I
107TH CONGRESS
1ST SESSION
H. R. 3238
To amend title XVIII of the Social Security Act to provide for patient
protection by limiting the number of mandatory overtime hours a nurse
may be required to work in certain providers of services to which pay-
ments are made under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 6, 2001
Mr. STARK (for himself, Mr. LATOURETTE, Mr. RANGEL, Mr. BARRETT, Mr.
KLECZKA, Mr. POMEROY, Mr. LEWIS of Georgia, Mr. WAXMAN, Mr.
COYNE, Ms. SCHAKOWSKY, Mr. TOWNS, Mr. FILNER, Mr. MURTHA, Ms.
KILPATRICK, Ms. SOLIS, Mr. SANDLIN, Mr. OWENS, Ms. LEE, Mr.
WEINER, Mr. BRADY of Pennsylvania, Mr. CONYERS, Ms. PELOSI, Ms.
EDDIE BERNICE JOHNSON of Texas, Mr. ACKERMAN, Ms. ROYBAL-AL-
LARD, Mr. GEORGE
MILLER
of California, Mr. FRANK, and Mr.
MCDERMOTT) 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 committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for patient protection by limiting the number of manda-
tory overtime hours a nurse may be required to work
in certain providers of services to which payments are
made under the Medicare Program.
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 ‘‘Safe Nursing and Pa-
tient Care Act of 2001’’.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) The Federal Government has a substantial
interest in assuring that delivery of health care serv-
ices to patients in health care facilities is adequate
and safe.
(2) Research, including a recent study by the
Harvard School of Public Health, documents that
higher nurse staffing levels result in better patient
outcomes, yet health care providers report substan-
tial difficulties in recruiting and retaining sufficient
nursing staff, as evidenced by the approximately
500,000 licensed nurses who are not practicing nurs-
ing.
(3) While job dissatisfaction and overtime work
are contributing to the departure of nurses from
their profession, as highlighted by a recent report of
the Comptroller General of the United States, health
care providers continue to make use of mandatory
overtime as a staffing method.
(4) The widespread practice of requiring nurses
to work extended shifts and forego days off causes
nurses to frequently provide care in a state of fa-
tigue, contributing to medical errors and other con-
sequences that compromise patient safety.
(5) Limitations on mandatory overtime will en-
sure that health care facilities throughout the coun-
try operate in a manner that safeguards public safe-
ty and guarantees the delivery of quality health care
services and facilitates the retention and recruitment
of nurses.
SEC. 3. LIMITATIONS ON MANDATORY OVERTIME FOR
NURSES.
(a) PROVIDER AGREEMENTS.—Section 1866 of the
Social Security Act (42 U.S.C. 1395cc) is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (R), by striking
‘‘and’’ at the end;
(B) in subparagraph (S), by striking the
period and inserting ‘‘, and’’; and
(C) by inserting after subparagraph (S),
the following:
‘‘(T) to comply with the requirements of sub-
section (j) (relating to limitations on mandatory
overtime for nurses).’’; and
(2) by adding at the end the following new sub-
section:
‘‘(j) LIMITATIONS ON MANDATORY OVERTIME FOR
NURSES.—For purposes of subsection (a)(1)(T), the re-
quirements of this subsection are the following:
‘‘(1) PROHIBITION
ON
MANDATORY
OVER-
TIME.—Except as provided in this subsection, a pro-
vider of services shall not, directly or indirectly, re-
quire a nurse to work in excess of any of the fol-
lowing:
‘‘(A) The scheduled work shift or duty pe-
riod of the nurse.
‘‘(B) 12 hours in a 24-hour period.
‘‘(C) 80 hours in a consecutive 14-day pe-
riod.
‘‘(2) EXCEPTIONS.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the requirements of paragraph (1)
shall not apply to a provider of services during
a declared state of emergency if the provider is
requested, or otherwise is expected, to provide
an exceptional level of emergency or other med-
ical services to the community.
‘‘(B) LIMITATIONS.—With respect to a
provider of services to which subparagraph (A)
applies, a nurse may only be required to work
for periods in excess of the periods described in
paragraph (1) if—
‘‘(i) the provider has made reasonable
efforts to fill the immediate staffing needs
of the provider through alternative means;
and
‘‘(ii) the duration of the work require-
ment does not extend past the earlier of—
‘‘(I) the date on which the de-
clared state of emergency ends; or
‘‘(II) the date on which the pro-
vider’s direct role in responding to the
medical needs resulting from the de-
clared state of emergency ends.
‘‘(3) REPORT OF VIOLATIONS.—
‘‘(A) RIGHT TO REPORT.—
‘‘(i) IN GENERAL.—A nurse may file a
complaint with the Secretary against a
provider of services who violates the provi-
sions of this subsection.
‘‘(ii) 
PROCEDURE.—The 
Secretary
shall establish a procedure under which a
nurse may file a complaint under clause
(i).
‘‘(B) INVESTIGATION
OF
COMPLAINT.—
The Secretary shall investigate complaints of
violations filed by a nurse under subparagraph
(A).
‘‘(C) ACTIONS.—If the Secretary deter-
mines that a provider of services has violated
the provisions of this subsection, the Secretary
shall require the provider to establish a plan of
action to eliminate the occurrence of such viola-
tion, and may seek civil money penalties under
paragraph (7).
‘‘(4) 
NURSE
NONDISCRIMINATION
PROTEC-
TIONS.—
‘‘(A) IN GENERAL.—A provider of services
shall not penalize, discriminate, or retaliate in
any manner with respect to any aspect of em-
ployment, including discharge, promotion, com-
pensation, or terms, conditions, or privileges of
employment against a nurse who refuses to
work mandatory overtime or who in good faith,
individually or in conjunction with another per-
son or persons—
‘‘(i) reports a violation or suspected
violation of this subsection to a public reg-
ulatory agency, a private accreditation
body, or the management personnel of the
provider of services;
‘‘(ii) initiates, cooperates, or otherwise
participates in an investigation or pro-
ceeding brought by a regulatory agency or
private accreditation body concerning mat-
ters covered by this subsection; or
‘‘(iii) informs or discusses with other
employees, with representatives of those
employees, or with representatives of asso-
ciations of health care professionals, viola-
tions or suspected violations of this sub-
section.
‘‘(B) RETALIATORY
REPORTING.—A pro-
vider of services may not file a complaint or a
report against a nurse with the appropriate
State professional disciplinary agency because
the nurse refused to comply with a request to
work mandatory overtime.
‘‘(C) GOOD FAITH.—For purposes of this
paragraph, a nurse is deemed to be acting in
good faith if the nurse reasonably believes—
‘‘(i) that the information reported or
disclosed is true; and
‘‘(ii) that a violation has occurred or
may occur.
‘‘(5) NOTICE.—
‘‘(A) REQUIREMENT TO POST NOTICE.—
Each provider of services shall post conspicu-
ously in an appropriate location a sign (in a
form specified by the Secretary) specifying
rights of nurses under this section.
‘‘(B) RIGHT TO FILE COMPLAINT.—Such
sign shall include a statement that a nurse may
file a complaint with the Secretary against a
provider of services who violates the provisions
of this subsection and information with respect
to the manner of filing such a complaint.
‘‘(6) POSTING OF NURSE SCHEDULES.—A pro-
vider of services shall regularly post in a conspicuous
manner the nurse schedules (for such periods of
time that the Secretary determines appropriate by
type or class of provider of services) for the depart-
ment or unit involved, and shall make available upon
request to nurses assigned to the department or unit
the daily nurse schedule for such department or
unit.
‘‘(7) CIVIL MONEY PENALTY.—
ship, as determined by the Secretary, penalties im-
posed on the provider of services while under pre-
vious ownership shall no longer be published by the
Secretary on such Internet site after the 1-year pe-
riod beginning on the date of change in ownership.
‘‘(8) RULE
OF
CONSTRUCTION.—Nothing in
this subsection shall be construed as precluding a
nurse from voluntarily working more than any of the
periods of time described in paragraph (1) so long
as such work is done consistent with professional
standards of safe patient care.
‘‘(9) DEFINITIONS.—In this subsection:
‘‘(A) MANDATORY OVERTIME.—The term
‘mandatory overtime’ means hours worked in
excess of the periods of time described in para-
graph (1), except as provided in paragraph (2),
pursuant to any request made by a provider of
services to a nurse which, if refused or declined
by the nurse involved, may result in an adverse
employment consequence to the nurse, including
discharge, discipline, loss of promotion, or retal-
iatory reporting of the nurse to the State pro-
fessional disciplinary agency involved.
‘‘(B) OVERTIME.—The term ‘overtime’
means time worked in excess of the periods of
time described in paragraph (1).
‘‘(C) NURSE.—The term ‘nurse’ means a
registered nurse or a licensed practical nurse.
‘‘(D) PROVIDER OF SERVICES.—The term
‘provider of services’ means—
‘‘(i) a hospital,
‘‘(ii) a hospital outpatient department,
‘‘(iii) a critical access hospital,
‘‘(iv) an ambulatory surgical center,
‘‘(v) a home health agency,
‘‘(vi) a rehabilitation agency,
‘‘(vii) a clinic, including a rural health
clinic, or
‘‘(viii) a Federally qualified health
center.
‘‘(E) DECLARED STATE OF EMERGENCY.—
The term ‘declared state of emergency’ means
an officially designated state of emergency that
has been declared by the Federal Government
or the head of the appropriate State or local
governmental agency having authority to de-
clare that the State, county, municipality, or lo-
cality is in a state of emergency, but does not
include a state of emergency that results from
a labor dispute in the health care industry or
consistent understaffing.
‘‘(F) 
STANDARDS
OF
SAFE
PATIENT
CARE.—The term ‘standards of safe patient
care’ means the recognized professional stand-
ards governing the profession of the nurse in-
volved.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall take effect 1 year after the date of enact-
ment of this Act.
SEC. 4. REPORTS.
(a) STANDARDS
ON SAFE WORKING HOURS
FOR
NURSES.—
(1) STUDY.—The Secretary of Health and
Human Services, acting through the Director of the
Agency for Healthcare Research and Quality, shall
conduct a study to establish appropriate standards
for the maximum number of hours that a nurse, who
furnishes health care to patients, may work without
compromising the safety of such patients. Such
standards may vary by provider of service and by de-
partment within a provider of services, by duties or
functions carried out by nurses, by shift, and by
other factors that the Director determines appro-
priate. The Director may contract with an eligible
entity or organization to carry out the study under
this paragraph.
(2) REPORT.—Not later than 2 years after the
date of the enactment of this Act, the Secretary
shall submit to Congress a report on the study con-
ducted under paragraph (1), and shall include rec-
ommendations for such appropriate standards of
maximum work hours.
(b) REPORT ON MANDATORY OVERTIME IN FEDER-
ALLY OPERATED MEDICAL FACILITIES.—
(1) STUDY.—
(A) IN GENERAL.—The Director of the Of-
fice of Management and Budget shall conduct
a study to determine the extent to which feder-
ally operated medical facilities have in effect
practices and policies with respect to overtime
requirements for nurses that are inconsistent
with the provisions of section 1866(j) of the So-
cial Security Act, as added by section 3.
(B) FEDERALLY OPERATED MEDICAL FA-
CILITIES
DEFINED.—In this subsection, the
term ‘‘federally operated medical facilities’’
means acute care hospitals, freestanding clinics,
and home health care clinics that are operated
by the Department of Veterans Affairs, the De-
partment of Defense, or any other department
or agency of the United States.
(2) REPORT.—Not later than 6 months after
the date of the enactment of this Act, the Director
of the Office of Management and Budget shall sub-
mit to Congress a report on the study conducted
under paragraph (1) and shall include recommenda-
tions for the implementation of policies within feder-
ally operated medical facilities with respect to over-
time requirements for nurses that are consistent
with such section 1866(j), as so added.
Æ