I 
109TH CONGRESS 
1ST SESSION H. R. 1166
To amend title XVIII of the Social Security Act to improve the quality 
of care in skilled nursing facilities under the Medicare Program through 
development of quality measures and changes in reimbursement. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 8, 2005
Ms. KAPTUR introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
the quality of care in skilled nursing facilities under 
the Medicare Program through development of quality 
measures and changes in reimbursement.
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 ‘‘Long Term Care Qual-
ity Improvement Act of 2005’’.
SEC. 2. IMPROVEMENT IN QUALITY OF LONG TERM CARE 
IN SKILLED NURSING FACILITIES UNDER 
MEDICARE. 
(a) DETAILED REPORTING OF NURSING EXPENDI-
TURES.—Section 1888 of the Social Security Act (42 
U.S.C. 1395yy) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(f) DETAILED REPORTING OF NURSING EXPENDI-
TURES.— 
‘‘(1) IN GENERAL.—For cost reports submitted 
for cost reporting periods beginning on or after four 
months after the date of the enactment of this sub-
section, skilled nursing facilities shall separately re-
port expenditures for wages and benefits for nursing 
staff (by staff level, breaking out at a minimum reg-
istered nurses, licensed professional nurses, and cer-
tified nurse assistants). 
‘‘(2) MODIFICATION OF FORM.—The Secretary, 
in consultation with private sector accountants expe-
rienced with medicare and medicaid nursing facility 
home cost reports, shall redesign such reports to 
meet the requirement of paragraph (1).’’. 
(b) DEVELOPMENT AND REPORTING OF NEW QUAL-
ITY MEASURES.—Such section is further amended by add-
ing at the end the following new subsection: 
‘‘(g) REPORTING ON QUALITY.—
‘‘(1) IN GENERAL.—The Secretary shall iden-
tify and develop in accordance with this subsection 
quality measures appropriate for use with a payment 
system under this subsection. Such measures shall 
be developed in consultation with measurement ex-
perts, the Medicare Payment Advisory Commission, 
the Institute of Medicine, and representatives of pro-
viders and consumers. 
‘‘(2) CONTENTS.—The quality measures under 
this subsection—
‘‘(A) shall include process measures; 
‘‘(B) may include structural measures, 
such as spending on direct care staffing or im-
plementation of new technologies; 
‘‘(C) may include outcome measures that 
are risk adjusted with sufficient precision to be 
used in a payment system; 
‘‘(D) shall be valid and reliable; 
‘‘(E) shall be structured in a manner so 
that data collection systems involving new tech-
nologies can be used in a manner that mini-
mizes provider burden and increases accuracy 
should be considered, particularly with respect 
to process measures;