hospital infected or colonized 

25 with such bacteria. The Secretary may suspend the 


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1 application of this paragraph in the case of an emer2 gency. 

3 (3) All patients who test positive for MRSA 

4 shall be informed of the results. All MRSA test re5 sults shall be noted in the patient’s medical record. 

6 (4) Each hospital shall, by January 1, 2010, 

7 adopt a policy requiring any patient who has a 

8 MRSA infection to receive oral and written instruc9 tions regarding aftercare and precautions to prevent 

10 the spread of the infection to others. 

11 (5) Patients being discharged from intensive 

12 care units shall be tested again for MRSA, and 

13 those patients testing positive shall be informed of 

14 their status, and that status shall be noted in the 

15 patient’s medical records in case of readmittance to 

16 a hospital. 

17 (6) A hospital shall educate its staff concerning 

18 modes of transmission of MRSA, use of protective 

19 equipment, disinfection policies and procedures, and 

20 other preventive measures. 

21 (7) A hospital shall provide other interventions, 

22 as the Secretary determines to be necessary, for con23 trol of MRSA infection. 

24 (d) REPORTING.— 


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1 (1) IN GENERAL.—Not later than January 1, 

2 2011, each hospital shall, using the National 

3 Healthcare Safety Network of the Centers for Dis4 ease Control and Prevention, report hospital-ac5 quired MRSA and other infections that occur in the 

6 hospital facility. The Secretary shall develop a proc7 ess for the risk adjustment of such reports by hos8 pitals. 

9 (2) PUBLICATION.—The Secretary shall develop 

10 a system for the publication of hospital-specific in11 fection rates, including the rate of MRSA infections. 

12 (e) NON-HOSPITAL MEDICARE PROVIDERS.— 

13 (1) MRSA INFECTION REPORTING.—The Sec14 retary, using the MRSA infection and other infection 

15 information identified under subsection (b) and such 

16 other billing and coding information as necessary, 

17 shall promulgate regulations to— 

18 (A) define the term ‘‘infected transferred 

19 patient’’, to describe a patient who, after dis20 charge from, or treatment at, a non-hospital 

21 Medicare provider, is admitted to the hospital 

22 with MRSA infection (or other infection); 

23 (B) establish a system for identifying in24 fected transferred patients; 


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1 (C) establish a system to promptly inform 

2 any facility that has transferred an infected pa3 tient; and 

4 (D) establish requirements that any non5 hospital Medicare provider that treats an in6 fected transferred patient described under sub7 paragraph (A) and that cannot provide a rea8 sonable explanation that the infection was not 

9 acquired in the facility, submit to the Secretary 

10 an action plan describing how such provider 

11 plans to reduce the incidence of such infections. 

12 (2) ASSISTANCE.—The Secretary shall promul13 gate regulations to develop a program to provide 

14 technical assistance and educational materials to 

15 non-hospital Medicare providers described in para16 graph (1)(A) in order to assist in preventing subse17 quent MRSA infections. 

18 (3) PUBLICATION OF CERTAIN INFORMATION.— 

19 If a non-hospital Medicare provider identified using 

20 the system established under paragraph (1) fails to 

21 take steps, as required by the regulations promul22 gated under subparagraph (1)(D), to combat MRSA 

23 infections, the Secretary shall publish the name of 

24 the provider and the number of MRSA infections 

25 from such provider in the previous year. 


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1 (f) ASSISTANCE.— 

2 (1) IN GENERAL.—To provide for the rapid im3 plementation of MRSA screening programs and ini4 tiatives through the installation of certified MRSA 

5 screening equipment and the provision of necessary 

6 support services, a hospital may submit an applica7 tion to the Secretary for a 1-year increase in the 

8 amount of the capital-related costs payment made to 

9 the hospital under the prospective payment system 

10 under section 1886(g) of the Social Security Act (42 

11 U.S.C. 1395ww(g)). The Secretary shall approve all 

12 requests that the Secretary determines are reason13 able and necessary. 

14 (2) REPAYMENT.—A hospital that receives an 

15 increase under paragraph (1) shall, not later than 4 

16 years after the date of receipt of such increase, reim17 burse the Secretary for the costs of such increase. 

18 Such costs shall include the accrual of interest at 

19 the rate payable for Federal Treasury notes. Such 

20 reimbursement may be in the form of reduced cap21 ital-related costs payments to the hospital under the 

22 system described in paragraph (1) for the years fol23 lowing the year in which the increase was received. 

24 (3) CERTIFICATION SYSTEM.—Not later than 

25 180 days after the date of enactment of this Act, the 


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1 Secretary shall promulgate regulations for the devel2 opment of a system to certify appropriate MRSA 

3 screening and support services for purposes of this 

4 subsection. 

5 SEC. 4. MRSA TESTING PILOT PROGRAM. 

6 (a) IN GENERAL.—The Director of the Centers for 

7 Disease Control and Prevention (referred to in this section 

8 as the ‘‘Director’’) shall award a grant to 1 collaborative 

9 project involving an eligible hospital and qualified testing 

10 corporation on a competitive basis to carry out a pilot pro11 gram designed to develop a rapid, cost-effective method 

12 for testing for MRSA using the polymerase chain reaction 

13 (referred to in this section as ‘‘PCR’’) or other molecular 

14 testing methods. 

15 (b) PURPOSE.—The pilot program described in sub16 section (a) shall be designed to— 

17 (1) develop a low-cost, nationally adoptable 

18 PCR-based analytical system for timely MRSA test19 ing and results; 

20 (2) develop the system described in paragraph 

21 (1) so that it is affordable to hospitals, thereby ena22 bling compliance with mandated MRSA testing re23 quirements; 

24 (3) develop a system for centralized reporting of 

25 results receiving through such testing to appropriate 


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1 governmental agencies for the purpose of disease re2 porting and surveillance; and 

3 (4) develop a technology platform that may be 

4 extended to other infections that the Director identi5 fies as priorities for detection, treatment, and sur6 veillance. 

7 (c) ELIGIBILITY.—The Secretary shall establish re8 quirements regarding eligibility to receive a grant under 

9 this section, which shall include the following require10 ments: 

11 (1) The collaborate project shall be between a 

12 nonprofit hospital organized for charitable purposes 

13 under section 501(c)(3) of the Internal Revenue 

14 Code of 1986 and a qualified testing corporation. 

15 (2) The hospital shall serve as the beta test site 

16 for any MRSA screening methods developed through 

17 the pilot program. 

Æ 


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