I 
114TH CONGRESS 
1ST SESSION H. R. 2083 
To amend title XVIII of the Social Security Act to provide for patient 
protection by establishing safe nurse staffing levels at certain Medicare 
providers, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 29, 2015 
Mrs. CAPPS (for herself, Mr. JOYCE, Mr. BLUMENAUER, Mr. DANNY K. 
DAVIS of Illinois, Mr. DEFAZIO, Mr. LANGEVIN, Mr. PAYNE, Mr. 
PETERS, Mr. SCHRADER, Ms. SLAUGHTER, and Mrs. TORRES) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committee on Ways and Means, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for patient protection by establishing safe nurse staffing 
levels at certain Medicare providers, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Registered Nurse Safe 
Staffing Act of 2015’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Research shows that patient safety in hos-
pitals is directly proportionate to the number of reg-
istered nurses working in the hospital. Higher staff-
ing levels by experienced registered nurses are re-
lated to lower rates of negative patient outcomes. 
(2) A 2011 study on nurse staffing and inpa-
tient hospital mortality shows that sub-optimal nurse 
staffing is linked with a greater likelihood of patient 
death in the hospital. A 2012 study of serious pa-
tient events reported to the Joint Commission dem-
onstrates that one of the leading causes of all hos-
pital sentinel events is human factors, including 
staffing and staffing skill mix. 
(3) Health care worker fatigue has been identi-
fied as a major patient safety hazard, and appro-
priate staffing policies and practices are indicated as 
an effective strategy to reduce health care worker fa-
tigue and to protect patients. A national survey of 
registered nurses found that 74 percent experience 
acute or chronic effects of stress and overwork. 
(4) A strategy that ensures optimal nurse staff-
ing and skill mix greatly influences patient satisfac-
tion and results in greater overall savings to hos-
pitals through reductions in adverse patient events. 
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(5) A 2009 study demonstrated that improved 
patient satisfaction due to increased and appropriate 
nurse staffing is reflected on hospital scores on 
HCAHPS, which is a key measure for value-based 
payment programs under the Medicare program and 
used by other payors. 
(6) Registered nurses play a vital role in pre-
venting patient care errors. A 2009 study found that 
sufficient staffing of critical care nurses can prevent 
adverse patient events, which can cost anywhere 
from $2,200,000 to $13,200,000. By contrast, the 
nurse staffing costs in the study time period were 
only $1,360,000. 
(7) Increasing the number of registered nurses 
can protect patients and yield a cost savings of near-
ly $3 billion, resulting from more than 4 million 
avoided extra stay days for adverse patient events, 
such as infection and bleeding occurring in the hos-
pital, and by reducing costly hospital readmissions. 
Adding registered nurses to unit staffing has been 
shown to eliminate nearly one-fifth of all hospital 
deaths, and to reduce the relative risk of adverse pa-
tient events. Higher nurse staffing also generates 
cost savings to payors and eliminates a significant 
financial burden to the United States healthcare sys-
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tem. This is demonstrated in the estimation in 2011 
by the Centers for Disease Control and Prevention 
that there were 648,000 patients with 721,800 hos-
pital acquired infections in United States acute care 
hospitals, costing hospitals an estimated $28.4 bil-
lion to $45 billion. 
(8) A 2012 study of Pennsylvania hospitals 
shows that by reducing nurse burnout, which is at-
tributed in part to poor nurse staffing, those hos-
pitals could prevent an estimated 4,160 infections 
with an associated savings of $41,000,000. That 
study also found that for each additional patient as-
signed to a registered nurse for care, there is an in-
cidence of roughly one additional catheter-acquired 
urinary tract infection per 1,000 patients or 1,351 
infections per year, costing those hospitals as much 
as $1,100,000 annually. 
(9) When hospitals employ insufficient numbers 
of nursing staff, registered nurses are being required 
to perform professional services under conditions 
that do not support quality health care or a health-
ful work environment for registered nurses. 
(10) High readmission rates within a hospital 
system can be perceived as an overall indicator of 
poor quality care. In 2013, 17.5 percent of Medicare 
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beneficiaries were readmitted to a hospital within 30 
days following discharge. These readmissions cost 
Medicare an estimated $26 billion per year. Optimal 
nurse staffing plays an important role in improving 
quality care by ensuring nurses have adequate time 
and resources to prepare each patient for discharge. 
(11) As a payor for inpatient and outpatient 
hospital services furnished to Medicare beneficiaries, 
the Federal Government has a compelling interest in 
promoting the safety of these patients by requiring 
any hospital participating in the Medicare program 
to establish minimum safe staffing levels for reg-
istered nurses. 
SEC. 3. ESTABLISHMENT OF SAFE NURSE STAFFING LEV-
ELS 
BY 
MEDICARE 
PARTICIPATING 
HOS-
PITALS. 
(a) REQUIREMENT OF MEDICARE PROVIDER AGREE-
MENT.—Section 1866(a)(1) of the Social Security Act (42 
U.S.C. 1395cc(a)(1)) is amended— 
(1) in subparagraph (V), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (W), as added by section 
3005 of the Patient Protection and Affordable Care 
Act (Public Law 111–148)— 
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(A) by moving such subparagraph 2 ems to 
the left; and 
(B) by striking the period at the end; 
(3) in subparagraph (W), as added by section 
6406(b) of the Patient Protection and Affordable 
Care Act (Public Law 111–148)— 
(A) by moving such subparagraph 2 ems to 
the left; 
(B) by redesignating such subparagraph as 
subparagraph (X); and 
(C) by striking the period at the end and 
inserting ‘‘, and’’; and 
(4) by inserting after subparagraph (X), as re-
designated by paragraph (3)(B), the following new 
subparagraph: 
‘‘(Y) in the case of a hospital (as defined 
in section 1861(e)), to meet the requirements of 
section 1899B.’’. 
(b) REQUIREMENTS.—Title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.) is amended by adding 
at the end the following new section: 
‘‘NURSE STAFFING REQUIREMENTS FOR MEDICARE 
PARTICIPATING HOSPITALS 
‘‘SEC. 1899B. (a) IMPLEMENTATION
OF NURSE 
STAFFING PLAN.— 
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‘‘(1) IN GENERAL.—Each participating hospital 
shall implement a hospital-wide staffing plan for 
nursing services furnished in the hospital. 
‘‘(2) REQUIREMENT
FOR
DEVELOPMENT
OF 
STAFFING
PLAN
BY
HOSPITAL
NURSE
STAFFING 
COMMITTEE.—The hospital-wide staffing plan for 
nursing services implemented by a hospital pursuant 
to paragraph (1)— 
‘‘(A) shall be developed by the hospital 
nurse staffing committee established under sub-
section (b); and 
‘‘(B) shall require that an appropriate 
number of registered nurses provide direct pa-
tient care in each unit and on each shift of the 
hospital to ensure staffing levels that— 
‘‘(i) address the unique characteristics 
of the patients and hospital units; and 
‘‘(ii) result in the delivery of safe, 
quality patient care, consistent with the re-
quirements under subsection (c). 
‘‘(b) HOSPITAL NURSE STAFFING COMMITTEE.— 
‘‘(1) 
ESTABLISHMENT.—Each 
participating 
hospital shall establish a hospital nurse staffing 
committee (in this section referred to as the ‘Com-
mittee’). 
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‘‘(2) COMPOSITION.—A Committee established 
pursuant to this subsection shall be composed of 
members as follows: 
‘‘(A) MINIMUM 55 PERCENT NURSE PAR-
TICIPATION.—Not less than 55 percent of the 
members of the Committee shall be registered 
nurses who provide direct patient care but who 
are neither hospital nurse managers nor part of 
the hospital administration staff. 
‘‘(B) INCLUSION
OF
HOSPITAL
NURSE 
MANAGERS.—The 
Committee 
shall 
include 
members who are hospital nurse managers. 
‘‘(C) INCLUSION OF NURSES FROM SPE-
CIALTY
UNITS.—The members of the Com-
mittee shall include at least 1 registered nurse 
who provides direct care from each nurse spe-
cialty or unit of the hospital (each such spe-
cialty or unit as determined by the hospital). 
‘‘(D) OTHER HOSPITAL PERSONNEL.—The 
Committee shall include such other personnel of 
the hospital as the hospital determines to be ap-
propriate. 
‘‘(3) DUTIES.— 
‘‘(A) 
DEVELOPMENT
OF
STAFFING 
PLAN.—The Committee shall develop a hospital- 
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wide staffing plan for nursing services furnished 
in the hospital consistent with the requirements 
under subsection (c). 
‘‘(B) REVIEW
AND
MODIFICATION
OF 
STAFFING PLAN.—The Committee shall— 
‘‘(i) conduct regular, ongoing moni-
toring of the implementation of the hos-
pital-wide staffing plan for nursing services 
furnished in the hospital; 
‘‘(ii) carry out evaluations of the hos-
pital-wide staffing plan for nursing services 
at least annually; and 
‘‘(iii) make such modifications to the 
hospital-wide staffing plan for nursing 
services as may be appropriate. 
‘‘(C) ADDITIONAL
DUTIES.—The Com-
mittee shall— 
‘‘(i) develop policies and procedures 
for overtime requirements of registered 
nurses providing direct patient care and 
for appropriate time and manner of relief 
of such registered nurses during routine 
absences; and 
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