‘‘(i) DIRECTOR
OF
NURSING
SERV-
ICES.—An individual who serves full time
as a director of nursing services and who
is a registered professional nurse.
‘‘(ii) ASSISTANT DIRECTOR OF NURS-
ING SERVICES.—An individual who serves
full time as an assistant director of nurs-
ing services and who is a registered profes-
sional nurse, except that in a facility with
fewer than 100 beds, such individual may
serve part time and may also serve as a di-
rect care clinical nursing supervisor.
‘‘(iii) DIRECTOR OF IN-SERVICE EDU-
CATION.—An individual who serves full
time as a director of in-service education,
who is a registered professional nurse, and
who has, to the extent practicable and ap-
propriate, training in adult education and
gerontology, except that in a facility with
fewer than 100 beds, such individual may
serve part time.
‘‘(iv) DIRECT CARE CLINICAL NURS-
ING
SUPERVISOR.—For each shift each
day, an individual who serves full time as
a direct care clinical nursing supervisor
and who is a registered professional nurse,
except that in a facility with fewer than
100 beds, such an individual may serve
part time and may also serve as an assist-
ant director of nursing.
An individual may not satisfy more than one re-
quirement of clauses (i) through (iv), except as
specifically provided.’’.
(b) 
CONFORMING
AMENDMENTS.—Sections
1819(b)(4) and 1919(b)(4) of such Act (42 U.S.C. 1395i–
3(b)(4); 1396r(b)(4)) are each amended in subparagraph
(D)(v), as added by section 2(a) and amended by section
3(b) of this Act, by striking ‘‘and paragraph (8)’’ and by
inserting ‘‘, paragraph (8), and subsection (d)(1)(D)’’.
(c) PAYMENT MODIFICATION.—
(1) MEDICARE.—Section 1888(e)(4)(G)(iv) of
such Act (42 U.S.C. 1395yy(e)(4)(G)(iv)), as added
by section 2(b)(1) of this Act, is amended by strik-
ing ‘‘section 1819(b)(4)(D)’’ and inserting ‘‘sub-
sections (b)(4)(D) and (d)(1)(D) of section 1819’’.
(2) MEDICAID.—Section 1902(a)(13)(A)(v) of
such Act (42 U.S.C. 1396a(a)(13)(A)(v)), as added
by section 2(b)(2) of this Act, is amended by strik-
ing ‘‘section 1919(b)(4)(D)’’ and inserting ‘‘sub-
sections (b)(4)(D) and (d)(1)(D) of section 1919’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services provided on or after
the date that is two years after the date of enactment of
this Act.
SEC. 5. APPLICATION OF REQUIREMENTS TO ALL BEDS.
(a) MEDICARE.—Section 1819 of the Social Security
Act (42 U.S.C. 1395i–3) is amended—
(1) by redesignating subsection (i) as subsection
(j); and
(2) by inserting after subsection (h) the fol-
lowing new subsection:
‘‘(i) APPLICABILITY OF PROTECTIONS TO ALL RESI-
DENTS.—The provisions of this section shall apply with
respect to all residents of a skilled nursing facility, without
regard to whether the resident is entitled to have payment
made for skilled nursing facility services under this title.’’.
(b) MEDICAID.—Section 1919(g) of the Social Secu-
rity Act (42 U.S.C. 1396r(g)) is amended by adding at
the end the following new paragraph:
(1) by redesignating subsection (i) as subsection
(j); and
(2) by inserting after subsection (h) the fol-
lowing new subsection:
‘‘(i) APPLICABILITY OF PROTECTIONS TO ALL RESI-
DENTS.—The provisions of this section shall apply with
respect to all residents of a nursing facility, without regard
to whether the resident is entitled to have payment made
for nursing facility services under the State plan or under
any other provision of this Act.’’.
Æ