‘‘(11) NURSE
DEFINED.—In this subsection, 
the term ‘nurse’ means a registered professional 
nurse, a licensed practical nurse, and a nurse aide.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of enactment of this 
Act and shall apply with respect to objections to or refus-
als of work assignments, complaints, retaliations and 
other adverse actions, and interferences with rights that 
occur on or after the date that is one year after such date 
of enactment and with respect to notices provided on or 
after the date that is one year after such date of enact-
ment. 
SEC. 7. PROHIBITING PRE-DISPUTE ARBITRATION AGREE-
MENTS. 
(a) MEDICARE.—Section 1819(c) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(c)) is amended by adding at 
the end the following new paragraph: 
‘‘(7) PROHIBITION
ON
USE
OF
PRE-DISPUTE 
ARBITRATION AGREEMENTS.— 
‘‘(A) IN GENERAL.—A skilled nursing fa-
cility may not require, solicit, accept, or move 
to enforce a pre-dispute arbitration agreement 
from or on behalf of any resident, whether the 
agreement is made before, during, or after the 
resident’s admission to the facility, or from or 
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on behalf of any employee, or contract employee 
of the facility, or any other individual if such 
individual is alleged to be engaged in conduct 
protected under subsection (k). 
‘‘(B) APPLICATION.—This paragraph shall 
apply to the skilled nursing facility and to any 
other business or person providing or respon-
sible for providing skilled nursing services to 
the resident. 
‘‘(C) NO VALIDITY OR ENFORCEMENT.—A 
pre-dispute arbitration agreement shall not be 
valid or specifically enforceable against a resi-
dent or former resident of a skilled nursing fa-
cility, without regard to whether the agreement 
was made prior to or after the effective date of 
this paragraph. 
‘‘(D) DEFINITION OF PRE-DISPUTE ARBI-
TRATION AGREEMENT.—In this paragraph, the 
term ‘pre-dispute arbitration agreement’ means 
any agreement to arbitrate a dispute when the 
dispute has arisen after such agreement has 
been made. 
‘‘(E) JUDICIAL REVIEW.—A determination 
as to whether and how this paragraph applies 
to an arbitration agreement shall be determined 
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under Federal law by a court of competent ju-
risdiction, rather than an arbitrator, without re-
gard to whether the party opposing arbitration 
challenges such agreement specifically or in 
conjunction with any other term of the contract 
containing such agreement.’’. 
(b) MEDICAID.— 
(1) HOME
AND
COMMUNITY-BASED
SERVICES 
AND HOME HEALTH CARE SERVICES.—Section 1915 
of the Social Security Act (42 U.S.C. 1396n) is 
amended by adding at the end the following new 
subsection: 
‘‘(m) PROHIBITING
PRE-DISPUTE
ARBITRATION 
AGREEMENTS.— 
‘‘(1) IN GENERAL.—For home and community- 
based services or home health care services provided 
under 
a 
waiver 
under 
this 
section, 
section 
1902(a)(10)(D), or any other provision authorizing 
the provision of home and community-based services 
or home health care services under this title, the 
provider of such services (and any employee, agent, 
related entity, or affiliate of such provider) shall not 
require, solicit, or accept a pre-dispute arbitration 
agreement from or on behalf of any individual re-
ceiving such services, whether the agreement is made 
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before, during, or after the first date on which serv-
ices are received, or from or on behalf of any em-
ployee, or contract employee of the provider, or any 
other individual if such individual is alleged to be 
engaged in conduct protected under section 1919(k). 
A pre-dispute arbitration agreement between such a 
provider (or entity or person) and an individual re-
ceiving services (or who formerly received services) 
shall not be valid or enforceable, without regard to 
whether such agreement was made prior to the effec-
tive date of this subsection. 
‘‘(2) DEFINITION
OF
PRE-DISPUTE
ARBITRA-
TION AGREEMENT.—The term ‘pre-dispute arbitra-
tion agreement’ means any agreement to arbitrate a 
dispute when the dispute has arisen after such 
agreement has been made. 
‘‘(3) JUDICIAL REVIEW.—A determination as to 
whether and how this subsection applies to an arbi-
tration agreement shall be determined under Federal 
law by a court of competent jurisdiction, rather than 
an arbitrator, without regard to whether the party 
opposing arbitration challenges such agreement spe-
cifically or in conjunction with any other term of the 
contract containing such agreement.’’. 
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(2) NURSING FACILITIES.—Section 1919(c) of 
the Social Security Act (42 U.S.C. 1396r(c)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(9) PROHIBITION
ON
USE
OF
PRE-DISPUTE 
ARBITRATION AGREEMENTS.— 
‘‘(A) IN GENERAL.—A nursing facility may 
not require, solicit, accept, or move to enforce 
a pre-dispute arbitration agreement from or on 
behalf of any resident, whether the agreement 
is made before, during, or after the resident’s 
admission to the facility, or from or on behalf 
of any employee, or contract employee of the fa-
cility, or any other individual if such individual 
is alleged to be engaged in conduct protected 
under subsection (k). 
‘‘(B) APPLICATION.—This paragraph shall 
apply to the nursing facility and to any other 
business or person providing or responsible for 
providing nursing services to the resident. 
‘‘(C) NO VALIDITY OR ENFORCEMENT.—A 
pre-dispute arbitration agreement shall not be 
valid or specifically enforceable against a resi-
dent or former resident of a nursing facility, 
without regard to whether the agreement was 
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made prior to or after the effective date of this 
paragraph. 
‘‘(D) DEFINITION OF PRE-DISPUTE ARBI-
TRATION AGREEMENT.—In this paragraph, the 
term ‘pre-dispute arbitration agreement’ means 
any agreement to arbitrate a dispute when the 
dispute has arisen after such agreement has 
been made. 
‘‘(E) JUDICIAL REVIEW.—A determination 
as to whether and how this paragraph applies 
to an arbitration agreement shall be determined 
under Federal law by a court of competent ju-
risdiction, rather than an arbitrator, without re-
gard to whether the party opposing arbitration 
challenges such agreement specifically or in 
conjunction with any other term of the contract 
containing such agreement.’’. 
SEC. 8. STANDARDIZED PROTOCOL FOR OBTAINING IN-
FORMED CONSENT FROM RESIDENTS PRIOR 
TO PRESCRIBING PSYCHOTROPIC DRUGS. 
(a) STANDARDIZED PROTOCOL.— 
(1) SKILLED
NURSING
FACILITIES.—Section 
1819(b) of the Social Security Act (42 U.S.C. 
1395i–3(b)) is amended by adding at the end the 
following new paragraph: 
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‘‘(9) STANDARDIZED PROTOCOL FOR OBTAIN-
ING INFORMED CONSENT FROM A RESIDENT PRIOR 
TO PRESCRIBING PSYCHOTROPIC DRUGS FOR A USE 
NOT APPROVED BY THE FOOD AND DRUG ADMINIS-
TRATION.— 
‘‘(A) PROTOCOL.—Not later than the date 
that is one year after the date of the enactment 
of this paragraph, the Secretary, taking into ac-
count the results of the study conducted by the 
Comptroller General of the United States under 
section 8(a)(3) of the Quality Care for Nursing 
Home Residents Act of 2019 and in consulta-
tion with stakeholder groups (including resi-
dents of skilled nursing facilities, family mem-
bers of such residents, advocates for such resi-
dents, long-term care ombudsmen, and pro-
viders), shall develop a standardized protocol 
for skilled nursing facilities to obtain written in-
formed consent, in accordance with this para-
graph, from a resident (or, if applicable, the 
resident’s designated health care agent or other 
surrogate under State law or regulation) prior 
to prescribing a psychotropic drug to the resi-
dent for a use not approved by the Food and 
Drug Administration. 
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‘‘(B) REQUIREMENTS.—The standardized 
protocol developed under subparagraph (A) 
shall include the following: 
‘‘(i) A requirement, with respect to a 
resident, that— 
‘‘(I) the facility, with the involve-
ment of the prescriber, inform the 
resident (or, if applicable, the resi-
dent’s designated health care agent or 
other surrogate under State law or 
regulation) of— 
‘‘(aa) possible side effects 
and risks associated with the psy-
chotropic drug, including the 
mention of any ‘black box warn-
ing’; 
‘‘(bb) treatment modalities 
that were attempted prior to the 
use of the psychotropic drug; and 
‘‘(cc) any other information 
the Secretary determines appro-
priate; 
‘‘(II) the resident (or, if applica-
ble, the resident’s designated health 
care agent or other surrogate under 
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State law or regulation) provide writ-
ten informed consent to the adminis-
tration of the psychotropic drug; and 
‘‘(III) the administration of the 
psychotropic drug is in accordance 
with any plan of care that the resi-
dent has in place, including non-phar-
macological interventions as appro-
priate that can effectively address un-
derlying medical and environmental 
causes of behavioral disorders. 
‘‘(ii) An alternative protocol for ob-
taining such written informed consent— 
‘‘(I) in the case of emergencies; 
and 
‘‘(II) in the absence of a clearly 
identified designated health care agent 
or other surrogate under State law or 
regulation. 
‘‘(iii) Other items determined appro-
priate by the Secretary. 
‘‘(C) TIMING OF INFORMED CONSENT.— 
Under the standardized protocol, a skilled nurs-
ing facility shall obtain the written informed 
consent described in subparagraph (A), with re-
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spect to a psychotropic drug and a resident of 
the facility— 
‘‘(i) prior to the initial prescribing of 
such psychotropic drug to such resident if 
such resident does not have a current pre-
scription for such psychotropic drug at the 
time such resident is admitted to the facil-
ity; and 
‘‘(ii) at least once a month to the ex-
tent that the administration of such psy-
chotropic drug to such resident is in ac-
cordance with the plan of care that the 
resident has in place. 
‘‘(D) COMPLIANCE.—Effective beginning 
on the date that is one year and 180 days after 
the date of the enactment of this paragraph, a 
skilled nursing facility shall comply with the 
standardized protocol developed under subpara-
graph (A). 
‘‘(E) NO
PREEMPTION.—Nothing in this 
paragraph shall preempt any provision of State 
or Federal law that provides broader rights 
with respect to written informed consent for 
residents of facilities.’’. 
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(2) NURSING FACILITIES.—Section 1919(b) of 
the Social Security Act (42 U.S.C. 1396r(b)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(9) STANDARDIZED PROTOCOL FOR OBTAIN-
ING INFORMED CONSENT FROM A RESIDENT PRIOR 
TO PRESCRIBING PSYCHOTROPIC DRUGS FOR A USE 
NOT APPROVED BY THE FOOD AND DRUG ADMINIS-
TRATION.— 
‘‘(A) PROTOCOL.—Not later than the date 
that is one year after the date of the enactment 
of this paragraph, the Secretary, taking into ac-
count the results of the study conducted by the 
Comptroller General of the United States under 
section 8(a)(3) of the Quality Care for Nursing 
Home Residents Act of 2019 and in consulta-
tion with stakeholder groups (including resi-
dents of skilled nursing facilities, family mem-
bers of such residents, advocates for such resi-
dents, long-term care ombudsmen, and pro-
viders), shall develop a standardized protocol 
for nursing facilities to obtain written informed 
consent, in accordance with this paragraph, 
from a resident (or, if applicable, the resident’s 
designated health care agent or other surrogate 
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‘‘(cc) any other information 
the Secretary determines appro-
priate; 
‘‘(II) the resident (or, if applica-
ble, the resident’s designated health 
care agent or other surrogate under 
State law or regulation) provide writ-
ten informed consent to the adminis-
tration of the psychotropic drug; and 
‘‘(III) the administration of the 
psychotropic drug is in accordance 
with any plan of care that the resi-
dent has in place, including non-phar-
macological interventions as appro-
priate that can effectively address un-
derlying medical and environmental 
causes of behavioral disorders. 
‘‘(ii) An alternative protocol for ob-
taining such written informed consent— 
‘‘(I) in the case of emergencies; 
and 
‘‘(II) in the absence of a clearly 
identified designated health care agent 
or other surrogate under State law or 
regulation. 
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‘‘(iii) Other items determined appro-
priate by the Secretary. 
‘‘(C) TIMING OF INFORMED CONSENT.— 
Under the standardized protocol, a nursing fa-
cility shall obtain the written informed consent 
described in subparagraph (A), with respect to 
a psychotropic drug and a resident of the facil-
ity— 
‘‘(i) prior to the initial prescribing of 
such psychotropic drug to such resident if 
such resident does not have a current pre-
scription for such psychotropic drug at the 
time such resident is admitted to the facil-
ity; and 
‘‘(ii) at least once a month to the ex-
tent that the administration of such psy-
chotropic drug to such resident is in ac-
cordance with the plan of care that the 
resident has in place. 
‘‘(D) COMPLIANCE.—Effective beginning 
on the date that is one year and 180 days after 
the date of the enactment of this paragraph, a 
nursing facility shall comply with the standard-
ized protocol developed under subparagraph 
(A). 
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‘‘(E) NO
PREEMPTION.—Nothing in this 
paragraph shall preempt any provision of State 
or Federal law that provides broader rights 
with respect to written informed consent for 
residents of facilities.’’. 
(3) GAO STUDY AND REPORT ON INFORMED 
CONSENT LAWS WITH RESPECT TO PRESCRIBING OF 
PSYCHOTROPIC DRUGS.— 
(A) STUDY.—The Comptroller General of 
the United States (in this paragraph referred to 
as the ‘‘Comptroller General’’) shall conduct a 
study of State laws and regulations concerning 
informed consent with respect to the adminis-
tration of a psychotropic drug with regard to 
the effectiveness of such laws and practices in 
changing the frequency of prescribing of psy-
chotropic drugs to older adults. The study shall 
include an analysis as to whether in the case of 
States that have not enacted such informed 
consent laws, such States have developed other 
mechanisms to guide appropriate prescribing of 
psychotropic drugs in older adults with demen-
tia. 
(B) REPORT.—Not later than 180 days 
after the date of enactment of this Act, the 
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Comptroller General shall submit to the Sec-
retary of Health and Human Services, the 
Committees on Energy and Commerce and 
Ways and Means of the House of Representa-
tives, and the Committee on Finance of the 
Senate a report containing the results of the 
study conducted under subparagraph (A), to-
gether with such recommendations as the 
Comptroller General determines appropriate. 
(b) DEVELOPMENT OF MEASURE OF UTILIZATION OF 
PSYCHOTROPIC DRUGS
FOR INCLUSION
ON NURSING 
HOME COMPARE WEBSITE.— 
(1) MEDICARE.—Section 1819(i) of the Social 
Security Act (42 U.S.C. 1395i–3(i)) is amended— 
(A) by redesignating paragraph (3) as 
paragraph (4); and 
(B) by inserting after paragraph (2) the 
following new paragraph: 
‘‘(3) DEVELOPMENT OF MEASURE OF UTILIZA-
TION OF PSYCHOTROPIC DRUGS.— 
‘‘(A) IN
GENERAL.—Not later than the 
date that is one year after the date of the en-
actment of this paragraph, the Secretary shall 
include a measure of the utilization of psycho-
tropic drugs for each skilled nursing facility for 
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inclusion on such website (or a successor 
website) as part of the quality measures or 
health inspections measures, or both such meas-
ures, under the Five-Star Quality Rating Sys-
tem established by the Administrator of the 
Centers for Medicare & Medicaid Services. 
‘‘(B) CONSIDERATIONS.—In developing the 
measure under subparagraph (A), the Secretary 
shall take into account special patient popu-
lations, special care units, appropriate diag-
noses, and other factors, as determined appro-
priate by the Secretary.’’. 
(2) MEDICAID.—Section 1919(i) of the Social 
Security Act (42 U.S.C. 1396r(i)) is amended— 
(A) by redesignating paragraph (3) as 
paragraph (4); and 
(B) by inserting after paragraph (2) the 
following new paragraph: 
‘‘(3) DEVELOPMENT OF MEASURE OF UTILIZA-
TION OF PSYCHOTROPIC DRUGS.— 
‘‘(A) IN
GENERAL.—Not later than the 
date that is one year after the date of the en-
actment of this paragraph, the Secretary shall 
include a measure of the utilization of psycho-
tropic drugs for each nursing facility for inclu-
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