I 
118TH CONGRESS 
1ST SESSION H. R. 3227 
To amend titles XVIII and XIX of the Social Security Act with respect 
to nursing facility requirements, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 11, 2023 
Mr. ESTES (for himself and Mr. CONNOLLY) 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 subse-
quently 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 
with respect to nursing facility requirements, 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 ‘‘Ensuring Seniors’ Ac-
cess to Quality Care Act’’. 
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SEC. 2. TRAINING AND COMPETENCY EVALUATION PRO-
GRAMS. 
(a) MEDICARE.—Section 1819(f)(2) of the Social Se-
curity Act (42 U.S.C. 1395i–3(f)(2)) is amended— 
(1) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subparagraph 
(B)(iii)(I))’’; 
(2) in subparagraph (B)— 
(A) in clause (i)— 
(i) by striking ‘‘(subject to clause 
(iii))’’; and 
(ii) by inserting ‘‘and’’ after the semi-
colon; 
(B) in clause (ii), by striking ‘‘; and’’ and 
inserting a period; and 
(C) by striking clause (iii); 
(3) by striking ‘‘A State may not delegate 
(through subcontract or otherwise) its responsibility 
under clause (iii)(II) to the skilled nursing facility.’’; 
(4) by striking subparagraphs (C) and (D); and 
(5) by adding at the end the following: 
‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN-
ING AND COMPETENCY EVALUATION PROGRAMS 
AND
NURSE
AIDE
COMPETENCY
EVALUATION 
PROGRAMS.— 
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‘‘(i) IN GENERAL.—With respect to a 
State, the Secretary shall, in consultation 
with such State, disapprove, for a period 
not to exceed 2 years, a nurse aide train-
ing and competency evaluation program or 
a nurse aide competency evaluation pro-
gram offered by or in a skilled nursing fa-
cility if such facility— 
‘‘(I) has been assessed a civil 
monetary penalty under subsection 
(h)(2)(B)(ii) 
or 
section 
1919(h)(2)(A)(ii) of not less than 
$10,697 for providing substandard 
quality of care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
skilled nursing facility that— 
‘‘(I) all deficiencies for which the 
civil monetary penalty described in 
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clause (i)(I) was assessed have been 
remedied; 
‘‘(II) the facility has not received 
deficiencies related to direct patient 
harm for substandard quality of care 
deficiencies in the prior 2 years; and 
‘‘(III) the Secretary certifies that 
the civil monetary penalty assessed 
under clause (i)(I) did not result in 
immediate jeopardy for direct patient 
harm or injury related to an abuse or 
neglect deficiency. 
For purposes of rescinding disapproval 
under this clause, the Secretary may re-
quire additional oversight of the skilled 
nursing facility for a period not to exceed 
the period of disapproval imposed under 
clause (i) with respect to such facility.’’. 
(b) MEDICAID.—Section 1919(f)(2) of the Social Se-
curity Act (42 U.S.C. 1396r(f)(2)) is amended— 
(1) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subparagraph 
(B)(iii)(I))’’; 
(2) in subparagraph (B)— 
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(A) in clause (i), by inserting ‘‘and’’ after 
the semicolon; 
(B) in clause (ii), by striking ‘‘; and’’ and 
inserting a period; 
(C) by striking clause (iii); and 
(D) by striking ‘‘A State may not delegate 
(through subcontract or otherwise) its responsi-
bility under clause (iii)(II) to the nursing facil-
ity.’’; 
(3) by striking subparagraphs (C) and (D); and 
(4) by adding at the end the following: 
‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN-
ING AND COMPETENCY EVALUATION PROGRAMS 
AND
NURSE
AIDE
COMPETENCY
EVALUATION 
PROGRAMS.— 
‘‘(i) IN GENERAL.—With respect to a 
State, the Secretary shall, in consultation 
with such State, disapprove, for a period 
not to exceed 2 years, a nurse aide train-
ing and competency evaluation program or 
a nurse aide competency evaluation pro-
gram offered by or in a nursing facility if 
such facility— 
‘‘(I) has been assessed a civil 
monetary 
penalty 
under 
section 
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1819(h)(2)(B)(ii) 
or 
subsection 
(h)(2)(A)(ii) of not less than $10,697 
for providing substandard quality of 
care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
nursing facility that— 
‘‘(I) all deficiencies for which the 
civil monetary penalty described in 
clause (i)(I) was assessed have been 
remedied; 
‘‘(II) the facility has not received 
deficiencies related to direct patient 
harm for substandard quality of care 
deficiencies in the prior 2 years; and 
‘‘(III) the Secretary certifies that 
the civil monetary penalty assessed 
under clause (i)(I) did not result in 
immediate jeopardy for direct patient 
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harm or injury related to an abuse or 
neglect deficiency. 
For purposes of rescinding disapproval 
under this clause, the Secretary may re-
quire additional oversight of the nursing 
facility for a period not to exceed the pe-
riod of disapproval imposed under clause 
(i) with respect to such facility.’’. 
(c) REGULATIONS.—Not later than 180 days after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall promulgate regulations as nec-
essary to implement the amendments made by this section. 
(d) APPLICABILITY.— 
(1) IN GENERAL.— 
(A) TIMING
OF
DETERMINATIONS.—The 
amendments made by subsections (a)(4) and 
(b)(4) of this section shall apply only to a civil 
monetary penalty if the relevant covered deter-
mination was made on or after the date of en-
actment of this Act. 
(B) 
COVERED
DETERMINATION
DE-
FINED.—The term ‘‘covered determination’’ 
means, with respect to a skilled nursing facility 
or a nursing facility in a State, a determination 
by the State or the Secretary of Health and 
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Human Services that the facility has provided 
a substandard quality of care for which a civil 
monetary 
penalty 
described 
in 
section 
1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 
Social Security Act (as such sections have been 
amended by this Act) may be assessed. 
(2) PREVIOUSLY PROHIBITED PROGRAMS.— 
(A) WAIVER.—With respect to a skilled 
nursing facility or a nursing facility subject, on 
the day before the date of enactment of this 
Act, to a prohibition under item (a) of either 
section 
1819(f)(2)(B)(iii)(I) 
or 
section 
1919(f)(2)(B)(iii)(I) of the Social Security Act 
(as in effect on the day before such date of en-
actment), such prohibition shall no longer apply 
to the facility on or after such date of enact-
ment. 
(B) SURVEY
OR
CIVIL
MONETARY
PEN-
ALTY.—With respect to a skilled nursing facil-
ity or a nursing facility subject, on the day be-
fore the date of enactment of this Act, to a pro-
hibition under item (b) or (c) of either section 
1819(f)(2)(B)(iii)(I) 
or 
section 
1919(f)(2)(B)(iii)(I) of the Social Security Act 
(as in effect on the day before such date of en-
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actment), such prohibition shall no longer apply 
to the facility on or after such date of enact-
ment upon a determination by the Secretary of 
Health and Human Services that the facility 
has corrected the issue that resulted in such 
prohibition. 
SEC. 3. PERMITTING MEDICARE AND MEDICAID PRO-
VIDERS TO ACCESS THE NATIONAL PRACTI-
TIONER DATA BANK TO CONDUCT EMPLOYEE 
BACKGROUND CHECKS. 
Section 1921(b)(6) of the Social Security Act (42 
U.S.C. 1396r–2(b)(6)) is amended— 
(1) by striking ‘‘and other health care entities 
(as defined in section 431 of the Health Care Qual-
ity Improvement Act of 1986)’’ and inserting ‘‘, 
other health care entities (as defined in section 431 
of the Health Care Quality Improvement Act of 
1986), providers of services (as defined in section 
1861(u)), suppliers (as defined in section 1861(d)), 
and providers of items or services under a State plan 
under this title (or a waiver of such a plan)’’; and 
(2) by striking ‘‘such hospitals or other health 
care entities’’ and inserting ‘‘such hospitals, health 
care entities, providers, or suppliers’’. 
Æ 
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