I 
112TH CONGRESS 
1ST SESSION H. R. 2522 
To amend titles XVIII and XIX of the Social Security Act to improve 
oversight of nursing facilities under the Medicare and Medicaid programs 
by preventing inappropriate influence over surveyors, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 13, 2011 
Ms. ROYBAL-ALLARD introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, 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 committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to improve oversight of nursing facilities under the Medi-
care and Medicaid programs by preventing inappropriate 
influence over surveyors, and for other purposes. 
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 ‘‘Nursing Home Patient 
Protection and Standards Act of 2011’’. 
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SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SUR-
VEYORS. 
(a) MEDICARE.—Section 1819(g)(2)(E)(iii) of the 
Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)(iii)) is 
amended by adding the following at the end: ‘‘The testing 
program must be sufficiently rigorous (as determined by 
the Secretary) to ensure that surveyors are adequately 
prepared to survey and certify facilities in a consistent and 
accurate manner.’’ 
(b) MEDICAID.—Section 1919(g)(2)(E)(iii) of the So-
cial Security Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is 
amended by adding the following at the end: ‘‘The testing 
program must be sufficiently rigorous (as determined by 
the Secretary) to ensure that surveyors are adequately 
prepared to survey and certify facilities in a consistent and 
accurate manner.’’ 
SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING 
FOR STATE SURVEYS OF NURSING HOMES. 
(a) MEDICARE.—Section 1819(g)(2)(E) of the Social 
Security Act (42 U.S.C. 1395i–3(g)(2)(E)) is amended by 
adding at the end the following: 
‘‘(iv) ADEQUATE
QUALIFIED
STAFF 
FOR
SURVEY
TEAMS.—The Secretary, in 
consultation with the advisory committee 
under subparagraph (F), shall establish re-
quirements for the qualifications and com-
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pensation of members of a survey team 
under this subsection and require that a 
State employs an adequate number of indi-
viduals as members of survey teams to en-
sure adequate oversight of skilled nursing 
facilities. 
‘‘(v) CONTINUING
EDUCATION.—In 
addition to the training and testing pro-
gram required under clause (iii), the Sec-
retary shall require that State and Federal 
surveyors regularly complete an adequate 
amount (as determined by the Secretary) 
of continuing education courses that meet 
requirements determined by the Secretary 
for content and the rigor of the material 
covered by such courses. An individual 
shall not serve as a member of a survey 
team unless the individual is in compliance 
with the requirements of this clause.’’. 
(b) MEDICAID.—Section 1919(g)(2)(E) of the Social 
Security Act (42 U.S.C. 1396r(g)(2)(E)) is amended by 
adding at the end the following: 
‘‘(iv) ADEQUATE
QUALIFED
STAFF 
FOR
SURVEY
TEAMS.—The Secretary, in 
consultation with the advisory committee 
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under subparagraph (F), shall establish re-
quirements for the qualifications and com-
pensation of members of a survey team 
under this subsection and require that a 
State employs an adequate number of indi-
viduals as members of survey teams to en-
sure adequate oversight of skilled nursing 
facilities. 
‘‘(v) CONTINUING
EDUCATION.—In 
addition to the training and testing pro-
gram required under clause (iii), the Sec-
retary shall require that State and Federal 
surveyors regularly complete an adequate 
amount (as determined by the Secretary) 
of continuing education courses that meet 
requirements determined by the Secretary 
for content and the rigor of the material 
covered by such courses. No individual 
shall serve as a member of a survey team 
unless the individual is in compliance with 
the requirements of this clause.’’. 
SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY 
OF SURVEYORS. 
(a) IN GENERAL.— 
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(1) MEDICARE.—Section 1819(g) of the Social 
Security Act (42 U.S.C. 1395i–3(g)) is amended by 
adding the following at the end: 
‘‘(6) REPORTING OF INACCURACIES.— 
‘‘(A) COVERED
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘cov-
ered individual’ means an individual— 
‘‘(i) who is a member of a State sur-
vey team under this subsection; or 
‘‘(ii) who is an employee of the State 
department or agency that conducts sur-
veys under this section. 
‘‘(B) REPORTING REQUIREMENT.—A cov-
ered individual shall report to the Secretary any 
instance in which the individual suspects that— 
‘‘(i) a survey under this subsection 
fails to report or under reports an issue in 
a facility that could impact the safety or 
quality of care of the residents in such fa-
cility; or 
‘‘(ii) a member of the survey team or 
an employee of the State survey agency 
was inappropriately influenced (through 
the offering of monetary awards or 
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through undue pressure) to alter the re-
sults of the survey. 
‘‘(C) RESPONSE TO REPORT.—If the Sec-
retary receives a report under subparagraph 
(B), the Secretary shall take appropriate action, 
as determined by the Secretary, to ensure the 
accuracy of the survey. 
‘‘(D) PENALTIES
FOR
INAPPROPRIATELY 
INFLUENCING
A
SURVEYOR.—Subject to sub-
paragraph (H), any individual (including an 
employee of a skilled nursing facility or any af-
filiated corporate entity, a representative of the 
skilled nursing facility industry, a member of a 
State survey team, an employee of the State de-
partment or agency that conducts surveys 
under this section, or an elected official) who 
attempts to inappropriately influence (as de-
fined by the Secretary through regulations) the 
results of a survey under this subsection, or the 
actions of a member of a survey team or an em-
ployee of a survey agency, shall be subject to a 
civil money penalty not to exceed $10,000. The 
provisions of section 1128A (other than sub-
sections (a) and (b)) shall apply to a civil 
money penalty under the previous sentence in 
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the same manner as such provisions apply to a 
penalty or proceeding under section 1128A(a). 
‘‘(E) WHISTLEBLOWER
PROTECTIONS.— 
With respect to a covered individual, any officer 
or employee of the State may not— 
‘‘(i) 
discharge, 
demote, 
suspend, 
threaten, harass, or deny a promotion or 
other employment-related benefit to such 
individual, or in any other manner dis-
criminate against an individual in the 
terms and conditions of employment be-
cause the individual submitted a report 
under subparagraph (B); or 
‘‘(ii) file a complaint or a report 
against the individual with the appropriate 
State professional disciplinary agency be-
cause the individual submitted a report 
under subparagraph (B). 
‘‘(F) PENALTIES
FOR
VIOLATING
WHIS-
TLEBLOWER
PROTECTIONS.—Subject to sub-
paragraph (H), any officer or employee of a 
State who engages in an activity that is prohib-
ited by subparagraph (E) shall be subject to a 
civil money penalty not to exceed $50,000. The 
provisions of section 1128A (other than sub-
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sections (a) and (b)) shall apply to a civil 
money penalty under the previous sentence in 
the same manner as such provisions apply to a 
penalty or proceeding under section 1128A(a). 
‘‘(G) REQUIREMENT TO POST NOTICE.— 
Each State shall post conspicuously in an ap-
propriate location a sign (in a form specified by 
the Secretary) specifying the rights of covered 
individuals under this section. Such sign shall 
include— 
‘‘(i) a statement that a covered indi-
vidual may file a complaint with the Sec-
retary describing any violations of the pro-
visions of this paragraph by an employee 
or officer of a State; and 
‘‘(ii) information concerning the form 
and manner in which such a complaint 
should be filed. 
‘‘(H) CONSTRUCTION RELATED TO LEGIS-
LATIVE
OVERSIGHT.—For purposes of this 
paragraph, to the extent that a member of a 
State legislature requests that a covered indi-
vidual appear at a hearing of a committee of 
such legislature or asks questions of such indi-
vidual during such a hearing, the actions of 
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such member shall not be construed in a man-
ner that would subject such member to a pen-
alty under this paragraph.’’. 
(2) MEDICAID.—Section 1919(g) of the Social 
Security Act (42 U.S.C. 1396r(g)) is amended by 
adding the following at the end: 
‘‘(6) REPORTING OF INACCURACIES.— 
‘‘(A) COVERED
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘cov-
ered individual’ means an individual— 
‘‘(i) who is a member of a State sur-
vey team under this subsection; or 
‘‘(ii) who is an employee of the State 
department or agency that conducts sur-
veys under this section. 
‘‘(B) REPORTING REQUIREMENT.—A cov-
ered individual shall report to the Secretary any 
instance in which the individual suspects that— 
‘‘(i) a survey under this subsection 
fails to report or under reports an issue in 
a facility that could impact the safety or 
quality of care of the residents in such fa-
cility; or 
‘‘(ii) a member of the survey team or 
an employee of the State survey agency 
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was inappropriately influenced (through 
the offering of monetary awards or 
through undue pressure) to alter the re-
sults of the survey. 
‘‘(C) RESPONSE TO REPORT.—If the Sec-
retary receives a report under subparagraph 
(B), the Secretary shall take appropriate action, 
as determined by the Secretary, to ensure the 
accuracy of the survey. 
‘‘(D) PENALTIES
FOR
INAPPROPRIATELY 
INFLUENCING
A
SURVEYOR.—Subject to sub-
paragraph (H), any individual (including an 
employee of a skilled nursing facility or any af-
filiated corporate entity, a representative of the 
skilled nursing facility industry, a member of a 
State survey team, an employee of the State de-
partment or agency that conducts surveys 
under this section, or an elected official) who 
attempts to inappropriately influence (as de-
fined by the Secretary through regulations) the 
results of a survey under this subsection, or the 
actions of a member of a survey team or an em-
ployee of a survey agency, shall be subject to a 
civil money penalty not to exceed $10,000. The 
provisions of section 1128A (other than sub-
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