‘‘(F) CONTINUATION OF PAYMENTS PEND-
ING REMEDIATION WHEN FLEXIBILITY NEEDED 
TO PROTECT RESIDENTS.—The Secretary may 
continue payments, over a period not longer 
than 12 months after the effective date of the 
findings, under this title with respect to a nurs-
ing facility not in compliance with a require-
ment of subsection (b), (c), or (d), if—
‘‘(i) the State survey agency finds 
that ceasing payments is not in the best 
interests of residents and that continuation 
of payments would not jeopardize resi-
dents’ health and safety; 
‘‘(ii) the State survey agency finds 
that it is more appropriate to take alter-
native action to assure compliance of the
facility with the requirements than to ter-
minate the certification of the facility; and 
‘‘(iii) the State has submitted a plan 
and timetable for corrective action to the 
Secretary for approval and the Secretary 
approves the plan of corrective action.’’. 
(2) MEDICAID PROGRAM.—Section 1919(h)(2) 
of such Act (42 U.S.C. 1396r(h)(2)) is amended—
(A) in subparagraph (C), by striking ‘‘If’’ 
and inserting ‘‘Subject to subparagraph (G), 
if’’; 
(B) in subparagraph (D), by striking ‘‘In’’ 
and inserting ‘‘Subject to subparagraph (G), 
in’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(G) CONTINUATION OF PAYMENTS PEND-
ING REMEDIATION WHEN FLEXIBILITY NEEDED 
TO PROTECT RESIDENTS.—The Secretary may 
continue payments, over a period not longer 
than 12 months after the effective date of the 
findings, under this title with respect to a nurs-
ing facility not in compliance with a require-
ment of subsection (b), (c), or (d), if—
‘‘(i) the State survey agency finds 
that ceasing payments is not in the best 
interests of residents and that continuation 
of payments would not jeopardize resi-
dents’ health and safety; 
‘‘(ii) the State survey agency finds 
that it is more appropriate to take alter-
native action to assure compliance of the
facility with the requirements than to ter-
minate the certification of the facility; and 
‘‘(iii) the State has submitted a plan 
and timetable for corrective action to the 
Secretary for approval and the Secretary 
approves the plan of corrective action.’’. 
(e) ACCESS
TO INFORMAL DISPUTE RESOLUTION 
PROCESS.—
(1) MEDICARE PROGRAM.—Section 1819(g)(1) 
of such Act (42 U.S.C. 1395i–3(g)(1)) is amended 
by adding at the end the following new subpara-
graph: 
‘‘(F) 
ESTABLISHMENT
OF
INFORMAL, 
INDEPENDENT
DISPUTE
RESOLUTION
PROC-
ESS.—Each State shall establish an informal 
dispute resolution process that allows facilities 
to settle disputes involving compliance with the 
standards established under this section. Such 
process shall rely on independent third parties, 
not related to the State survey agency or the 
facilities, in resolving disputes.’’. 
(2) MEDICAID PROGRAM.—Section 1919(g)(1) 
of such Act (42 U.S.C. 1396r(g)(1)) is amended by 
adding at the end the following new subparagraph:
‘‘(F) 
ESTABLISHMENT
OF
INFORMAL, 
INDEPENDENT
DISPUTE
RESOLUTION
PROC-
ESS.—Each State shall establish an informal 
dispute resolution process that allows facilities 
to settle disputes involving compliance with the 
standards established under this section. Such 
process shall rely on independent third parties, 
not related to the State survey agency or the 
facilities, in resolving disputes.’’. 
(f) DEFERENCE TO ATTENDING PHYSICIAN DIAG-
NOSIS AND TREATMENT DECISIONS DURING THE SURVEY 
PROCESS.—
(1) MEDICARE PROGRAM.—Section 1819(g)(2) 
of such Act (42 U.S.C. 1395i–3(g)(2)) is amended 
by inserting at the end the following new subpara-
graph: 
‘‘(F) DEFERENCE TO ATTENDING PHYSI-
CIAN DIAGNOSIS AND TREATMENT.—
‘‘(i) IN GENERAL.—In the conduct of 
any surveys under this subsection and the 
compliance decisions made thereunder, sur-
veyors shall defer to the diagnosis and 
treatment decisions of the resident’s at-
tending physician and of the facility’s med-
ical director, and to a plan of care estab-
lished pursuant to subsection (b)(2), as 
long as such decisions and plans are con-
sistent with acceptable standards of prac-
tice. 
‘‘(ii) FAILURE TO DEFER TO TREAT-
ING DECISION.—Each State and the Sec-
retary shall implement programs to mon-
itor and correct instances of failure of sur-
veyors to adhere to the requirements of 
this subparagraph.’’. 
(2) MEDICAID PROGRAM.—Section 1919(g)(2) 
of such Act (42 U.S.C. 1396r(g)(2)) is amended by 
inserting at the end the following new subparagraph: 
‘‘(F) DEFERENCE TO ATTENDING PHYSI-
CIAN DIAGNOSIS AND TREATMENT.—
‘‘(i) IN GENERAL.—In the conduct of 
any surveys under this subsection and the 
compliance decisions made thereunder, sur-
veyors shall defer to the diagnosis and 
treatment decisions of the resident’s at-
tending physician and of the facility’s med-
ical director, and to a plan of care estab-
lished pursuant to subsection (b)(2), as 
long as such decisions and plans are con-
sistent with acceptable standards of prac-
tice. 
‘‘(ii) FAILURE TO DEFER TO TREAT-
ING DECISION.—The State and the Sec-
retary shall implement programs to mon-
itor and correct instances of failure of sur-
veyors to adhere to the requirements of 
this subparagraph.’’. 
(g) DISSEMINATION
OF INFORMATION
ON BEST 
PRACTICES.—
(1) 
MEDICARE
PROGRAM.—Section 
1819(g)(2)(E) of such Act (42 U.S.C. 1395i–
3(g)(2)(E)) is amended by adding at the end the fol-
lowing new clause: 
‘‘(iv) PERMITTING DISSEMINATION OF 
INFORMATION ON BEST AND INNOVATIVE 
PRACTICES.—Nothing in this section shall 
be construed as precluding a member of a 
survey team from providing information to 
facility staff on best or innovative practices 
in complying with the requirements of this 
section.’’. 
(2) 
MEDICAID
PROGRAM.—Section 
1919(g)(2)(E) 
of 
such 
Act 
(42 
U.S.C.