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shall publish in the Federal Register the final de-
cision with respect to such application. 
‘‘(H) LIMITATION ON REVIEW.—There shall 
be no administrative or judicial review under 
section 1869, section 1878, or otherwise of the 
process under this paragraph (including the es-
tablishment of such process). 
‘‘(4) COLLECTION OF OWNERSHIP AND INVEST-
MENT INFORMATION.—For purposes of subparagraphs 
(A)(i) and (D)(i) of paragraph (1), the Secretary 
shall collect physician ownership and investment in-
formation for each hospital. 
‘‘(5) PHYSICIAN
OWNER
OR
INVESTOR
DE-
FINED.—For purposes of this subsection, the term 
‘physician owner or investor’ means a physician (or 
an immediate family member of such physician) with 
a direct or an indirect ownership or investment inter-
est in the hospital. 
‘‘(6) CLARIFICATION.—Nothing in this subsection 
shall be construed as preventing the Secretary from 
revoking a hospital’s provider agreement if not in 
compliance with regulations implementing section 
1866.’’. 
(b) ENFORCEMENT.— 
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(1) ENSURING COMPLIANCE.—The Secretary of 
Health and Human Services shall establish policies 
and procedures to ensure compliance with the require-
ments described in subsection (i)(1) of section 1877 of 
the Social Security Act, as added by subsection 
(a)(3), beginning on the date such requirements first 
apply. Such policies and procedures may include un-
announced site reviews of hospitals. 
(2) AUDITS.—Beginning not later than Novem-
ber 1, 2011, the Secretary of Health and Human 
Services shall conduct audits to determine if hospitals 
violate the requirements referred to in paragraph (1). 
SEC. 6002. TRANSPARENCY REPORTS AND REPORTING OF 
PHYSICIAN OWNERSHIP OR INVESTMENT IN-
TERESTS. 
Part A of title XI of the Social Security Act (42 U.S.C. 
1301 et seq.) is amended by inserting after section 1128F 
the following new section: 
‘‘SEC. 1128G. TRANSPARENCY REPORTS AND REPORTING OF 
PHYSICIAN OWNERSHIP OR INVESTMENT IN-
TERESTS. 
‘‘(a) TRANSPARENCY REPORTS.— 
‘‘(1) PAYMENTS
OR
OTHER
TRANSFERS
OF 
VALUE.— 
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‘‘(A) IN
GENERAL.—On March 31, 2013, 
and on the 90th day of each calendar year begin-
ning thereafter, any applicable manufacturer 
that provides a payment or other transfer of 
value to a covered recipient (or to an entity or 
individual at the request of or designated on be-
half of a covered recipient), shall submit to the 
Secretary, in such electronic form as the Sec-
retary shall require, the following information 
with respect to the preceding calendar year: 
‘‘(i) The name of the covered recipient. 
‘‘(ii) The business address of the cov-
ered recipient and, in the case of a covered 
recipient who is a physician, the specialty 
and National Provider Identifier of the cov-
ered recipient. 
‘‘(iii) The amount of the payment or 
other transfer of value. 
‘‘(iv) The dates on which the payment 
or other transfer of value was provided to 
the covered recipient. 
‘‘(v) A description of the form of the 
payment or other transfer of value, indi-
cated (as appropriate for all that apply) 
as— 
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‘‘(I) cash or a cash equivalent; 
‘‘(II) in-kind items or services; 
‘‘(III) stock, a stock option, or 
any other ownership interest, dividend, 
profit, or other return on investment; 
or 
‘‘(IV) any other form of payment 
or other transfer of value (as defined 
by the Secretary). 
‘‘(vi) A description of the nature of the 
payment or other transfer of value, indi-
cated (as appropriate for all that apply) 
as— 
‘‘(I) consulting fees; 
‘‘(II) compensation for services 
other than consulting; 
‘‘(III) honoraria; 
‘‘(IV) gift; 
‘‘(V) entertainment; 
‘‘(VI) food; 
‘‘(VII) travel (including the speci-
fied destinations); 
‘‘(VIII) education; 
‘‘(IX) research; 
‘‘(X) charitable contribution; 
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‘‘(XI) royalty or license; 
‘‘(XII) 
current 
or 
prospective 
ownership or investment interest; 
‘‘(XIII) direct compensation for 
serving as faculty or as a speaker for 
a medical education program; 
‘‘(XIV) grant; or 
‘‘(XV) any other nature of the 
payment or other transfer of value (as 
defined by the Secretary). 
‘‘(vii) If the payment or other transfer 
of value is related to marketing, education, 
or research specific to a covered drug, de-
vice, biological, or medical supply, the name 
of that covered drug, device, biological, or 
medical supply. 
‘‘(viii) Any other categories of informa-
tion regarding the payment or other trans-
fer of value the Secretary determines appro-
priate. 
‘‘(B) SPECIAL
RULE
FOR
CERTAIN
PAY-
MENTS OR OTHER TRANSFERS OF VALUE.—In 
the case where an applicable manufacturer pro-
vides a payment or other transfer of value to an 
entity or individual at the request of or des-
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ignated on behalf of a covered recipient, the ap-
plicable manufacturer shall disclose that pay-
ment or other transfer of value under the name 
of the covered recipient. 
‘‘(2) PHYSICIAN OWNERSHIP.—In addition to the 
requirement under paragraph (1)(A), on March 31, 
2013, and on the 90th day of each calendar year be-
ginning thereafter, any applicable manufacturer or 
applicable group purchasing organization shall sub-
mit to the Secretary, in such electronic form as the 
Secretary shall require, the following information re-
garding any ownership or investment interest (other 
than an ownership or investment interest in a pub-
licly traded security and mutual fund, as described in 
section 1877(c)) held by a physician (or an imme-
diate family member of such physician (as defined for 
purposes of section 1877(a))) in the applicable manu-
facturer or applicable group purchasing organization 
during the preceding year: 
‘‘(A) The dollar amount invested by each 
physician holding such an ownership or invest-
ment interest. 
‘‘(B) The value and terms of each such own-
ership or investment interest. 
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‘‘(C) Any payment or other transfer of 
value provided to a physician holding such an 
ownership or investment interest (or to an entity 
or individual at the request of or designated on 
behalf of a physician holding such an ownership 
or investment interest), including the informa-
tion described in clauses (i) through (viii) of 
paragraph (1)(A), except that in applying such 
clauses, ‘physician’ shall be substituted for ‘cov-
ered recipient’ each place it appears. 
‘‘(D) Any other information regarding the 
ownership or investment interest the Secretary 
determines appropriate. 
‘‘(b) PENALTIES FOR NONCOMPLIANCE.— 
‘‘(1) FAILURE TO REPORT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) except as provided in paragraph (2), 
any applicable manufacturer or applicable group 
purchasing organization that fails to submit in-
formation required under subsection (a) in a 
timely manner in accordance with rules or regu-
lations promulgated to carry out such subsection, 
shall be subject to a civil money penalty of not 
less than $1,000, but not more than $10,000, for 
each payment or other transfer of value or own-
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ership or investment interest not reported as re-
quired under such subsection. Such penalty shall 
be imposed and collected in the same manner as 
civil money penalties under subsection (a) of sec-
tion 1128A are imposed and collected under that 
section. 
‘‘(B) LIMITATION.—The total amount of 
civil money penalties imposed under subpara-
graph (A) with respect to each annual submis-
sion of information under subsection (a) by an 
applicable manufacturer or applicable group 
purchasing 
organization 
shall 
not 
exceed 
$150,000. 
‘‘(2) KNOWING FAILURE TO REPORT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), any applicable manufacturer or ap-
plicable group purchasing organization that 
knowingly fails to submit information required 
under subsection (a) in a timely manner in ac-
cordance with rules or regulations promulgated 
to carry out such subsection, shall be subject to 
a civil money penalty of not less than $10,000, 
but not more than $100,000, for each payment or 
other transfer of value or ownership or invest-
ment interest not reported as required under 
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such subsection. Such penalty shall be imposed 
and collected in the same manner as civil money 
penalties under subsection (a) of section 1128A 
are imposed and collected under that section. 
‘‘(B) LIMITATION.—The total amount of 
civil money penalties imposed under subpara-
graph (A) with respect to each annual submis-
sion of information under subsection (a) by an 
applicable manufacturer or applicable group 
purchasing 
organization 
shall 
not 
exceed 
$1,000,000. 
‘‘(3) USE
OF
FUNDS.—Funds collected by the 
Secretary as a result of the imposition of a civil 
money penalty under this subsection shall be used to 
carry out this section. 
‘‘(c) PROCEDURES FOR SUBMISSION OF INFORMATION 
AND PUBLIC AVAILABILITY.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ESTABLISHMENT.—Not later than Oc-
tober 1, 2011, the Secretary shall establish proce-
dures— 
‘‘(i) for applicable manufacturers and 
applicable group purchasing organizations 
to submit information to the Secretary 
under subsection (a); and 
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‘‘(ii) for the Secretary to make such in-
formation submitted available to the public. 
‘‘(B) DEFINITION
OF
TERMS.—The proce-
dures established under subparagraph (A) shall 
provide for the definition of terms (other than 
those terms defined in subsection (e)), as appro-
priate, for purposes of this section. 
‘‘(C) PUBLIC
AVAILABILITY.—Except as 
provided in subparagraph (E), the procedures es-
tablished under subparagraph (A)(ii) shall en-
sure that, not later than September 30, 2013, 
and on June 30 of each calendar year beginning 
thereafter, the information submitted under sub-
section (a) with respect to the preceding calendar 
year is made available through an Internet 
website that— 
‘‘(i) is searchable and is in a format 
that is clear and understandable; 
‘‘(ii) contains information that is pre-
sented by the name of the applicable manu-
facturer or applicable group purchasing or-
ganization, the name of the covered recipi-
ent, the business address of the covered re-
cipient, the specialty of the covered recipi-
ent, the value of the payment or other trans-
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fer of value, the date on which the payment 
or other transfer of value was provided to 
the covered recipient, the form of the pay-
ment or other transfer of value, indicated 
(as 
appropriate) 
under 
subsection 
(a)(1)(A)(v), the nature of the payment or 
other transfer of value, indicated (as appro-
priate) under subsection (a)(1)(A)(vi), and 
the name of the covered drug, device, bio-
logical, or medical supply, as applicable; 
‘‘(iii) contains information that is able 
to be easily aggregated and downloaded; 
‘‘(iv) contains a description of any en-
forcement actions taken to carry out this 
section, including any penalties imposed 
under subsection (b), during the preceding 
year; 
‘‘(v) contains background information 
on industry-physician relationships; 
‘‘(vi) in the case of information sub-
mitted with respect to a payment or other 
transfer of value described in subparagraph 
(E)(i), lists such information separately 
from the other information submitted under 
subsection (a) and designates such sepa-
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rately listed information as funding for 
clinical research; 
‘‘(vii) contains any other information 
the Secretary determines would be helpful to 
the average consumer; 
‘‘(viii) does not contain the National 
Provider Identifier of the covered recipient, 
and 
‘‘(ix) subject to subparagraph (D), pro-
vides the applicable manufacturer, applica-
ble group purchasing organization, or cov-
ered recipient an opportunity to review and 
submit corrections to the information sub-
mitted with respect to the applicable manu-
facturer, applicable group purchasing orga-
nization, or covered recipient, respectively, 
for a period of not less than 45 days prior 
to such information being made available to 
the public. 
‘‘(D) CLARIFICATION OF TIME PERIOD FOR 
REVIEW AND CORRECTIONS.—In no case may the 
45-day period for review and submission of cor-
rections to information under subparagraph 
(C)(ix) prevent such information from being 
made available to the public in accordance with 
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the dates described in the matter preceding 
clause (i) in subparagraph (C). 
‘‘(E) DELAYED
PUBLICATION
FOR
PAY-
MENTS MADE PURSUANT TO PRODUCT RESEARCH 
OR DEVELOPMENT AGREEMENTS AND CLINICAL 
INVESTIGATIONS.— 
‘‘(i) IN GENERAL.—In the case of in-
formation submitted under subsection (a) 
with respect to a payment or other transfer 
of value made to a covered recipient by an 
applicable manufacturer pursuant to a 
product research or development agreement 
for services furnished in connection with re-
search on a potential new medical tech-
nology or a new application of an existing 
medical technology or the development of a 
new drug, device, biological, or medical sup-
ply, or by an applicable manufacturer in 
connection with a clinical investigation re-
garding a new drug, device, biological, or 
medical supply, the procedures established 
under subparagraph (A)(ii) shall provide 
that such information is made available to 
the public on the first date described in the 
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matter preceding clause (i) in subparagraph 
(C) after the earlier of the following: 
‘‘(I) The date of the approval or 
clearance of the covered drug, device, 
biological, or medical supply by the 
Food and Drug Administration. 
‘‘(II) Four calendar years after 
the date such payment or other trans-
fer of value was made. 
‘‘(ii) CONFIDENTIALITY
OF
INFORMA-
TION PRIOR TO PUBLICATION.—Information 
described in clause (i) shall be considered 
confidential and shall not be subject to dis-
closure under section 552 of title 5, United 
States Code, or any other similar Federal, 
State, or local law, until on or after the 
date on which the information is made 
available to the public under such clause. 
‘‘(2) CONSULTATION.—In establishing the proce-
dures under paragraph (1), the Secretary shall con-
sult with the Inspector General of the Department of 
Health and Human Services, affected industry, con-
sumers, consumer advocates, and other interested par-
ties in order to ensure that the information made 
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available to the public under such paragraph is pre-
sented in the appropriate overall context. 
‘‘(d) ANNUAL REPORTS
AND RELATION
TO STATE 
LAWS.— 
‘‘(1) ANNUAL REPORT TO CONGRESS.—Not later 
than April 1 of each year beginning with 2013, the 
Secretary shall submit to Congress a report that in-
cludes the following: 
‘‘(A) The information submitted under sub-
section (a) during the preceding year, aggregated 
for each applicable manufacturer and applicable 
group purchasing organization that submitted 
such information during such year (except, in 
the case of information submitted with respect to 
a payment or other transfer of value described in 
subsection (c)(1)(E)(i), such information shall be 
included in the first report submitted to Congress 
after the date on which such information is made 
available to the public under such subsection). 
‘‘(B) A description of any enforcement ac-
tions taken to carry out this section, including 
any penalties imposed under subsection (b), dur-
ing the preceding year. 
‘‘(2) ANNUAL REPORTS TO STATES.—Not later 
than September 30, 2013 and on June 30 of each cal-
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endar year thereafter, the Secretary shall submit to 
States a report that includes a summary of the infor-
mation submitted under subsection (a) during the 
preceding year with respect to covered recipients in 
the State (except, in the case of information submitted 
with respect to a payment or other transfer of value 
described in subsection (c)(1)(E)(i), such information 
shall be included in the first report submitted to 
States after the date on which such information is 
made available to the public under such subsection). 
‘‘(3) RELATION TO STATE LAWS.— 
‘‘(A) IN GENERAL.—In the case of a pay-
ment or other transfer of value provided by an 
applicable manufacturer that is received by a 
covered recipient (as defined in subsection (e)) 
on or after January 1, 2012, subject to subpara-
graph (B), the provisions of this section shall 
preempt any statute or regulation of a State or 
of a political subdivision of a State that requires 
an applicable manufacturer (as so defined) to 
disclose or report, in any format, the type of in-
formation (as described in subsection (a)) re-
garding such payment or other transfer of value. 
‘‘(B) NO PREEMPTION OF ADDITIONAL RE-
QUIREMENTS.—Subparagraph (A) shall not pre-
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empt any statute or regulation of a State or of 
a political subdivision of a State that requires 
the disclosure or reporting of information— 
‘‘(i) not of the type required to be dis-
closed or reported under this section; 
‘‘(ii) described in subsection (e)(10)(B), 
except in the case of information described 
in clause (i) of such subsection; 
‘‘(iii) by any person or entity other 
than an applicable manufacturer (as so de-
fined) or a covered recipient (as defined in 
subsection (e)); or 
‘‘(iv) to a Federal, State, or local gov-
ernmental agency for public health surveil-
lance, investigation, or other public health 
purposes or health oversight purposes. 
‘‘(C) Nothing in subparagraph (A) shall be 
construed to limit the discovery or admissibility 
of information described in such subparagraph 
in a criminal, civil, or administrative pro-
ceeding. 
‘‘(4) CONSULTATION.—The Secretary shall con-
sult with the Inspector General of the Department of 
Health and Human Services on the implementation 
of this section. 
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‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) APPLICABLE GROUP PURCHASING ORGANI-
ZATION.—The term ‘applicable group purchasing or-
ganization’ means a group purchasing organization 
(as defined by the Secretary) that purchases, arranges 
for, or negotiates the purchase of a covered drug, de-
vice, biological, or medical supply which is operating 
in the United States, or in a territory, possession, or 
commonwealth of the United States. 
‘‘(2) APPLICABLE
MANUFACTURER.—The term 
‘applicable manufacturer’ means a manufacturer of a 
covered drug, device, biological, or medical supply 
which is operating in the United States, or in a terri-
tory, possession, or commonwealth of the United 
States. 
‘‘(3) CLINICAL INVESTIGATION.—The term ‘clin-
ical investigation’ means any experiment involving 1 
or more human subjects, or materials derived from 
human subjects, in which a drug or device is admin-
istered, dispensed, or used. 
‘‘(4) COVERED DEVICE.—The term ‘covered de-
vice’ means any device for which payment is avail-
able under title XVIII or a State plan under title 
XIX or XXI (or a waiver of such a plan). 
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‘‘(5) COVERED DRUG, DEVICE, BIOLOGICAL, OR 
MEDICAL SUPPLY.—The term ‘covered drug, device, 
biological, or medical supply’ means any drug, bio-
logical product, device, or medical supply for which 
payment is available under title XVIII or a State 
plan under title XIX or XXI (or a waiver of such a 
plan). 
‘‘(6) COVERED RECIPIENT.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘covered recipient’ 
means the following: 
‘‘(i) A physician. 
‘‘(ii) A teaching hospital. 
‘‘(B) EXCLUSION.—Such term does not in-
clude a physician who is an employee of the ap-
plicable manufacturer that is required to submit 
information under subsection (a). 
‘‘(7) EMPLOYEE.—The term ‘employee’ has the 
meaning given such term in section 1877(h)(2). 
‘‘(8) KNOWINGLY.—The term ‘knowingly’ has the 
meaning given such term in section 3729(b) of title 
31, United States Code. 
‘‘(9) MANUFACTURER OF A COVERED DRUG, DE-
VICE, BIOLOGICAL, OR MEDICAL SUPPLY.—The term 
‘manufacturer of a covered drug, device, biological, or 
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medical supply’ means any entity which is engaged 
in 
the 
production, 
preparation, 
propagation, 
compounding, or conversion of a covered drug, device, 
biological, or medical supply (or any entity under 
common ownership with such entity which provides 
assistance or support to such entity with respect to 
the 
production, 
preparation, 
propagation, 
compounding, conversion, marketing, promotion, sale, 
or distribution of a covered drug, device, biological, or 
medical supply). 
‘‘(10) PAYMENT
OR
OTHER
TRANSFER
OF 
VALUE.— 
‘‘(A) IN GENERAL.—The term ‘payment or 
other transfer of value’ means a transfer of any-
thing of value. Such term does not include a 
transfer of anything of value that is made indi-
rectly to a covered recipient through a third 
party in connection with an activity or service 
in the case where the applicable manufacturer is 
unaware of the identity of the covered recipient. 
‘‘(B) EXCLUSIONS.—An applicable manu-
facturer shall not be required to submit informa-
tion under subsection (a) with respect to the fol-
lowing: 
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‘‘(i) A transfer of anything the value of 
which is less than $10, unless the aggregate 
amount transferred to, requested by, or des-
ignated on behalf of the covered recipient by 
the applicable manufacturer during the cal-
endar year exceeds $100. For calendar years 
after 2012, the dollar amounts specified in 
the preceding sentence shall be increased by 
the same percentage as the percentage in-
crease in the consumer price index for all 
urban consumers (all items; U.S. city aver-
age) for the 12-month period ending with 
June of the previous year. 
‘‘(ii) Product samples that are not in-
tended to be sold and are intended for pa-
tient use. 
‘‘(iii) Educational materials that di-
rectly benefit patients or are intended for 
patient use. 
‘‘(iv) The loan of a covered device for 
a short-term trial period, not to exceed 90 
days, to permit evaluation of the covered de-
vice by the covered recipient. 
‘‘(v) Items or services provided under a 
contractual warranty, including the re-
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placement of a covered device, where the 
terms of the warranty are set forth in the 
purchase or lease agreement for the covered 
device. 
‘‘(vi) A transfer of anything of value to 
a covered recipient when the covered recipi-
ent is a patient and not acting in the pro-
fessional capacity of a covered recipient. 
‘‘(vii) Discounts (including rebates). 
‘‘(viii) In-kind items used for the pro-
vision of charity care. 
‘‘(ix) A dividend or other profit dis-
tribution from, or ownership or investment 
interest in, a publicly traded security and 
mutual fund (as described in section 
1877(c)). 
‘‘(x) In the case of an applicable man-
ufacturer who offers a self-insured plan, 
payments for the provision of health care to 
employees under the plan. 
‘‘(xi) In the case of a covered recipient 
who is a licensed non-medical professional, 
a transfer of anything of value to the cov-
ered recipient if the transfer is payment 
solely for the non-medical professional serv-
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ices of such licensed non-medical profes-
sional. 
‘‘(xii) In the case of a covered recipient 
who is a physician, a transfer of anything 
of value to the covered recipient if the trans-
fer is payment solely for the services of the 
covered recipient with respect to a civil or 
criminal action or an administrative pro-
ceeding. 
‘‘(11) PHYSICIAN.—The term ‘physician’ has the 
meaning given that term in section 1861(r).’’. 
SEC. 6003. DISCLOSURE REQUIREMENTS FOR IN-OFFICE AN-
CILLARY SERVICES EXCEPTION TO THE PRO-
HIBITION 
ON 
PHYSICIAN 
SELF-REFERRAL 
FOR CERTAIN IMAGING SERVICES. 
(a) IN GENERAL.—Section 1877(b)(2) of the Social Se-
curity Act (42 U.S.C. 1395nn(b)(2)) is amended by adding 
at the end the following new sentence: ‘‘Such requirements 
shall, with respect to magnetic resonance imaging, com-
puted tomography, positron emission tomography, and any 
other designated health services specified under subsection 
(h)(6)(D) that the Secretary determines appropriate, in-
clude a requirement that the referring physician inform the 
individual in writing at the time of the referral that the 
individual may obtain the services for which the individual 
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is being referred from a person other than a person de-
scribed in subparagraph (A)(i) and provide such individual 
with a written list of suppliers (as defined in section 
1861(d)) who furnish such services in the area in which 
such individual resides.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to services furnished on or after January 
1, 2010. 
SEC. 6004. PRESCRIPTION DRUG SAMPLE TRANSPARENCY. 
Part A of title XI of the Social Security Act (42 U.S.C. 
1301 et seq.), as amended by section 6002, is amended by 
inserting after section 1128G the following new section: 
‘‘SEC. 1128H. REPORTING OF INFORMATION RELATING TO 
DRUG SAMPLES. 
‘‘(a) IN GENERAL.—Not later than April 1 of each 
year (beginning with 2012), each manufacturer and author-
ized distributor of record of an applicable drug shall submit 
to the Secretary (in a form and manner specified by the 
Secretary) the following information with respect to the pre-
ceding year: 
‘‘(1) In the case of a manufacturer or authorized 
distributor of record which makes distributions by 
mail or common carrier under subsection (d)(2) of 
section 503 of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 353), the identity and quantity of 
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drug samples requested and the identity and quantity 
of drug samples distributed under such subsection 
during that year, aggregated by— 
‘‘(A) the name, address, professional des-
ignation, and signature of the practitioner mak-
ing the request under subparagraph (A)(i) of 
such subsection, or of any individual who makes 
or signs for the request on behalf of the practi-
tioner; and 
‘‘(B) any other category of information de-
termined appropriate by the Secretary. 
‘‘(2) In the case of a manufacturer or authorized 
distributor of record which makes distributions by 
means other than mail or common carrier under sub-
section (d)(3) of such section 503, the identity and 
quantity of drug samples requested and the identity 
and quantity of drug samples distributed under such 
subsection during that year, aggregated by— 
‘‘(A) the name, address, professional des-
ignation, and signature of the practitioner mak-
ing the request under subparagraph (A)(i) of 
such subsection, or of any individual who makes 
or signs for the request on behalf of the practi-
tioner; and 
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‘‘(B) any other category of information de-
termined appropriate by the Secretary. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) APPLICABLE DRUG.—The term ‘applicable 
drug’ means a drug— 
‘‘(A) which is subject to subsection (b) of 
such section 503; and 
‘‘(B) for which payment is available under 
title XVIII or a State plan under title XIX or 
XXI (or a waiver of such a plan). 
‘‘(2) AUTHORIZED DISTRIBUTOR OF RECORD.— 
The term ‘authorized distributor of record’ has the 
meaning given that term in subsection (e)(3)(A) of 
such section. 
‘‘(3) MANUFACTURER.—The term ‘manufacturer’ 
has the meaning given that term for purposes of sub-
section (d) of such section.’’. 
SEC. 6005. PHARMACY BENEFIT MANAGERS TRANSPARENCY 
REQUIREMENTS. 
Part A of title XI of the Social Security Act (42 U.S.C. 
1301 et seq.) is amended by inserting after section 1150 
the following new section: 
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‘‘SEC. 
1150A. 
PHARMACY 
BENEFIT 
MANAGERS 
TRANS-
PARENCY REQUIREMENTS. 
‘‘(a) PROVISION OF INFORMATION.—A health benefits 
plan or any entity that provides pharmacy benefits man-
agement services on behalf of a health benefits plan (in this 
section referred to as a ‘PBM’) that manages prescription 
drug coverage under a contract with— 
‘‘(1) a PDP sponsor of a prescription drug plan 
or an MA organization offering an MA–PD plan 
under part D of title XVIII; or 
‘‘(2) a qualified health benefits plan offered 
through an exchange established by a State under sec-
tion 1311 of the Patient Protection and Affordable 
Care Act, 
shall provide the information described in subsection (b) to 
the Secretary and, in the case of a PBM, to the plan with 
which the PBM is under contract with, at such times, and 
in such form and manner, as the Secretary shall specify. 
‘‘(b) INFORMATION DESCRIBED.—The information de-
scribed in this subsection is the following with respect to 
services provided by a health benefits plan or PBM for a 
contract year: 
‘‘(1) The percentage of all prescriptions that were 
provided through retail pharmacies compared to mail 
order pharmacies, and the percentage of prescriptions 
for which a generic drug was available and dispensed 
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(generic dispensing rate), by pharmacy type (which 
includes an independent pharmacy, chain pharmacy, 
supermarket pharmacy, or mass merchandiser phar-
macy that is licensed as a pharmacy by the State and 
that dispenses medication to the general public), that 
is paid by the health benefits plan or PBM under the 
contract. 
‘‘(2) The aggregate amount, and the type of re-
bates, discounts, or price concessions (excluding bona 
fide service fees, which include but are not limited to 
distribution service fees, inventory management fees, 
product stocking allowances, and fees associated with 
administrative services agreements and patient care 
programs (such as medication compliance programs 
and patient education programs)) that the PBM ne-
gotiates that are attributable to patient utilization 
under the plan, and the aggregate amount of the re-
bates, discounts, or price concessions that are passed 
through to the plan sponsor, and the total number of 
prescriptions that were dispensed. 
‘‘(3) The aggregate amount of the difference be-
tween the amount the health benefits plan pays the 
PBM and the amount that the PBM pays retail phar-
macies, and mail order pharmacies, and the total 
number of prescriptions that were dispensed. 
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‘‘(c) CONFIDENTIALITY.—Information disclosed by a 
health benefits plan or PBM under this section is confiden-
tial and shall not be disclosed by the Secretary or by a plan 
receiving the information, except that the Secretary may 
disclose the information in a form which does not disclose 
the identity of a specific PBM, plan, or prices charged for 
drugs, for the following purposes: 
‘‘(1) As the Secretary determines to be necessary 
to carry out this section or part D of title XVIII. 
‘‘(2) To permit the Comptroller General to re-
view the information provided. 
‘‘(3) To permit the Director of the Congressional 
Budget Office to review the information provided. 
‘‘(4) To States to carry out section 1311 of the 
Patient Protection and Affordable Care Act. 
‘‘(d) 
PENALTIES.—The 
provisions 
of 
subsection 
(b)(3)(C) of section 1927 shall apply to a health benefits 
plan or PBM that fails to provide information required 
under subsection (a) on a timely basis or that knowingly 
provides false information in the same manner as such pro-
visions apply to a manufacturer with an agreement under 
that section.’’. 
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Subtitle B—Nursing Home 
Transparency and Improvement 
PART I—IMPROVING TRANSPARENCY OF 
INFORMATION 
SEC. 6101. REQUIRED DISCLOSURE OF OWNERSHIP AND AD-
DITIONAL DISCLOSABLE PARTIES INFORMA-
TION. 
(a) IN GENERAL.—Section 1124 of the Social Security 
Act (42 U.S.C. 1320a–3) is amended by adding at the end 
the following new subsection: 
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP AND AD-
DITIONAL DISCLOSABLE PARTIES INFORMATION.— 
‘‘(1) DISCLOSURE.—A facility shall have the in-
formation described in paragraph (2) available— 
‘‘(A) during the period beginning on the 
date of the enactment of this subsection and end-
ing on the date such information is made avail-
able to the public under section 6101(b) of the 
Patient Protection and Affordable Care Act for 
submission to the Secretary, the Inspector Gen-
eral of the Department of Health and Human 
Services, the State in which the facility is lo-
cated, and the State long-term care ombudsman 
in the case where the Secretary, the Inspector 
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General, the State, or the State long-term care 
ombudsman requests such information; and 
‘‘(B) beginning on the effective date of the 
final regulations promulgated under paragraph 
(3)(A), for reporting such information in accord-
ance with such final regulations. 
Nothing in subparagraph (A) shall be construed as 
authorizing a facility to dispose of or delete informa-
tion described in such subparagraph after the effective 
date of the final regulations promulgated under para-
graph (3)(A). 
‘‘(2) INFORMATION DESCRIBED.— 
‘‘(A) IN GENERAL.—The following informa-
tion is described in this paragraph: 
‘‘(i) The information described in sub-
sections (a) and (b), subject to subpara-
graph (C). 
‘‘(ii) The identity of and information 
on— 
‘‘(I) each member of the governing 
body of the facility, including the 
name, title, and period of service of 
each such member; 
‘‘(II) each person or entity who is 
an officer, director, member, partner, 
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trustee, or managing employee of the 
facility, including the name, title, and 
period of service of each such person or 
entity; and 
‘‘(III) each person or entity who 
is an additional disclosable party of 
the facility. 
‘‘(iii) The organizational structure of 
each additional disclosable party of the fa-
cility and a description of the relationship 
of each such additional disclosable party to 
the facility and to one another. 
‘‘(B) SPECIAL RULE WHERE INFORMATION 
IS ALREADY REPORTED OR SUBMITTED.—To the 
extent that information reported by a facility to 
the Internal Revenue Service on Form 990, in-
formation submitted by a facility to the Securi-
ties and Exchange Commission, or information 
otherwise submitted to the Secretary or any other 
Federal agency contains the information de-
scribed in clauses (i), (ii), or (iii) of subpara-
graph (A), the facility may provide such Form 
or such information submitted to meet the re-
quirements of paragraph (1). 
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‘‘(C) SPECIAL
RULE.—In applying sub-
paragraph (A)(i)— 
‘‘(i) with respect to subsections (a) and 
(b), ‘ownership or control interest’ shall in-
clude direct or indirect interests, including 
such interests in intermediate entities; and 
‘‘(ii) subsection (a)(3)(A)(ii) shall in-
clude the owner of a whole or part interest 
in any mortgage, deed of trust, note, or 
other obligation secured, in whole or in 
part, by the entity or any of the property 
or assets thereof, if the interest is equal to 
or exceeds 5 percent of the total property or 
assets of the entirety. 
‘‘(3) REPORTING.— 
‘‘(A) IN GENERAL.—Not later than the date 
that is 2 years after the date of the enactment of 
this subsection, the Secretary shall promulgate 
final regulations requiring, effective on the date 
that is 90 days after the date on which such 
final regulations are published in the Federal 
Register, a facility to report the information de-
scribed in paragraph (2) to the Secretary in a 
standardized format, and such other regulations 
as are necessary to carry out this subsection. 
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Such final regulations shall ensure that the facil-
ity certifies, as a condition of participation and 
payment under the program under title XVIII or 
XIX, that the information reported by the facil-
ity in accordance with such final regulations is, 
to the best of the facility’s knowledge, accurate 
and current. 
‘‘(B) GUIDANCE.—The Secretary shall pro-
vide guidance and technical assistance to States 
on how to adopt the standardized format under 
subparagraph (A). 
‘‘(4) NO EFFECT ON EXISTING REPORTING RE-
QUIREMENTS.—Nothing in this subsection shall re-
duce, diminish, or alter any reporting requirement 
for a facility that is in effect as of the date of the en-
actment of this subsection. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) ADDITIONAL
DISCLOSABLE
PARTY.— 
The term ‘additional disclosable party’ means, 
with respect to a facility, any person or entity 
who— 
‘‘(i) exercises operational, financial, or 
managerial control over the facility or a 
part thereof, or provides policies or proce-
dures for any of the operations of the facil-
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ity, or provides financial or cash manage-
ment services to the facility; 
‘‘(ii) leases or subleases real property 
to the facility, or owns a whole or part in-
terest equal to or exceeding 5 percent of the 
total value of such real property; or 
‘‘(iii) provides management or admin-
istrative services, management or clinical 
consulting services, or accounting or finan-
cial services to the facility. 
‘‘(B) FACILITY.—The term ‘facility’ means 
a disclosing entity which is— 
‘‘(i) a skilled nursing facility (as de-
fined in section 1819(a)); or 
‘‘(ii) a nursing facility (as defined in 
section 1919(a)). 
‘‘(C) 
MANAGING
EMPLOYEE.—The 
term 
‘managing employee’ means, with respect to a fa-
cility, an individual (including a general man-
ager, business manager, administrator, director, 
or consultant) who directly or indirectly man-
ages, advises, or supervises any element of the 
practices, finances, or operations of the facility. 
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‘‘(D) ORGANIZATIONAL
STRUCTURE.—The 
term ‘organizational structure’ means, in the 
case of— 
‘‘(i) a corporation, the officers, direc-
tors, and shareholders of the corporation 
who have an ownership interest in the cor-
poration which is equal to or exceeds 5 per-
cent; 
‘‘(ii) a limited liability company, the 
members and managers of the limited liabil-
ity company (including, as applicable, what 
percentage each member and manager has 
of the ownership interest in the limited li-
ability company); 
‘‘(iii) a general partnership, the part-
ners of the general partnership; 
‘‘(iv) a limited partnership, the general 
partners and any limited partners of the 
limited partnership who have an ownership 
interest in the limited partnership which is 
equal to or exceeds 10 percent; 
‘‘(v) a trust, the trustees of the trust; 
‘‘(vi) an individual, contact informa-
tion for the individual; and 
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‘‘(vii) any other person or entity, such 
information as the Secretary determines ap-
propriate.’’. 
(b) PUBLIC AVAILABILITY
OF INFORMATION.—Not 
later than the date that is 1 year after the date on which 
the 
final 
regulations 
promulgated 
under 
section 
1124(c)(3)(A) of the Social Security Act, as added by sub-
section (a), are published in the Federal Register, the Sec-
retary of Health and Human Services shall make the infor-
mation reported in accordance with such final regulations 
available to the public in accordance with procedures estab-
lished by the Secretary. 
(c) CONFORMING AMENDMENTS.— 
(1) IN GENERAL.— 
(A) SKILLED
NURSING
FACILITIES.—Sec-
tion 1819(d)(1) of the Social Security Act (42 
U.S.C. 1395i–3(d)(1)) is amended by striking 
subparagraph (B) and redesignating subpara-
graph (C) as subparagraph (B). 
(B) 
NURSING
FACILITIES.—Section 
1919(d)(1) of the Social Security Act (42 U.S.C. 
1396r(d)(1)) is amended by striking subpara-
graph (B) and redesignating subparagraph (C) 
as subparagraph (B). 
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(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on the date on 
which the Secretary makes the information described 
in subsection (b)(1) available to the public under such 
subsection. 
SEC. 6102. ACCOUNTABILITY REQUIREMENTS FOR SKILLED 
NURSING FACILITIES AND NURSING FACILI-
TIES. 
Part A of title XI of the Social Security Act (42 U.S.C. 
1301 et seq.), as amended by sections 6002 and 6004, is 
amended by inserting after section 1128H the following new 
section: 
‘‘SEC. 1128I. ACCOUNTABILITY REQUIREMENTS FOR FACILI-
TIES. 
‘‘(a) DEFINITION OF FACILITY.—In this section, the 
term ‘facility’ means— 
‘‘(1) a skilled nursing facility (as defined in sec-
tion 1819(a)); or 
‘‘(2) a nursing facility (as defined in section 
1919(a)). 
‘‘(b) EFFECTIVE COMPLIANCE
AND ETHICS PRO-
GRAMS.— 
‘‘(1) REQUIREMENT.—On or after the date that 
is 36 months after the date of the enactment of this 
section, a facility shall, with respect to the entity that 
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operates the facility (in this subparagraph referred to 
as the ‘operating organization’ or ‘organization’), 
have in operation a compliance and ethics program 
that is effective in preventing and detecting criminal, 
civil, and administrative violations under this Act 
and in promoting quality of care consistent with reg-
ulations developed under paragraph (2). 
‘‘(2) DEVELOPMENT OF REGULATIONS.— 
‘‘(A) IN GENERAL.—Not later than the date 
that is 2 years after such date of the enactment, 
the Secretary, working jointly with the Inspector 
General of the Department of Health and 
Human Services, shall promulgate regulations 
for an effective compliance and ethics program 
for operating organizations, which may include 
a model compliance program. 
‘‘(B) DESIGN OF REGULATIONS.—Such reg-
ulations with respect to specific elements or for-
mality of a program shall, in the case of an or-
ganization that operates 5 or more facilities, 
vary with the size of the organization, such that 
larger organizations should have a more formal 
program and include established written policies 
defining the standards and procedures to be fol-
lowed by its employees. Such requirements may 
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specifically apply to the corporate level manage-
ment of multi unit nursing home chains. 
‘‘(C) EVALUATION.—Not later than 3 years 
after the date of the promulgation of regulations 
under this paragraph, the Secretary shall com-
plete an evaluation of the compliance and ethics 
programs required to be established under this 
subsection. Such evaluation shall determine if 
such programs led to changes in deficiency cita-
tions, changes in quality performance, or 
changes in other metrics of patient quality of 
care. The Secretary shall submit to Congress a 
report on such evaluation and shall include in 
such report such recommendations regarding 
changes in the requirements for such programs 
as the Secretary determines appropriate. 
‘‘(3) REQUIREMENTS FOR COMPLIANCE AND ETH-
ICS PROGRAMS.—In this subsection, the term ‘compli-
ance and ethics program’ means, with respect to a fa-
cility, a program of the operating organization 
that— 
‘‘(A) has been reasonably designed, imple-
mented, and enforced so that it generally will be 
effective in preventing and detecting criminal, 
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civil, and administrative violations under this 
Act and in promoting quality of care; and 
‘‘(B) includes at least the required compo-
nents specified in paragraph (4). 
‘‘(4) REQUIRED
COMPONENTS
OF
PROGRAM.— 
The required components of a compliance and ethics 
program of an operating organization are the fol-
lowing: 
‘‘(A) The organization must have estab-
lished compliance standards and procedures to be 
followed by its employees and other agents that 
are reasonably capable of reducing the prospect 
of criminal, civil, and administrative violations 
under this Act. 
‘‘(B) Specific individuals within high-level 
personnel of the organization must have been as-
signed overall responsibility to oversee compli-
ance with such standards and procedures and 
have sufficient resources and authority to assure 
such compliance. 
‘‘(C) The organization must have used due 
care not to delegate substantial discretionary au-
thority to individuals whom the organization 
knew, or should have known through the exercise 
of due diligence, had a propensity to engage in 
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criminal, civil, and administrative violations 
under this Act. 
‘‘(D) The organization must have taken 
steps to communicate effectively its standards 
and procedures to all employees and other 
agents, such as by requiring participation in 
training programs or by disseminating publica-
tions that explain in a practical manner what 
is required. 
‘‘(E) The organization must have taken rea-
sonable steps to achieve compliance with its 
standards, such as by utilizing monitoring and 
auditing systems reasonably designed to detect 
criminal, civil, and administrative violations 
under this Act by its employees and other agents 
and by having in place and publicizing a report-
ing system whereby employees and other agents 
could report violations by others within the orga-
nization without fear of retribution. 
‘‘(F) The standards must have been consist-
ently enforced through appropriate disciplinary 
mechanisms, including, as appropriate, dis-
cipline of individuals responsible for the failure 
to detect an offense. 
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‘‘(G) After an offense has been detected, the 
organization must have taken all reasonable 
steps to respond appropriately to the offense and 
to prevent further similar offenses, including any 
necessary modification to its program to prevent 
and detect criminal, civil, and administrative 
violations under this Act. 
‘‘(H) The organization must periodically 
undertake reassessment of its compliance pro-
gram to identify changes necessary to reflect 
changes within the organization and its facili-
ties. 
‘‘(c) QUALITY ASSURANCE
AND PERFORMANCE IM-
PROVEMENT PROGRAM.— 
‘‘(1) IN GENERAL.—Not later than December 31, 
2011, the Secretary shall establish and implement a 
quality assurance and performance improvement pro-
gram (in this subparagraph referred to as the ‘QAPI 
program’) for facilities, including multi unit chains 
of facilities. Under the QAPI program, the Secretary 
shall establish standards relating to quality assurance 
and performance improvement with respect to facili-
ties and provide technical assistance to facilities on 
the development of best practices in order to meet such 
standards. Not later than 1 year after the date on 
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which the regulations are promulgated under para-
graph (2), a facility must submit to the Secretary a 
plan for the facility to meet such standards and im-
plement such best practices, including how to coordi-
nate the implementation of such plan with quality as-
sessment and assurance activities conducted under 
sections 1819(b)(1)(B) and 1919(b)(1)(B), as applica-
ble. 
‘‘(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out this subsection.’’. 
SEC. 6103. NURSING HOME COMPARE MEDICARE WEBSITE. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819 of the Social Se-
curity Act (42 U.S.C. 1395i–3) is amended— 
(A) by redesignating subsection (i) as sub-
section (j); and 
(B) by inserting after subsection (h) the fol-
lowing new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMATION.— 
‘‘(A) IN GENERAL.—The Secretary shall en-
sure that the Department of Health and Human 
Services includes, as part of the information pro-
vided for comparison of nursing homes on the of-
ficial Internet website of the Federal Government 
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for Medicare beneficiaries (commonly referred to 
as the ‘Nursing Home Compare’ Medicare 
website) (or a successor website), the following 
information in a manner that is prominent, up-
dated on a timely basis, easily accessible, readily 
understandable to consumers of long-term care 
services, and searchable: 
‘‘(i) Staffing data for each facility (in-
cluding resident census data and data on 
the hours of care provided per resident per 
day) based on data submitted under section 
1128I(g), including information on staffing 
turnover and tenure, in a format that is 
clearly understandable to consumers of long- 
term care services and allows such con-
sumers to compare differences in staffing be-
tween facilities and State and national 
averages for the facilities. Such format shall 
include— 
‘‘(I) concise explanations of how 
to interpret the data (such as a plain 
English explanation of data reflecting 
‘nursing home staff hours per resident 
day’); 
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‘‘(II) differences in types of staff 
(such as training associated with dif-
ferent categories of staff); 
‘‘(III) the relationship between 
nurse staffing levels and quality of 
care; and 
‘‘(IV) an explanation that appro-
priate staffing levels vary based on pa-
tient case mix. 
‘‘(ii) Links to State Internet websites 
with information regarding State survey 
and certification programs, links to Form 
2567 State inspection reports (or a suc-
cessor form) on such websites, information 
to guide consumers in how to interpret and 
understand such reports, and the facility 
plan of correction or other response to such 
report. Any such links shall be posted on a 
timely basis. 
‘‘(iii) The standardized complaint form 
developed under section 1128I(f), including 
explanatory material on what complaint 
forms are, how they are used, and how to 
file a complaint with the State survey and 
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certification program and the State long- 
term care ombudsman program. 
‘‘(iv) Summary information on the 
number, type, severity, and outcome of sub-
stantiated complaints. 
‘‘(v) The number of adjudicated in-
stances of criminal violations by a facility 
or the employees of a facility— 
‘‘(I) that were committed inside 
the facility; 
‘‘(II) with respect to such in-
stances of violations or crimes com-
mitted inside of the facility that were 
the violations or crimes of abuse, ne-
glect, and exploitation, criminal sexual 
abuse, or other violations or crimes 
that resulted in serious bodily injury; 
and 
‘‘(III) the number of civil mone-
tary penalties levied against the facil-
ity, employees, contractors, and other 
agents. 
‘‘(B) DEADLINE FOR PROVISION OF INFOR-
MATION.— 
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‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), the Secretary shall ensure 
that the information described in subpara-
graph (A) is included on such website (or a 
successor website) not later than 1 year 
after the date of the enactment of this sub-
section. 
‘‘(ii) EXCEPTION.—The Secretary shall 
ensure that the information described in 
subparagraph (A)(i) is included on such 
website (or a successor website) not later 
than the date on which the requirements 
under section 1128I(g) are implemented. 
‘‘(2) REVIEW AND MODIFICATION OF WEBSITE.— 
‘‘(A) IN GENERAL.—The Secretary shall es-
tablish a process— 
‘‘(i) to review the accuracy, clarity of 
presentation, timeliness, and comprehensive-
ness of information reported on such website 
as of the day before the date of the enact-
ment of this subsection; and 
‘‘(ii) not later than 1 year after the 
date of the enactment of this subsection, to 
modify or revamp such website in accord-
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ance with the review conducted under clause 
(i). 
‘‘(B) CONSULTATION.—In conducting the 
review under subparagraph (A)(i), the Secretary 
shall consult with— 
‘‘(i) State long-term care ombudsman 
programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; and 
‘‘(iv) any other representatives of pro-
grams or groups the Secretary determines 
appropriate.’’. 
(2) TIMELINESS OF SUBMISSION OF SURVEY AND 
CERTIFICATION INFORMATION.— 
(A) IN GENERAL.—Section 1819(g)(5) of the 
Social Security Act (42 U.S.C. 1395i–3(g)(5)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(E) SUBMISSION OF SURVEY AND CERTIFI-
CATION INFORMATION TO THE SECRETARY.—In 
order to improve the timeliness of information 
made available to the public under subparagraph 
(A) and provided on the Nursing Home Compare 
Medicare website under subsection (i), each State 
shall submit information respecting any survey 
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or certification made respecting a skilled nursing 
facility (including any enforcement actions taken 
by the State) to the Secretary not later than the 
date on which the State sends such information 
to the facility. The Secretary shall use the infor-
mation submitted under the preceding sentence 
to update the information provided on the Nurs-
ing Home Compare Medicare website as expedi-
tiously as practicable but not less frequently 
than quarterly.’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by this paragraph shall take effect 1 year 
after the date of the enactment of this Act. 
(3) SPECIAL
FOCUS
FACILITY
PROGRAM.—Sec-
tion 1819(f) of the Social Security Act (42 U.S.C. 
1395i–3(f)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) SPECIAL FOCUS FACILITY PROGRAM.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
conduct a special focus facility program for en-
forcement of requirements for skilled nursing fa-
cilities that the Secretary has identified as hav-
ing substantially failed to meet applicable re-
quirement of this Act. 
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‘‘(B) PERIODIC SURVEYS.—Under such pro-
gram the Secretary shall conduct surveys of each 
facility in the program not less than once every 
6 months.’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919 of the Social Se-
curity Act (42 U.S.C. 1396r) is amended— 
(A) by redesignating subsection (i) as sub-
section (j); and 
(B) by inserting after subsection (h) the fol-
lowing new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMATION.— 
‘‘(A) IN GENERAL.—The Secretary shall en-
sure that the Department of Health and Human 
Services includes, as part of the information pro-
vided for comparison of nursing homes on the of-
ficial Internet website of the Federal Government 
for Medicare beneficiaries (commonly referred to 
as the ‘Nursing Home Compare’ Medicare 
website) (or a successor website), the following 
information in a manner that is prominent, up-
dated on a timely basis, easily accessible, readily 
understandable to consumers of long-term care 
services, and searchable: 
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‘‘(i) Staffing data for each facility (in-
cluding resident census data and data on 
the hours of care provided per resident per 
day) based on data submitted under section 
1128I(g), including information on staffing 
turnover and tenure, in a format that is 
clearly understandable to consumers of long- 
term care services and allows such con-
sumers to compare differences in staffing be-
tween facilities and State and national 
averages for the facilities. Such format shall 
include— 
‘‘(I) concise explanations of how 
to interpret the data (such as plain 
English explanation of data reflecting 
‘nursing home staff hours per resident 
day’); 
‘‘(II) differences in types of staff 
(such as training associated with dif-
ferent categories of staff); 
‘‘(III) the relationship between 
nurse staffing levels and quality of 
care; and 
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‘‘(IV) an explanation that appro-
priate staffing levels vary based on pa-
tient case mix. 
‘‘(ii) Links to State Internet websites 
with information regarding State survey 
and certification programs, links to Form 
2567 State inspection reports (or a suc-
cessor form) on such websites, information 
to guide consumers in how to interpret and 
understand such reports, and the facility 
plan of correction or other response to such 
report. Any such links shall be posted on a 
timely basis. 
‘‘(iii) The standardized complaint form 
developed under section 1128I(f), including 
explanatory material on what complaint 
forms are, how they are used, and how to 
file a complaint with the State survey and 
certification program and the State long- 
term care ombudsman program. 
‘‘(iv) Summary information on the 
number, type, severity, and outcome of sub-
stantiated complaints. 
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‘‘(v) The number of adjudicated in-
stances of criminal violations by a facility 
or the employees of a facility— 
‘‘(I) that were committed inside of 
the facility; and 
‘‘(II) with respect to such in-
stances of violations or crimes com-
mitted outside of the facility, that were 
violations or crimes that resulted in 
the serious bodily injury of an elder. 
‘‘(B) DEADLINE FOR PROVISION OF INFOR-
MATION.— 
‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), the Secretary shall ensure 
that the information described in subpara-
graph (A) is included on such website (or a 
successor website) not later than 1 year 
after the date of the enactment of this sub-
section. 
‘‘(ii) EXCEPTION.—The Secretary shall 
ensure that the information described in 
subparagraph (A)(i) is included on such 
website (or a successor website) not later 
than the date on which the requirements 
under section 1128I(g) are implemented. 
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‘‘(2) REVIEW AND MODIFICATION OF WEBSITE.— 
‘‘(A) IN GENERAL.—The Secretary shall es-
tablish a process— 
‘‘(i) to review the accuracy, clarity of 
presentation, timeliness, and comprehensive-
ness of information reported on such website 
as of the day before the date of the enact-
ment of this subsection; and 
‘‘(ii) not later than 1 year after the 
date of the enactment of this subsection, to 
modify or revamp such website in accord-
ance with the review conducted under clause 
(i). 
‘‘(B) CONSULTATION.—In conducting the 
review under subparagraph (A)(i), the Secretary 
shall consult with— 
‘‘(i) State long-term care ombudsman 
programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; 
‘‘(iv) skilled nursing facility employees 
and their representatives; and 
‘‘(v) any other representatives of pro-
grams or groups the Secretary determines 
appropriate.’’. 
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(2) TIMELINESS OF SUBMISSION OF SURVEY AND 
CERTIFICATION INFORMATION.— 
(A) IN GENERAL.—Section 1919(g)(5) of the 
Social Security Act (42 U.S.C. 1396r(g)(5)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(E) SUBMISSION OF SURVEY AND CERTIFI-
CATION INFORMATION TO THE SECRETARY.—In 
order to improve the timeliness of information 
made available to the public under subparagraph 
(A) and provided on the Nursing Home Compare 
Medicare website under subsection (i), each State 
shall submit information respecting any survey 
or certification made respecting a nursing facil-
ity (including any enforcement actions taken by 
the State) to the Secretary not later than the 
date on which the State sends such information 
to the facility. The Secretary shall use the infor-
mation submitted under the preceding sentence 
to update the information provided on the Nurs-
ing Home Compare Medicare website as expedi-
tiously as practicable but not less frequently 
than quarterly.’’. 
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(B) EFFECTIVE
DATE.—The amendment 
made by this paragraph shall take effect 1 year 
after the date of the enactment of this Act. 
(3) SPECIAL
FOCUS
FACILITY
PROGRAM.—Sec-
tion 1919(f) of the Social Security Act (42 U.S.C. 
1396r(f)) is amended by adding at the end of the fol-
lowing new paragraph: 
‘‘(10) SPECIAL FOCUS FACILITY PROGRAM.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
conduct a special focus facility program for en-
forcement of requirements for nursing facilities 
that the Secretary has identified as having sub-
stantially failed to meet applicable requirements 
of this Act. 
‘‘(B) PERIODIC SURVEYS.—Under such pro-
gram the Secretary shall conduct surveys of each 
facility in the program not less often than once 
every 6 months.’’. 
(c) AVAILABILITY OF REPORTS ON SURVEYS, CERTIFI-
CATIONS, AND COMPLAINT INVESTIGATIONS.— 
(1) SKILLED
NURSING
FACILITIES.—Section 
1819(d)(1) of the Social Security Act (42 U.S.C. 
1395i–3(d)(1)), as amended by section 6101, is 
amended by adding at the end the following new sub-
paragraph: 
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‘‘(C) AVAILABILITY
OF
SURVEY, CERTIFI-
CATION, AND
COMPLAINT
INVESTIGATION
RE-
PORTS.—A skilled nursing facility must— 
‘‘(i) have reports with respect to any 
surveys, certifications, and complaint inves-
tigations made respecting the facility dur-
ing the 3 preceding years available for any 
individual to review upon request; and 
‘‘(ii) post notice of the availability of 
such reports in areas of the facility that are 
prominent and accessible to the public. 
The facility shall not make available under 
clause (i) identifying information about com-
plainants or residents.’’. 
(2) NURSING FACILITIES.—Section 1919(d)(1) of 
the Social Security Act (42 U.S.C. 1396r(d)(1)), as 
amended by section 6101, is amended by adding at 
the end the following new subparagraph: 
‘‘(V) AVAILABILITY
OF
SURVEY, CERTIFI-
CATION, AND
COMPLAINT
INVESTIGATION
RE-
PORTS.—A nursing facility must— 
‘‘(i) have reports with respect to any 
surveys, certifications, and complaint inves-
tigations made respecting the facility dur-
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ing the 3 preceding years available for any 
individual to review upon request; and 
‘‘(ii) post notice of the availability of 
such reports in areas of the facility that are 
prominent and accessible to the public. 
The facility shall not make available under 
clause (i) identifying information about com-
plainants or residents.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect 1 year after the 
date of the enactment of this Act. 
(d) GUIDANCE TO STATES ON FORM 2567 STATE IN-
SPECTION REPORTS AND COMPLAINT INVESTIGATION RE-
PORTS.— 
(1) GUIDANCE.—The Secretary of Health and 
Human Services (in this subtitle referred to as the 
‘‘Secretary’’) shall provide guidance to States on how 
States can establish electronic links to Form 2567 
State inspection reports (or a successor form), com-
plaint investigation reports, and a facility’s plan of 
correction or other response to such Form 2567 State 
inspection reports (or a successor form) on the Inter-
net website of the State that provides information on 
skilled nursing facilities and nursing facilities and 
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the Secretary shall, if possible, include such informa-
tion on Nursing Home Compare. 
(2) REQUIREMENT.—Section 1902(a)(9) of the 
Social Security Act (42 U.S.C. 1396a(a)(9)) is 
amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (B); 
(B) by striking the semicolon at the end of 
subparagraph (C) and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) that the State maintain a consumer- 
oriented website providing useful information to 
consumers regarding all skilled nursing facilities 
and all nursing facilities in the State, including 
for each facility, Form 2567 State inspection re-
ports (or a successor form), complaint investiga-
tion reports, the facility’s plan of correction, and 
such other information that the State or the Sec-
retary considers useful in assisting the public to 
assess the quality of long term care options and 
the quality of care provided by individual facili-
ties;’’. 
(3) DEFINITIONS.—In this subsection: 
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(A) NURSING FACILITY.—The term ‘‘nurs-
ing facility’’ has the meaning given such term in 
section 1919(a) of the Social Security Act (42 
U.S.C. 1396r(a)). 
(B) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human Serv-
ices. 
(C) SKILLED NURSING FACILITY.—The term 
‘‘skilled nursing facility’’ has the meaning given 
such term in section 1819(a) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(a)). 
(e) DEVELOPMENT OF CONSUMER RIGHTS INFORMA-
TION PAGE ON NURSING HOME COMPARE WEBSITE.—Not 
later than 1 year after the date of enactment of this Act, 
the Secretary shall ensure that the Department of Health 
and Human Services, as part of the information provided 
for comparison of nursing facilities on the Nursing Home 
Compare Medicare website develops and includes a con-
sumer rights information page that contains links to de-
scriptions of, and information with respect to, the following: 
(1) The documentation on nursing facilities that 
is available to the public. 
(2) General information and tips on choosing a 
nursing facility that meets the needs of the indi-
vidual. 
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(3) General information on consumer rights with 
respect to nursing facilities. 
(4) The nursing facility survey process (on a na-
tional and State-specific basis). 
(5) On a State-specific basis, the services avail-
able through the State long-term care ombudsman for 
such State. 
SEC. 6104. REPORTING OF EXPENDITURES. 
Section 1888 of the Social Security Act (42 U.S.C. 
1395yy) is amended by adding at the end the following new 
subsection: 
‘‘(f) REPORTING OF DIRECT CARE EXPENDITURES.— 
‘‘(1) IN GENERAL.—For cost reports submitted 
under this title for cost reporting periods beginning 
on or after the date that is 2 years after the date of 
the enactment of this subsection, skilled nursing fa-
cilities shall separately report expenditures for wages 
and benefits for direct care staff (breaking out (at a 
minimum) registered nurses, licensed professional 
nurses, certified nurse assistants, and other medical 
and therapy staff). 
‘‘(2) MODIFICATION OF FORM.—The Secretary, 
in consultation with private sector accountants expe-
rienced with Medicare and Medicaid nursing facility 
home cost reports, shall redesign such reports to meet 
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the requirement of paragraph (1) not later than 1 
year after the date of the enactment of this subsection. 
‘‘(3) CATEGORIZATION
BY
FUNCTIONAL
AC-
COUNTS.—Not later than 30 months after the date of 
the enactment of this subsection, the Secretary, work-
ing in consultation with the Medicare Payment Advi-
sory Commission, the Medicaid and CHIP Payment 
and Access Commission, the Inspector General of the 
Department of Health and Human Services, and 
other expert parties the Secretary determines appro-
priate, shall take the expenditures listed on cost re-
ports, as modified under paragraph (1), submitted by 
skilled nursing facilities and categorize such expendi-
tures, regardless of any source of payment for such ex-
penditures, for each skilled nursing facility into the 
following functional accounts on an annual basis: 
‘‘(A) Spending on direct care services (in-
cluding nursing, therapy, and medical services). 
‘‘(B) Spending on indirect care (including 
housekeeping and dietary services). 
‘‘(C) Capital assets (including building and 
land costs). 
‘‘(D) Administrative services costs. 
‘‘(4) 
AVAILABILITY
OF
INFORMATION
SUB-
MITTED.—The Secretary shall establish procedures to 
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make information on expenditures submitted under 
this subsection readily available to interested parties 
upon request, subject to such requirements as the Sec-
retary may specify under the procedures established 
under this paragraph.’’. 
SEC. 6105. STANDARDIZED COMPLAINT FORM. 
(a) IN GENERAL.—Section 1128I of the Social Secu-
rity Act, as added and amended by this Act, is amended 
by adding at the end the following new subsection: 
‘‘(f) STANDARDIZED COMPLAINT FORM.— 
‘‘(1) DEVELOPMENT BY THE SECRETARY.—The 
Secretary shall develop a standardized complaint 
form for use by a resident (or a person acting on the 
resident’s behalf) in filing a complaint with a State 
survey and certification agency and a State long-term 
care ombudsman program with respect to a facility. 
‘‘(2) COMPLAINT FORMS AND RESOLUTION PROC-
ESSES.— 
‘‘(A) COMPLAINT FORMS.—The State must 
make the standardized complaint form developed 
under paragraph (1) available upon request to— 
‘‘(i) a resident of a facility; and 
‘‘(ii) any person acting on the resi-
dent’s behalf. 
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‘‘(B) COMPLAINT RESOLUTION PROCESS.— 
The State must establish a complaint resolution 
process in order to ensure that the legal rep-
resentative of a resident of a facility or other re-
sponsible party is not denied access to such resi-
dent or otherwise retaliated against if they have 
complained about the quality of care provided by 
the facility or other issues relating to the facility. 
Such complaint resolution process shall in-
clude— 
‘‘(i) procedures to assure accurate 
tracking of complaints received, including 
notification to the complainant that a com-
plaint has been received; 
‘‘(ii) procedures to determine the likely 
severity of a complaint and for the inves-
tigation of the complaint; and 
‘‘(iii) deadlines for responding to a 
complaint and for notifying the complain-
ant of the outcome of the investigation. 
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this 
subsection shall be construed as preventing a resident 
of a facility (or a person acting on the resident’s be-
half) from submitting a complaint in a manner or 
format other than by using the standardized com-
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plaint form developed under paragraph (1) (including 
submitting a complaint orally).’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall take effect 1 year after the date of the enact-
ment of this Act. 
SEC. 6106. ENSURING STAFFING ACCOUNTABILITY. 
Section 1128I of the Social Security Act, as added and 
amended by this Act, is amended by adding at the end the 
following new subsection: 
‘‘(g) SUBMISSION OF STAFFING INFORMATION BASED 
ON PAYROLL DATA IN A UNIFORM FORMAT.—Beginning 
not later than 2 years after the date of the enactment of 
this subsection, and after consulting with State long-term 
care ombudsman programs, consumer advocacy groups, 
provider stakeholder groups, employees and their represent-
atives, and other parties the Secretary deems appropriate, 
the Secretary shall require a facility to electronically sub-
mit to the Secretary direct care staffing information (in-
cluding information with respect to agency and contract 
staff) based on payroll and other verifiable and auditable 
data in a uniform format (according to specifications estab-
lished by the Secretary in consultation with such programs, 
groups, and parties). Such specifications shall require that 
the information submitted under the preceding sentence— 
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‘‘(1) specify the category of work a certified em-
ployee performs (such as whether the employee is a 
registered nurse, licensed practical nurse, licensed vo-
cational nurse, certified nursing assistant, therapist, 
or other medical personnel); 
‘‘(2) include resident census data and informa-
tion on resident case mix; 
‘‘(3) include a regular reporting schedule; and 
‘‘(4) include information on employee turnover 
and tenure and on the hours of care provided by each 
category of certified employees referenced in para-
graph (1) per resident per day. 
Nothing in this subsection shall be construed as preventing 
the Secretary from requiring submission of such informa-
tion with respect to specific categories, such as nursing staff, 
before other categories of certified employees. Information 
under this subsection with respect to agency and contract 
staff shall be kept separate from information on employee 
staffing.’’. 
SEC. 6107. GAO STUDY AND REPORT ON FIVE-STAR QUALITY 
RATING SYSTEM. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall conduct a study on the Five-Star Quality Rat-
ing System for nursing homes of the Centers for Medicare 
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& Medicaid Services. Such study shall include an analysis 
of— 
(1) how such system is being implemented; 
(2) any problems associated with such system or 
its implementation; and 
(3) how such system could be improved. 
(b) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Comptroller General shall sub-
mit to Congress a report containing the results of the study 
conducted under subsection (a), together with recommenda-
tions for such legislation and administrative action as the 
Comptroller General determines appropriate. 
PART II—TARGETING ENFORCEMENT 
SEC. 6111. CIVIL MONEY PENALTIES. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395i– 
3(h)(2)(B)(ii)) is amended— 
(A) by striking ‘‘PENALTIES.—The Sec-
retary’’ and inserting ‘‘PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the Secretary’’; and 
(B) by adding at the end the following new 
subclauses: 
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‘‘(II) REDUCTION OF CIVIL MONEY 
PENALTIES
IN
CERTAIN
CIR-
CUMSTANCES.—Subject 
to 
subclause 
(III), in the case where a facility self- 
reports and promptly corrects a defi-
ciency for which a penalty was im-
posed under this clause not later than 
10 calendar days after the date of such 
imposition, the Secretary may reduce 
the amount of the penalty imposed by 
not more than 50 percent. 
‘‘(III) PROHIBITIONS ON REDUC-
TION FOR CERTAIN DEFICIENCIES.— 
‘‘(aa) 
REPEAT
DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (II) if the 
Secretary had reduced a penalty 
imposed on the facility in the pre-
ceding year under such subclause 
with respect to a repeat defi-
ciency. 
‘‘(bb) CERTAIN OTHER DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
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alty under subclause (II) if the 
penalty is imposed on the facility 
for a deficiency that is found to 
result in a pattern of harm or 
widespread 
harm, 
immediately 
jeopardizes the health or safety of 
a resident or residents of the facil-
ity, or results in the death of a 
resident of the facility. 
‘‘(IV) 
COLLECTION
OF
CIVIL 
MONEY PENALTIES.—In the case of a 
civil money penalty imposed under 
this clause, the Secretary shall issue 
regulations that— 
‘‘(aa) subject to item (cc), not 
later than 30 days after the impo-
sition of the penalty, provide for 
the facility to have the oppor-
tunity to participate in an inde-
pendent informal dispute resolu-
tion process which generates a 
written record prior to the collec-
tion of such penalty; 
‘‘(bb) in the case where the 
penalty is imposed for each day of 
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noncompliance, provide that a 
penalty may not be imposed for 
any day during the period begin-
ning on the initial day of the im-
position of the penalty and ending 
on the day on which the informal 
dispute resolution process under 
item (aa) is completed; 
‘‘(cc) may provide for the col-
lection of such civil money pen-
alty and the placement of such 
amounts collected in an escrow 
account under the direction of the 
Secretary on the earlier of the 
date on which the informal dis-
pute resolution process under item 
(aa) is completed or the date that 
is 90 days after the date of the 
imposition of the penalty; 
‘‘(dd) may provide that such 
amounts collected are kept in such 
account pending the resolution of 
any subsequent appeals; 
‘‘(ee) in the case where the 
facility successfully appeals the 
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penalty, may provide for the re-
turn of such amounts collected 
(plus interest) to the facility; and 
‘‘(ff) in the case where all 
such appeals are unsuccessful, 
may provide that some portion of 
such amounts collected may be 
used to support activities that 
benefit residents, including assist-
ance to support and protect resi-
dents of a facility that closes (vol-
untarily or involuntarily) or is 
decertified (including offsetting 
costs of relocating residents to 
home and community-based set-
tings or another facility), projects 
that support resident and family 
councils and other consumer in-
volvement in assuring quality 
care in facilities, and facility im-
provement initiatives approved by 
the Secretary (including joint 
training of facility staff and sur-
veyors, technical assistance for fa-
cilities implementing quality as-
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surance programs, the appoint-
ment of temporary management 
firms, and other activities ap-
proved by the Secretary).’’. 
(2) CONFORMING AMENDMENT.—The second sen-
tence of section 1819(h)(5) of the Social Security Act 
(42 U.S.C. 1395i–3(h)(5)) is amended by inserting 
‘‘(ii)(IV),’’ after ‘‘(i),’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919(h)(3)(C)(ii) of 
the Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is 
amended— 
(A) by striking ‘‘PENALTIES.—The Sec-
retary’’ and inserting ‘‘PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the Secretary’’; and 
(B) by adding at the end the following new 
subclauses: 
‘‘(II) REDUCTION OF CIVIL MONEY 
PENALTIES
IN
CERTAIN
CIR-
CUMSTANCES.—Subject 
to 
subclause 
(III), in the case where a facility self- 
reports and promptly corrects a defi-
ciency for which a penalty was im-
posed under this clause not later than 
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10 calendar days after the date of such 
imposition, the Secretary may reduce 
the amount of the penalty imposed by 
not more than 50 percent. 
‘‘(III) PROHIBITIONS ON REDUC-
TION FOR CERTAIN DEFICIENCIES.— 
‘‘(aa) 
REPEAT
DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (II) if the 
Secretary had reduced a penalty 
imposed on the facility in the pre-
ceding year under such subclause 
with respect to a repeat defi-
ciency. 
‘‘(bb) CERTAIN OTHER DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (II) if the 
penalty is imposed on the facility 
for a deficiency that is found to 
result in a pattern of harm or 
widespread 
harm, 
immediately 
jeopardizes the health or safety of 
a resident or residents of the facil-
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ity, or results in the death of a 
resident of the facility. 
‘‘(IV) 
COLLECTION
OF
CIVIL 
MONEY PENALTIES.—In the case of a 
civil money penalty imposed under 
this clause, the Secretary shall issue 
regulations that— 
‘‘(aa) subject to item (cc), not 
later than 30 days after the impo-
sition of the penalty, provide for 
the facility to have the oppor-
tunity to participate in an inde-
pendent informal dispute resolu-
tion process which generates a 
written record prior to the collec-
tion of such penalty; 
‘‘(bb) in the case where the 
penalty is imposed for each day of 
noncompliance, provide that a 
penalty may not be imposed for 
any day during the period begin-
ning on the initial day of the im-
position of the penalty and ending 
on the day on which the informal 
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dispute resolution process under 
item (aa) is completed; 
‘‘(cc) may provide for the col-
lection of such civil money pen-
alty and the placement of such 
amounts collected in an escrow 
account under the direction of the 
Secretary on the earlier of the 
date on which the informal dis-
pute resolution process under item 
(aa) is completed or the date that 
is 90 days after the date of the 
imposition of the penalty; 
‘‘(dd) may provide that such 
amounts collected are kept in such 
account pending the resolution of 
any subsequent appeals; 
‘‘(ee) in the case where the 
facility successfully appeals the 
penalty, may provide for the re-
turn of such amounts collected 
(plus interest) to the facility; and 
‘‘(ff) in the case where all 
such appeals are unsuccessful, 
may provide that some portion of 
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such amounts collected may be 
used to support activities that 
benefit residents, including assist-
ance to support and protect resi-
dents of a facility that closes (vol-
untarily or involuntarily) or is 
decertified (including offsetting 
costs of relocating residents to 
home and community-based set-
tings or another facility), projects 
that support resident and family 
councils and other consumer in-
volvement in assuring quality 
care in facilities, and facility im-
provement initiatives approved by 
the Secretary (including joint 
training of facility staff and sur-
veyors, technical assistance for fa-
cilities implementing quality as-
surance programs, the appoint-
ment of temporary management 
firms, and other activities ap-
proved by the Secretary).’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1919(h)(5)(8) of the Social Security Act (42 U.S.C. 
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1396r(h)(5)(8)) is amended by inserting ‘‘(ii)(IV),’’ 
after ‘‘(i),’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect 1 year after the date of the enact-
ment of this Act. 
SEC. 
6112. 
NATIONAL 
INDEPENDENT 
MONITOR 
DEM-
ONSTRATION PROJECT. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—The Secretary, in consultation 
with the Inspector General of the Department of 
Health and Human Services, shall conduct a dem-
onstration project to develop, test, and implement an 
independent monitor program to oversee interstate 
and large intrastate chains of skilled nursing facili-
ties and nursing facilities. 
(2) SELECTION.—The Secretary shall select 
chains of skilled nursing facilities and nursing facili-
ties described in paragraph (1) to participate in the 
demonstration project under this section from among 
those chains that submit an application to the Sec-
retary at such time, in such manner, and containing 
such information as the Secretary may require. 
(3) DURATION.—The Secretary shall conduct the 
demonstration project under this section for a 2-year 
period. 
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(4) IMPLEMENTATION.—The Secretary shall im-
plement the demonstration project under this section 
not later than 1 year after the date of the enactment 
of this Act. 
(b) REQUIREMENTS.—The Secretary shall evaluate 
chains selected to participate in the demonstration project 
under this section based on criteria selected by the Sec-
retary, including where evidence suggests that a number of 
the facilities of the chain are experiencing serious safety 
and quality of care problems. Such criteria may include 
the evaluation of a chain that includes a number of facili-
ties participating in the ‘‘Special Focus Facility’’ program 
(or a successor program) or multiple facilities with a record 
of repeated serious safety and quality of care deficiencies. 
(c) RESPONSIBILITIES.—An independent monitor that 
enters into a contract with the Secretary to participate in 
the conduct of the demonstration project under this section 
shall— 
(1) conduct periodic reviews and prepare root- 
cause quality and deficiency analyses of a chain to 
assess if facilities of the chain are in compliance with 
State and Federal laws and regulations applicable to 
the facilities; 
(2) conduct sustained oversight of the efforts of 
the chain, whether publicly or privately held, to 
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achieve compliance by facilities of the chain with 
State and Federal laws and regulations applicable to 
the facilities; 
(3) analyze the management structure, distribu-
tion of expenditures, and nurse staffing levels of fa-
cilities of the chain in relation to resident census, 
staff turnover rates, and tenure; 
(4) report findings and recommendations with 
respect to such reviews, analyses, and oversight to the 
chain and facilities of the chain, to the Secretary, and 
to relevant States; and 
(5) publish the results of such reviews, analyses, 
and oversight. 
(d) IMPLEMENTATION OF RECOMMENDATIONS.— 
(1) RECEIPT OF FINDING BY CHAIN.—Not later 
than 10 days after receipt of a finding of an inde-
pendent monitor under subsection (c)(4), a chain par-
ticipating in the demonstration project shall submit 
to the independent monitor a report— 
(A) outlining corrective actions the chain 
will take to implement the recommendations in 
such report; or 
(B) indicating that the chain will not im-
plement such recommendations, and why it will 
not do so. 
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(2) RECEIPT OF REPORT BY INDEPENDENT MON-
ITOR.—Not later than 10 days after receipt of a re-
port submitted by a chain under paragraph (1), an 
independent monitor shall finalize its recommenda-
tions and submit a report to the chain and facilities 
of the chain, the Secretary, and the State or States, 
as appropriate, containing such final recommenda-
tions. 
(e) COST OF APPOINTMENT.—A chain shall be respon-
sible for a portion of the costs associated with the appoint-
ment of independent monitors under the demonstration 
project under this section. The chain shall pay such portion 
to the Secretary (in an amount and in accordance with 
procedures established by the Secretary). 
(f) WAIVER AUTHORITY.—The Secretary may waive 
such requirements of titles XVIII and XIX of the Social Se-
curity Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may 
be necessary for the purpose of carrying out the demonstra-
tion project under this section. 
(g) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
(h) DEFINITIONS.—In this section: 
(1) ADDITIONAL DISCLOSABLE PARTY.—The term 
‘‘additional disclosable party’’ has the meaning given 
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such term in section 1124(c)(5)(A) of the Social Secu-
rity Act, as added by section 4201(a). 
(2) FACILITY.—The term ‘‘facility’’ means a 
skilled nursing facility or a nursing facility. 
(3) NURSING FACILITY.—The term ‘‘nursing fa-
cility’’ has the meaning given such term in section 
1919(a) of the Social Security Act (42 U.S.C. 
1396r(a)). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services, acting 
through the Assistant Secretary for Planning and 
Evaluation. 
(5) SKILLED
NURSING
FACILITY.—The term 
‘‘skilled nursing facility’’ has the meaning given such 
term in section 1819(a) of the Social Security Act (42 
U.S.C. 1395(a)). 
(i) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary, in consulta-
tion with the Inspector General of the Department of 
Health and Human Services, shall evaluate the dem-
onstration project conducted under this section. 
(2) REPORT.—Not later than 180 days after the 
completion of the demonstration project under this 
section, the Secretary shall submit to Congress a re-
port containing the results of the evaluation con-
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ducted under paragraph (1), together with rec-
ommendations— 
(A) as to whether the independent monitor 
program should be established on a permanent 
basis; 
(B) if the Secretary recommends that such 
program be so established, on appropriate proce-
dures and mechanisms for such establishment; 
and 
(C) for such legislation and administrative 
action as the Secretary determines appropriate. 
SEC. 6113. NOTIFICATION OF FACILITY CLOSURE. 
(a) IN GENERAL.—Section 1128I of the Social Secu-
rity Act, as added and amended by this Act, is amended 
by adding at the end the following new subsection: 
‘‘(h) NOTIFICATION OF FACILITY CLOSURE.— 
‘‘(1) IN GENERAL.—Any individual who is the 
administrator of a facility must— 
‘‘(A) submit to the Secretary, the State 
long-term care ombudsman, residents of the facil-
ity, and the legal representatives of such resi-
dents or other responsible parties, written notifi-
cation of an impending closure— 
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‘‘(i) subject to clause (ii), not later 
than the date that is 60 days prior to the 
date of such closure; and 
‘‘(ii) in the case of a facility where the 
Secretary terminates the facility’s partici-
pation under this title, not later than the 
date that the Secretary determines appro-
priate; 
‘‘(B) ensure that the facility does not admit 
any new residents on or after the date on which 
such written notification is submitted; and 
‘‘(C) include in the notice a plan for the 
transfer and adequate relocation of the residents 
of the facility by a specified date prior to closure 
that has been approved by the State, including 
assurances that the residents will be transferred 
to the most appropriate facility or other setting 
in terms of quality, services, and location, taking 
into consideration the needs, choice, and best in-
terests of each resident. 
‘‘(2) RELOCATION.— 
‘‘(A) IN GENERAL.—The State shall ensure 
that, before a facility closes, all residents of the 
facility have been successfully relocated to an-
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other facility or an alternative home and com-
munity-based setting. 
‘‘(B) CONTINUATION
OF
PAYMENTS
UNTIL 
RESIDENTS RELOCATED.—The Secretary may, as 
the Secretary determines appropriate, continue 
to make payments under this title with respect 
to residents of a facility that has submitted a no-
tification under paragraph (1) during the period 
beginning on the date such notification is sub-
mitted and ending on the date on which the resi-
dent is successfully relocated. 
‘‘(3) SANCTIONS.—Any individual who is the ad-
ministrator of a facility that fails to comply with the 
requirements of paragraph (1)— 
‘‘(A) shall be subject to a civil monetary 
penalty of up to $100,000; 
‘‘(B) may be subject to exclusion from par-
ticipation in any Federal health care program 
(as defined in section 1128B(f)); and 
‘‘(C) shall be subject to any other penalties 
that may be prescribed by law. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A (other than subsections (a) and (b) and the 
second sentence of subsection (f)) shall apply to a civil 
money penalty or exclusion under paragraph (3) in 
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the same manner as such provisions apply to a pen-
alty or proceeding under section 1128A(a).’’. 
(b) CONFORMING AMENDMENTS.—Section 1819(h)(4) 
of the Social Security Act (42 U.S.C. 1395i–3(h)(4)) is 
amended— 
(1) in the first sentence, by striking ‘‘the Sec-
retary shall terminate’’ and inserting ‘‘the Secretary, 
subject to section 1128I(h), shall terminate’’; and 
(2) in the second sentence, by striking ‘‘sub-
section (c)(2)’’ and inserting ‘‘subsection (c)(2) and 
section 1128I(h)’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect 1 year after the date of the enact-
ment of this Act. 
SEC. 6114. NATIONAL DEMONSTRATION PROJECTS ON CUL-
TURE CHANGE AND USE OF INFORMATION 
TECHNOLOGY IN NURSING HOMES. 
(a) IN GENERAL.—The Secretary shall conduct 2 dem-
onstration projects, 1 for the development of best practices 
in skilled nursing facilities and nursing facilities that are 
involved in the culture change movement (including the de-
velopment of resources for facilities to find and access fund-
ing in order to undertake culture change) and 1 for the de-
velopment of best practices in skilled nursing facilities and 
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nursing facilities for the use of information technology to 
improve resident care. 
(b) CONDUCT OF DEMONSTRATION PROJECTS.— 
(1) GRANT AWARD.—Under each demonstration 
project conducted under this section, the Secretary 
shall award 1 or more grants to facility-based settings 
for the development of best practices described in sub-
section (a) with respect to the demonstration project 
involved. Such award shall be made on a competitive 
basis and may be allocated in 1 lump-sum payment. 
(2) CONSIDERATION OF SPECIAL NEEDS OF RESI-
DENTS.—Each demonstration project conducted under 
this section shall take into consideration the special 
needs of residents of skilled nursing facilities and 
nursing facilities who have cognitive impairment, in-
cluding dementia. 
(c) DURATION AND IMPLEMENTATION.— 
(1) DURATION.—The demonstration projects 
shall each be conducted for a period not to exceed 3 
years. 
(2) 
IMPLEMENTATION.—The 
demonstration 
projects shall each be implemented not later than 1 
year after the date of the enactment of this Act. 
(d) DEFINITIONS.—In this section: 
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‘‘(i) has paid premiums for enrollment 
in such program for at least 60 months; 
‘‘(ii) has earned, with respect to at 
least 3 calendar years that occur during the 
first 60 months for which the individual has 
paid premiums for enrollment in the pro-
gram, at least an amount equal to the 
amount of wages and self-employment in-
come which an individual must have in 
order to be credited with a quarter of cov-
erage under section 213(d) of the Social Se-
curity Act for the year; and 
‘‘(iii) has paid premiums for enroll-
ment in such program for at least 24 con-
secutive months, if a lapse in premium pay-
ments of more than 3 months has occurred 
during the period that begins on the date of 
the individual’s enrollment and ends on the 
date of such determination. 
‘‘(B) DATE DESCRIBED.—For purposes of 
subparagraph (A), the date described in this sub-
paragraph is the date on which the individual is 
determined to have a functional limitation de-
scribed in section 3203(a)(1)(C) that is expected 
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