I 
114TH CONGRESS 
1ST SESSION 
H. R. 952 
To amend titles XVIII and XIX of the Social Security Act to establish 
a minimum direct care registered nurse staffing requirement at nursing 
facilities and skilled nursing facilities under Medicare and Medicaid and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 12, 2015 
Ms. SCHAKOWSKY (for herself, Mr. BLUMENAUER, Mr. RANGEL, Ms. LOF-
GREN, Ms. ROYBAL-ALLARD, and Mr. PAYNE) introduced the following 
bill; which was referred to the Committee on Ways and Means, and in 
addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to establish a minimum direct care registered nurse staff-
ing requirement at nursing facilities and skilled nursing 
facilities under Medicare and Medicaid 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 ‘‘Put a Registered 
Nurse in the Nursing Home Act of 2015’’. 
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SEC. 2. ESTABLISHMENT OF MINIMUM DIRECT CARE REG-
ISTERED NURSE STAFFING REQUIREMENT AT 
NURSING FACILITIES AND SKILLED NURSING 
FACILITIES UNDER MEDICARE AND MED-
ICAID. 
(a) MEDICARE SKILLED NURSING FACILITIES.—Sec-
tion 1819(b)(4)(C) of the Social Security Act (42 U.S.C. 
1395i–3(b)(4)(C)) is amended— 
(1) in clause (i)— 
(A) by striking ‘‘Except as provided in 
clause (ii), a’’ and inserting ‘‘A’’; and 
(B) by striking all that follows ‘‘residents’’ 
and inserting a period; and 
(2) by striking clause (ii) and inserting the fol-
lowing: 
‘‘(ii) USE
OF
DIRECT
CARE
REG-
ISTERED NURSE.—A skilled nursing facil-
ity must use the services of at least 1 reg-
istered professional nurse to provide as-
sessment, surveillance, and direct care to 
residents 24 hours a day, 7 days a week. 
In the preceding sentence, the term ‘sur-
veillance’ means the purposeful and ongo-
ing acquisition, interpretation, and syn-
thesis of residents’ data for clinical deci-
sionmaking.’’. 
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(b) 
MEDICAID
NURSING
FACILITIES.—Section 
1919(b)(4)(C) of the Social Security Act (42 U.S.C. 
1396r(b)(4)(C)) is amended— 
(1) in the heading, by striking ‘‘; FACILITY 
WAIVERS’’; 
(2) in clause (i)— 
(A) by striking ‘‘With respect to’’ and all 
that follows through ‘‘clause (ii), must provide’’ 
and inserting ‘‘A nursing facility must provide’’; 
and 
(B) by striking all that follows ‘‘residents’’ 
and inserting a period; and 
(3) by striking clauses (ii) and (iii) and insert-
ing the following: 
‘‘(ii) USE
OF
DIRECT
CARE
REG-
ISTERED NURSE.—A nursing facility must 
use the services of at least 1 registered 
professional nurse to provide assessment, 
surveillance, and direct care to residents 
24 hours a day, 7 days a week. In the pre-
ceding sentence, the term ‘surveillance’ 
means the purposeful and ongoing acquisi-
tion, interpretation, and synthesis of resi-
dents’ data for clinical decisionmaking.’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to payments made for 
items and services furnished on or after the first day of 
the first calendar quarter beginning on or after the date 
that is 1 year after the date of the enactment of this Act. 
Æ 
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