I 
108TH CONGRESS 
2D SESSION 
H. R. 4967
To amend titles XVIII and XIX of the Social Security Act to require auto-
matic 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 with-
in 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 Pro-
grams.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Nursing Home Fire Safety Act of 2004’’. 
(b) FINDINGS.—Congress finds the following:
(1) On February 26, 2003, a fire at a Hart-
ford, Connecticut, nursing facility without an auto-
matic fire sprinkler system claimed the lives of 16 
patients. 
(2) On September 27, 2003, a fire at a Nash-
ville, Tennessee, nursing facility without an auto-
matic fire sprinkler system claimed the lives of 15 
patients. 
(3) The National Fire Protection Association 
finds no record of a multiple death fire in a nursing 
facility equipped with an automatic fire sprinkler 
system. 
(4) An estimated 1.5 million of the nation’s el-
derly population reside in nursing facilities. 
(5) The Centers for Medicare and Medicaid 
Services estimates that of the approximate 17,000 
nursing facilities nationwide, about 25 percent do 
not have an automatic fire sprinkler system. 
(6) Many State governments lack requirements 
for their nursing facilities that were not originally 
equipped with automatic fire sprinkler systems to be 
retrofitted with such systems. 
(7) Automatic fire sprinkler systems greatly im-
prove the chances of survival for older adults in the 
event of a fire.
SEC. 2. REQUIRING AUTOMATIC FIRE SPRINKLER SYSTEMS 
IN MEDICARE AND MEDICAID FUNDED NURS-
ING FACILITIES. 
(a) REQUIREMENT FOR MEDICARE SKILLED NURS-
ING FACILITIES.—
(1) IN GENERAL.—Section 1819(d)(2) of the 
Social Security Act (42 U.S.C. 1395i–3(d)(2)) is 
amended—
(A) in subparagraph (B), by inserting ‘‘, 
subject to subparagraph (C)’’ after ‘‘except 
that’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(C) AUTOMATIC
FIRE
SPRINKLER
SYS-
TEM.—
‘‘(i) IN GENERAL.—A skilled nursing 
facility shall be equipped with an oper-
ational automatic fire sprinkler system 
that meets the requirements for such a 
system under the National Fire Protection 
Association’s Standard for the Installation 
of Sprinkler Systems (1999 edition), or, at 
the option of a facility, such later edition 
of standard as the Secretary may recog-
nize.
‘‘(ii) PERIOD FOR COMPLIANCE AND 
DISCLOSURE
OF
COMPLIANCE
FOR
CUR-
RENT FACILITIES.—In the case of a skilled 
nursing facility that is providing extended 
care services for which payment is made 
under this title as of the date of the enact-
ment of this subparagraph and that was 
not in compliance with the requirement of 
clause (i) as of such date—
‘‘(I) the requirement of clause (i) 
shall not apply until such date, not 
earlier than 3 years and not later 
than 5 years after the date of the en-
actment of this subparagraph, as the 
Secretary shall specify; and 
‘‘(II) the facility shall provide for 
public disclosure, in a form and man-
ner specified by the Secretary, of 
whether the facility is in compliance 
with the standard described in clause 
(i). 
‘‘(iii) TREATMENT OF EARLIER STATE 
DEADLINE.—Nothing in clause (ii)(I) shall 
be construed to prevent a State from es-
tablishing a deadline for the installation of
automatic fire sprinkler systems for skilled 
nursing facilities that is earlier than the 
deadline specified by the Secretary under 
such clause.’’. 
(2) REIMBURSEMENT OF ADDITIONAL COSTS.—
Section 1888(e) of such Act (42 U.S.C. 1395yy(e)) 
is amended—
(A) in paragraph (1) by striking ‘‘and 
(12)’’ and inserting ‘‘(12), and (13)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(13) ADDITIONAL AMOUNT TO AMORTIZE FOR 
COSTS OF INSTALLING AUTOMATIC FIRE SPRINKLER 
SYSTEM.—
‘‘(A) IN
GENERAL.—In the case of a 
skilled nursing facility that, as of a date that is 
on or after September 11, 2003, is participating 
in the program under this title, is not partici-
pating in the program under title XIX, and 
does not have installed an automatic fire sprin-
kler system that met the requirements de-
scribed in section 1819(d)(2)(C), and which 
subsequently incurs expenses in order to meet 
such requirements, in addition to any other 
payments made to the facility under this sub-
section, there shall be paid, in an amortized 
manner over a five year period, an amount 
equal to the reasonable amount incurred by the 
facility in meeting such requirements, less the 
amount of any payment made before October 1, 
2004, under this title or title XIX that is di-
rectly attributable (such as through deprecia-
tion) to such expenses. Such payments shall be 
made by the Secretary in such form and man-
ner as the Secretary shall specify and based 
upon the presentation of such information as 
the Secretary requires. 
‘‘(B) NO EFFECT ON OTHER PAYMENTS.—
The additional payment under subparagraph 
(A) shall not affect the amount of any other 
payment made under this subsection and the in-
curred expenses described in subparagraph (A) 
shall not be taken into account in making any 
other payments to a facility under this title.’’. 
(b) REQUIREMENT FOR MEDICAID NURSING FACILI-
TIES.—
(1) IN GENERAL.—Section 1919(d)(2) of the 
Social Security Act (42 U.S.C. 1396r(d)(2)) is 
amended—