H. R. 3590—583 
paragraph (2) to the Secretary in a standardized format, 
and such other regulations as are necessary to carry out 
this subsection. Such final regulations shall ensure that 
the facility certifies, as a condition of participation and 
payment under the program under title XVIII or XIX, 
that the information reported by the facility in accordance 
with such final regulations is, to the best of the facility’s 
knowledge, accurate and current. 
‘‘(B) GUIDANCE.—The Secretary shall provide guidance 
and technical assistance to States on how to adopt the 
standardized format under subparagraph (A). 
‘‘(4) NO EFFECT ON EXISTING REPORTING REQUIREMENTS.— 
Nothing in this subsection shall reduce, diminish, or alter any 
reporting requirement for a facility that is in effect as of the 
date of the enactment of this subsection. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) ADDITIONAL DISCLOSABLE PARTY.—The term ‘addi-
tional disclosable party’ means, with respect to a facility, 
any person or entity who— 
‘‘(i) exercises operational, financial, or managerial 
control over the facility or a part thereof, or provides 
policies or procedures for any of the operations of the 
facility, or provides financial or cash management serv-
ices to the facility; 
‘‘(ii) leases or subleases real property to the facility, 
or owns a whole or part interest equal to or exceeding 
5 percent of the total value of such real property; 
or 
‘‘(iii) provides management or administrative serv-
ices, management or clinical consulting services, or 
accounting or financial services to the facility. 
‘‘(B) FACILITY.—The term ‘facility’ means a disclosing 
entity which is— 
‘‘(i) a skilled nursing facility (as defined in section 
1819(a)); or 
‘‘(ii) a nursing facility (as defined in section 
1919(a)). 
‘‘(C) MANAGING
EMPLOYEE.—The term ‘managing 
employee’ means, with respect to a facility, an individual 
(including a general manager, business manager, adminis-
trator, director, or consultant) who directly or indirectly 
manages, advises, or supervises any element of the prac-
tices, finances, or operations of the facility. 
‘‘(D) ORGANIZATIONAL STRUCTURE.—The term ‘organiza-
tional structure’ means, in the case of— 
‘‘(i) a corporation, the officers, directors, and share-
holders of the corporation who have an ownership 
interest in the corporation which is equal to or exceeds 
5 percent; 
‘‘(ii) a limited liability company, the members and 
managers of the limited liability company (including, 
as applicable, what percentage each member and man-
ager has of the ownership interest in the limited 
liability company); 
‘‘(iii) a general partnership, the partners of the 
general partnership;
H. R. 3590—584 
‘‘(iv) a limited partnership, the general partners 
and any limited partners of the limited partnership 
who have an ownership interest in the limited partner-
ship which is equal to or exceeds 10 percent; 
‘‘(v) a trust, the trustees of the trust; 
‘‘(vi) an individual, contact information for the indi-
vidual; and 
‘‘(vii) any other person or entity, such information 
as the Secretary determines appropriate.’’. 
(b) PUBLIC AVAILABILITY OF INFORMATION.—Not later than the 
date that is 1 year after the date on which the final regulations 
promulgated under section 1124(c)(3)(A) of the Social Security Act, 
as added by subsection (a), are published in the Federal Register, 
the Secretary of Health and Human Services shall make the 
information reported in accordance with such final regulations avail-
able to the public in accordance with procedures established by 
the Secretary. 
(c) CONFORMING AMENDMENTS.— 
(1) IN GENERAL.— 
(A) SKILLED NURSING FACILITIES.—Section 1819(d)(1) 
of the Social Security Act (42 U.S.C. 1395i–3(d)(1)) is 
amended by striking subparagraph (B) and redesignating 
subparagraph (C) as subparagraph (B). 
(B) NURSING
FACILITIES.—Section 1919(d)(1) of the 
Social Security Act (42 U.S.C. 1396r(d)(1)) is amended by 
striking subparagraph (B) and redesignating subparagraph 
(C) as subparagraph (B). 
(2) EFFECTIVE DATE.—The amendments made by paragraph 
(1) shall take effect on the date on which the Secretary makes 
the information described in subsection (b)(1) available to the 
public under such subsection. 
SEC. 6102. ACCOUNTABILITY REQUIREMENTS FOR SKILLED NURSING 
FACILITIES AND NURSING FACILITIES. 
Part A of title XI of the Social Security Act (42 U.S.C. 1301 
et seq.), as amended by sections 6002 and 6004, is amended by 
inserting after section 1128H the following new section: 
‘‘SEC. 1128I. ACCOUNTABILITY REQUIREMENTS FOR FACILITIES. 
‘‘(a) DEFINITION OF FACILITY.—In this section, the term ‘facility’ 
means— 
‘‘(1) a skilled nursing facility (as defined in section 1819(a)); 
or 
‘‘(2) a nursing facility (as defined in section 1919(a)). 
‘‘(b) EFFECTIVE COMPLIANCE AND ETHICS PROGRAMS.— 
‘‘(1) REQUIREMENT.—On or after the date that is 36 months 
after the date of the enactment of this section, a facility shall, 
with respect to the entity that operates the facility (in this 
subparagraph referred to as the ‘operating organization’ or 
‘organization’), have in operation a compliance and ethics pro-
gram that is effective in preventing and detecting criminal, 
civil, and administrative violations under this Act and in pro-
moting quality of care consistent with regulations developed 
under paragraph (2). 
‘‘(2) DEVELOPMENT OF REGULATIONS.— 
‘‘(A) IN
GENERAL.—Not later than the date that is 
2 years after such date of the enactment, the Secretary,
H. R. 3590—585 
working jointly with the Inspector General of the Depart-
ment of Health and Human Services, shall promulgate 
regulations for an effective compliance and ethics program 
for operating organizations, which may include a model 
compliance program. 
‘‘(B) DESIGN OF REGULATIONS.—Such regulations with 
respect to specific elements or formality of a program shall, 
in the case of an organization that operates 5 or more 
facilities, vary with the size of the organization, such that 
larger organizations should have a more formal program 
and include established written policies defining the stand-
ards and procedures to be followed by its employees. Such 
requirements may specifically apply to the corporate level 
management of multi unit nursing home chains. 
‘‘(C) EVALUATION.—Not later than 3 years after the 
date of the promulgation of regulations under this para-
graph, the Secretary shall complete an evaluation of the 
compliance and ethics programs required to be established 
under this subsection. Such evaluation shall determine if 
such programs led to changes in deficiency citations, 
changes in quality performance, or changes in other metrics 
of patient quality of care. The Secretary shall submit to 
Congress a report on such evaluation and shall include 
in such report such recommendations regarding changes 
in the requirements for such programs as the Secretary 
determines appropriate. 
‘‘(3) REQUIREMENTS
FOR
COMPLIANCE
AND
ETHICS
PRO-
GRAMS.—In this subsection, the term ‘compliance and ethics 
program’ means, with respect to a facility, a program of the 
operating organization that— 
‘‘(A) has been reasonably designed, implemented, and 
enforced so that it generally will be effective in preventing 
and detecting criminal, civil, and administrative violations 
under this Act and in promoting quality of care; and 
‘‘(B) includes at least the required components specified 
in paragraph (4). 
‘‘(4) REQUIRED COMPONENTS OF PROGRAM.—The required 
components of a compliance and ethics program of an operating 
organization are the following: 
‘‘(A) The organization must have established compli-
ance standards and procedures to be followed by its 
employees and other agents that are reasonably capable 
of reducing the prospect of criminal, civil, and administra-
tive violations under this Act. 
‘‘(B) Specific individuals within high-level personnel 
of the organization must have been assigned overall respon-
sibility to oversee compliance with such standards and 
procedures and have sufficient resources and authority to 
assure such compliance. 
‘‘(C) The organization must have used due care not 
to delegate substantial discretionary authority to individ-
uals whom the organization knew, or should have known 
through the exercise of due diligence, had a propensity 
to engage in criminal, civil, and administrative violations 
under this Act. 
‘‘(D) The organization must have taken steps to commu-
nicate effectively its standards and procedures to all
H. R. 3590—586 
employees and other agents, such as by requiring participa-
tion in training programs or by disseminating publications 
that explain in a practical manner what is required. 
‘‘(E) The organization must have taken reasonable 
steps to achieve compliance with its standards, such as 
by utilizing monitoring and auditing systems reasonably 
designed to detect criminal, civil, and administrative viola-
tions under this Act by its employees and other agents 
and by having in place and publicizing a reporting system 
whereby employees and other agents could report violations 
by others within the organization without fear of retribu-
tion. 
‘‘(F) The standards must have been consistently 
enforced through appropriate disciplinary mechanisms, 
including, as appropriate, discipline of individuals respon-
sible for the failure to detect an offense. 
‘‘(G) After an offense has been detected, the organiza-
tion must have taken all reasonable steps to respond appro-
priately to the offense and to prevent further similar 
offenses, including any necessary modification to its pro-
gram to prevent and detect criminal, civil, and administra-
tive violations under this Act. 
‘‘(H) The organization must periodically undertake 
reassessment of its compliance program to identify changes 
necessary to reflect changes within the organization and 
its facilities. 
‘‘(c) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PRO-
GRAM.— 
‘‘(1) IN GENERAL.—Not later than December 31, 2011, the 
Secretary shall establish and implement a quality assurance 
and performance improvement program (in this subparagraph 
referred to as the ‘QAPI program’) for facilities, including multi 
unit chains of facilities. Under the QAPI program, the Secretary 
shall establish standards relating to quality assurance and 
performance improvement with respect to facilities and provide 
technical assistance to facilities on the development of best 
practices in order to meet such standards. Not later than 1 
year after the date on which the regulations are promulgated 
under paragraph (2), a facility must submit to the Secretary 
a plan for the facility to meet such standards and implement 
such 
best 
practices, 
including 
how 
to 
coordinate 
the 
implementation of such plan with quality assessment and 
assurance activities conducted under sections 1819(b)(1)(B) and 
1919(b)(1)(B), as applicable. 
‘‘(2) REGULATIONS.—The Secretary shall promulgate regula-
tions to carry out this subsection.’’. 
SEC. 6103. NURSING HOME COMPARE MEDICARE WEBSITE. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819 of the Social Security Act 
(42 U.S.C. 1395i–3) is amended— 
(A) by redesignating subsection (i) as subsection (j); 
and 
(B) by inserting after subsection (h) the following new 
subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMATION.—