1396r(g)(2)(E)) is amended by adding at the end 
the following new clause: 
‘‘(iv) PERMITTING DISSEMINATION OF 
INFORMATION ON BEST AND INNOVATIVE 
PRACTICES.—Nothing in this section shall 
be construed as precluding a member of a 
survey team from providing information to 
facility staff on best or innovative practices 
in complying with the requirements of this 
section.’’. 
(h) REMOVING BARRIERS THAT DETER NEW MAN-
AGEMENT FROM TAKING OVER AND IMPROVING PROB-
LEM FACILITIES.—
(1) MEDICARE PROGRAM.—Section 1819(h) of 
such Act (42 U.S.C. 1395i–3(h)) is amended by 
adding at the end the following new paragraph: 
‘‘(7) FOSTERING IMPROVEMENT OF FACILITIES 
WITH
POOR
COMPLIANCE
HISTORIES.—The Sec-
retary shall provide incentives for operators with his-
tories of good compliance to acquire facilities with 
poor compliance histories. Such incentives shall be 
designed to promote the sustained provision of high-
quality care and shall only be made available in the 
case of bona fide, arm’s-length sale of facilities with 
poor compliance histories.’’.
(2) MEDICAID PROGRAM.—Section 1919(h) of 
such Act (42 U.S.C. 1396r(h)) is amended by add-
ing at the end the following new paragraph: 
‘‘(10) FOSTERING
IMPROVEMENT
OF
FACILI-
TIES
WITH
POOR
COMPLIANCE
HISTORIES.—The 
Secretary shall provide incentives for operators with 
histories of good compliance to acquire facilities with 
poor compliance histories. Such incentives shall be 
designed to promote the sustained provision of high-
quality care and shall only be made available in the 
case of bona fide, arm’s-length sale of facilities with 
poor compliance histories.’’. 
(i) ALLOWING APPEALS OF ALL DEFICIENCIES.—
(1) MEDICARE PROGRAM.—Section 1819(h) of 
such Act, as amended by subsection (g)(1), is fur-
ther amended by adding at the end the following 
new paragraph: 
‘‘(8) RIGHT TO APPEAL ALL DEFICIENCY CITA-
TIONS.—Notwithstanding any other provision of law, 
a facility may appeal any deficiency determination 
under this section with respect to which a penalty 
has not been imposed in the same manner as the fa-
cility may appeal such determination if a penalty 
had been imposed.’’.
(2) MEDICAID PROGRAM.—Section 1919(h) of 
such Act, as amended by subsection (g)(2), is fur-
ther amended by adding at the end the following 
new paragraph: 
‘‘(11) RIGHT TO APPEAL ALL DEFICIENCY CITA-
TIONS.—Notwithstanding any other provision of law, 
a facility may appeal any deficiency determination 
under this section with respect to which a penalty 
has not been imposed in the same manner as the fa-
cility may appeal such determination if a penalty 
had been imposed.’’. 
(j) ENCOURAGEMENT OF EXCELLENCE IN NURSING 
FACILITY CARE.—
(1) MEDICARE PROGRAM.—Section 1819(h)(2) 
of such Act is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) AWARD
PROGRAMS.—The Secretary 
shall establish a program that rewards skilled 
nursing facilities that provide the highest qual-
ity care in a manner similar to that required to 
be 
established 
by 
States 
under 
section 
1919(h)(2)(F). Such program may use public 
recognition, 
incentive 
payments, 
or 
other 
means.’’.
(2) 
MEDICAID
PROGRAM.—Section 
1919(h)(2)(F) of such Act is amended by striking 
‘‘may establish’’ and inserting ‘‘shall establish’’. 
(k) EFFECTIVE DATE.—The amendments made by 
this section shall take effect 1 month after the date of 
the enactment of this Act except in cases where regula-
tions are needed to implement these changes and in such 
cases shall be effective 6 months after such enactment 
date.
Æ