I 
109TH CONGRESS 
2D SESSION 
H. R. 6199 
To improve the quality of, and access to, long-term care. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 27, 2006 
Ms. GINNY BROWN-WAITE of Florida (for herself and Mr. CAMP) 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 com-
mittee concerned 
A BILL 
To improve the quality of, and access to, long-term care. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Long-term Care Quality and Modernization Act of 
2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE AND MEDICAID MODERNIZATION 
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Sec. 101. Joint training of surveyors and providers. 
Sec. 102. Facility-based training for new surveyors. 
Sec. 103. Resumption of nurse aide training program after correction of defi-
ciencies. 
Sec. 104. Clarifying and eliminating the distinction between physician super-
vision requirements for skilled nursing facilities and nursing fa-
cilities. 
Sec. 105. Permitting split or shared billing by physicians and nurse practi-
tioners in skilled nursing facilities. 
Sec. 106. Permitting nurse practitioners employed by skilled nursing facilities 
to certify skilled care. 
Sec. 107. Modernization of therapy caps. 
Sec. 108. Establishment of a Medicare skilled nursing facility specific wage 
index. 
Sec. 109. Authority to exclude high cost and low probability drugs used in the 
treatment of cancer from the Medicare prospective payment 
system for skilled nursing facilities. 
Sec. 110. Exclusion of all ambulance services from the Medicare prospective 
payment system for skilled nursing facilities. 
Sec. 111. Authority to exclude additional items and services from the Medicare 
prospective payment system for skilled nursing facilities. 
Sec. 112. Elimination of Medicare 3-day post-hospital stay requirement for cov-
erage of skilled nursing facility services. 
TITLE II—WORKFORCE SUPPORT 
Sec. 201. Nursing loan repayment program. 
Sec. 202. National nursing database. 
Sec. 203. Reports on nursing levels. 
TITLE III—TAX INCENTIVES 
Sec. 301. 10-year recovery period for qualified long-term care improvement 
property. 
TITLE I—MEDICARE AND 
MEDICAID MODERNIZATION 
SEC. 101. JOINT TRAINING OF SURVEYORS AND PRO-
VIDERS. 
(a) MEDICARE PROGRAM.—Section 1819(e) of the 
Social Security Act (42 U.S.C. 1395i–3(e)) is amended by 
adding at the end the following new paragraph: 
‘‘(6) JOINT SURVEYOR/PROVIDER TRAINING.— 
The Secretary shall require the State to establish a 
process for joint training and education of surveyors 
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and providers at least annually and periodically as 
changes to regulations, guidelines, and policy gov-
erning nursing facility operations are implemented 
and used in surveys of participating facilities.’’. 
(b) MEDICAID PROGRAM.—Section 1919(e) of the 
Social Security Act (42 U.S.C. 1396r(e)) is amended by 
adding at the end the following new paragraph: 
‘‘(8) JOINT SURVEYOR/PROVIDER TRAINING.— 
The State shall establish a process for joint training 
and education to surveyors and providers at least 
annually and periodically as changes to regulations, 
guidelines, and policy governing nursing facility op-
erations are implemented and used in surveys of 
participating facilities.’’ 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2007. 
SEC. 102. FACILITY-BASED TRAINING FOR NEW SUR-
VEYORS. 
(a) MEDICARE PROGRAM.—Section 1819(e) of the 
Social Security Act (42 U.S.C. 1395i–3(e)), as amended 
by section 101(a), is amended by adding at the end the 
following new paragraph: 
‘‘(7) FACILITY-BASED TRAINING FOR NEW SUR-
VEYORS.—The Secretary shall require the State to 
establish a process for assuring that— 
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‘‘(A) each individual newly hired as a nurs-
ing home surveyor, as part of the individual’s 
basic training, is assigned full-time to a partici-
pating nursing facility for at least 5 days within 
a 7-day period to observe actual operations out-
side of the survey process before the individual 
begins oversight responsibilities; 
‘‘(B) such individual shall not assume 
oversight responsibility during this training pe-
riod and such observations may not be the sole 
basis of a deficiency citation against the facility; 
and 
‘‘(C) such individual shall not be assigned 
as a member of a survey team for the facility 
in which the individual received training for two 
standard surveys following the training period 
in the facility.’’. 
(b) MEDICAID PROGRAM.—Section 1919(e) of the 
Social Security Act (42 U.S.C. 1396r(e)), as amended by 
section 101(b), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) FACILITY-BASED TRAINING FOR NEW SUR-
VEYORS.—The State shall establish a process for as-
suring that— 
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‘‘(A) each individual newly hired as a nurs-
ing home surveyor, as part of the individual’s 
basic training, is assigned full-time to a partici-
pating nursing facility for at least 5 days within 
a 7-day period to observe actual operations out-
side of the survey process before the individual 
begins oversight responsibilities; 
‘‘(B) such individual shall not assume 
oversight responsibility during this training pe-
riod and such observations may not be the sole 
basis of a deficiency citation against the facility; 
and 
‘‘(C) such individual shall not be assigned 
as a member of a survey team for the facility 
in which the individual received training for two 
standard surveys following the training period 
in the facility.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2007. 
SEC. 103. RESUMPTION OF NURSE AIDE TRAINING PRO-
GRAM 
AFTER 
CORRECTION 
OF 
DEFI-
CIENCIES. 
(a) RESUMPTION OF NURSE AIDE TRAINING PRO-
GRAM
FOR
SKILLED
NURSING
FACILITIES.—Section 
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1819(f)(2) of the Social Security Act (42 U.S.C. 1395i– 
3(f)(2)) is amended— 
(1) in paragraph (B)(iii), in the matter pre-
ceding subclause (I), by striking ‘‘(C) and (D)’’ and 
inserting ‘‘(C), (D), and (E)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) RESUMPTION OF NURSE AIDE TRAIN-
ING
PROGRAM
AFTER
CORRECTION
OF
DEFI-
CIENCIES.—Clause (iii)(I) of subparagraph (B) 
shall not apply to a program offered by or in 
a skilled nursing facility if the facility has— 
‘‘(i) corrected any deficiencies that re-
sulted in the prohibition of approval of 
such program; and 
‘‘(ii) demonstrated compliance with 
the requirements of subsections (b), (c), 
and (d) of this section.’’. 
(b) RESUMPTION OF NURSE AIDE TRAINING PRO-
GRAM FOR NURSING FACILITIES.—Section 1919(f)(2) of 
the Social Security Act (42 U.S.C. 1396r(f)(2)) is amend-
ed— 
(1) in paragraph (B)(iii), in the matter pre-
ceding subclause (I), by striking ‘‘(C) and (D)’’ and 
inserting ‘‘(C), (D), and (E)’’; and 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) RESUMPTION OF NURSE AIDE TRAIN-
ING
PROGRAM
AFTER
CORRECTION
OF
DEFI-
CIENCIES.—Clause (iii)(I) of subparagraph (B) 
shall not apply to a program offered by or in 
a nursing facility if the facility has— 
‘‘(i) corrected any deficiencies that re-
sulted in the prohibition of approval of 
such program; and 
‘‘(ii) been determined to be in compli-
ance with the requirements of subsections 
(b), (c), and (d) of this section.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2007. 
SEC. 104. CLARIFYING AND ELIMINATING THE DISTINC-
TION BETWEEN PHYSICIAN SUPERVISION RE-
QUIREMENTS FOR SKILLED NURSING FACILI-
TIES AND NURSING FACILITIES. 
(a) PHYSICIAN SUPERVISION REQUIREMENTS FOR 
SKILLED NURSING FACILITIES.—Section 1819(b)(6)(A) 
of the Social Security Act (42 U.S.C. 1395i–3(b)(6)(A)) 
is amended by inserting ‘‘(or, at the option of a State, 
under the supervision of a nurse practitioner, clinical 
nurse specialist, or physician assistant who is working in 
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collaboration with a physician)’’ before the semicolon at 
the end. 
(b) CLARIFYING PHYSICIAN SUPERVISION REQUIRE-
MENTS
FOR
NURSING
FACILITIES.—Section 
1919(b)(6)(A) of the Social Security Act (42 U.S.C. 
1396r(b)(6)(A)) is amended by striking ‘‘who is not an 
employee of the facility but’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2007. 
SEC. 105. PERMITTING SPLIT OR SHARED BILLING BY PHY-
SICIANS 
AND 
NURSE 
PRACTITIONERS 
IN 
SKILLED NURSING FACILITIES. 
(a) IN GENERAL.—Section 1888(e) of the Social Se-
curity Act (42 U.S.C. 1395yy(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(13) PERMITTING SPLIT OR SHARED BILLING 
BY
PHYSICIANS
AND
NURSE
PRACTITIONERS
IN 
SKILLED
NURSING
FACILITIES.—Notwithstanding 
section 1861(s)(2)(K)(ii), a physician and a nurse 
practitioner may each submit a claim for payment 
for their portion of a service provided to a resident 
of a skilled nursing facility, except that, in no case 
may the total amount paid under this title be great-
er than it would have been if only one person had 
submitted a claim for such service.’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2007. 
SEC. 106. PERMITTING NURSE PRACTITIONERS EMPLOYED 
BY SKILLED NURSING FACILITIES TO CER-
TIFY SKILLED CARE. 
(a) IN GENERAL.—Section 1814(a)(2) of the Social 
Security Act (42 U.S.C. 1395f(a)(2)) is amended by strik-
ing ‘‘or a nurse practitioner or’’ and inserting ‘‘a nurse 
practitioner, or a’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall take effect on January 1, 2007. 
SEC. 107. MODERNIZATION OF THERAPY CAPS. 
Section 1833(g) of the Social Security Act (42 U.S.C. 
1395l(g)) is amended— 
(1) in paragraph (4)— 
(A) by striking ‘‘This subsection’’ and in-
serting ‘‘Except as provided in paragraph (6), 
this subsection’’; and 
(B) by inserting ‘‘and with respect to serv-
ices furnished on or after January 1, 2009’’ be-
fore the period at the end; and 
(2) by adding at the end the following new 
paragraph: 
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‘‘(6) In the case of services described in para-
graph (1), with respect to such services furnished on 
or after January 1, 2009, the Secretary shall estab-
lish and implement a condition-based system based 
on medical necessity for necessary and clinically ap-
propriate services. Such system shall utilize a stand-
ardized patient assessment tool to evaluate the level 
of such services that are needed by an individual and 
impose a limitation on coverage of such services 
under this part based on such tool.’’. 
SEC. 108. ESTABLISHMENT OF A MEDICARE SKILLED NURS-
ING FACILITY SPECIFIC WAGE INDEX. 
Section 1888(e)(4)(G)(ii) of the Social Security Act 
(42 U.S.C. 1395yy(e)(4)(G)(ii)) is amended by inserting 
after the first sentence the following new sentence: ‘‘For 
services furnished on or after October 1, 2008, in making 
the adjustment under the preceding sentence, the Sec-
retary shall utilize an area wage index for skilled nursing 
facilities based on wage data from such facilities and not 
from hospitals.’’ 
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SEC. 109. AUTHORITY TO EXCLUDE HIGH COST AND LOW 
PROBABILITY DRUGS USED IN THE TREAT-
MENT OF CANCER FROM THE MEDICARE 
PROSPECTIVE 
PAYMENT 
SYSTEM 
FOR 
SKILLED NURSING FACILITIES. 
(a) IN GENERAL.—Section 1888(e)(2)(A)(iii) of the 
Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is 
amended— 
(1) by redesignating subclauses (IV) and (V) as 
subclauses (V) and (VI), respectively; and 
(2) by inserting after subclause (III) the fol-
lowing new subclause: 
‘‘(IV) Any drugs (not otherwise 
described in subclause (II)) used in 
the treatment of cancer, including 
antineoplastic drugs, antiemetics, and 
supportive medications, that the Sec-
retary determines to be appropriate.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to drugs furnished on or after 
October 1, 2007. 
SEC. 110. EXCLUSION OF ALL AMBULANCE SERVICES FROM 
THE MEDICARE PROSPECTIVE PAYMENT SYS-
TEM FOR SKILLED NURSING FACILITIES. 
(a) IN GENERAL.—Section 1888(e)(2)(A)(iii)(I) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
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1395yy(e)(2)(A)(iii)(I)) is amended by striking ‘‘furnished 
to’’ and all that follows before the period. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to services furnished on or after 
October 1, 2007. 
SEC. 111. AUTHORITY TO EXCLUDE ADDITIONAL ITEMS 
AND SERVICES FROM THE MEDICARE PRO-
SPECTIVE PAYMENT SYSTEM FOR SKILLED 
NURSING FACILITIES. 
(a) AUTHORITY.—Section 1888(e)(2)(A) of the So-
cial Security Act (42 U.S.C. 1395yy(e)(2)(A)) is amend-
ed— 
(1) in clause (i)(II), by striking ‘‘and (iv)’’ and 
inserting ‘‘(iv), and (v)(I)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(v) 
EXCLUSION
OF
ADDITIONAL 
ITEMS AND SERVICES DETERMINED APPRO-
PRIATE BY THE SECRETARY.— 
‘‘(I) IN
GENERAL.—Items and 
services described in this clause are 
any items and services not otherwise 
described in clauses (ii), (iii), or (iv), 
that the Secretary determines to be 
appropriate. 
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‘‘(II) 
ANNUAL
UPDATE.—The 
Secretary shall annually update the 
items and services described in sub-
clause (I) to take into account 
changes in the practice of medicine.’’. 
(b) CLARIFICATION.—Items and services described in 
section 1888(e)(2)(A)(v)(I) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(v)(I)), as added by subsection (a), 
may include items and services furnished in a freestanding 
clinic to an individual who is a resident of a skilled nursing 
facility. 
(c) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on October 1, 2007. 
SEC. 112. ELIMINATION OF MEDICARE 3-DAY POST-HOS-
PITAL STAY REQUIREMENT FOR COVERAGE 
OF SKILLED NURSING FACILITY SERVICES. 
(a) IN GENERAL.—Section 1812(a)(2) of the Social 
Security Act (42 U.S.C. 1395d(a)(2)) is amended— 
(1) by striking ‘‘(A) post-hospital’’ and 
(2) by striking ‘‘, and (B)’’ and all that follows 
up to the period at the end. 
(b) CONFORMING AMENDMENTS.— 
(1) Title XVIII of the Social Security Act are 
each amended by striking ‘‘post-hospital’’ before 
‘‘extended care services’’ each place it appears. 
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(2) Section 1812(f) of such Act is repealed. 
(3) Section 1861(i) of such Act is repealed. 
(4) Section 1888(e)(2)(A)(i)(I) of such Act is 
amended by striking ‘‘section 1861(i)’’ and inserting 
‘‘section 1861(h)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to extended care services furnished 
in periods of stay beginning on or after January 1, 2007. 
TITLE II—WORKFORCE SUPPORT 
SEC. 201. NURSING LOAN REPAYMENT PROGRAM. 
Section 846(a) of the Public Health Service Act (42 
U.S.C. 297n(a)) is amended by striking the last sentence. 
SEC. 202. NATIONAL NURSING DATABASE. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall provide for the establishment of a 
national nursing database to be used to predict future 
nursing shortages. 
(b) INFORMATION IN DATABASE.—The database es-
tablished under subsection (a) shall be designed to include 
nursing workforce data across all healthcare provider set-
tings, including nursing educators, as determined by the 
Secretary of Health and Human Services to be appro-
priate for use in the analysis of trends in the supply and 
demand of nurses and to create an educational model to 
predict future nursing workforce needs. 
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(c) FUNDING.—The Secretary of Health and Human 
Services may transfer, from amounts appropriated for the 
National Center for Health Workforce Analysis, such 
sums as may be necessary to carry out this section. 
SEC. 203. REPORTS ON NURSING LEVELS. 
Section 806 of the Public Health Service Act (42 
U.S.C. 296e), as amended by section 202, is further 
amended by adding at the end the following: 
‘‘(j) REPORTS CONCERNING NURSING LEVELS.— 
‘‘(1) IN GENERAL.—The entities described in 
paragraph (2) shall annually submit to the Secretary 
a report concerning how assistance under this title 
is being used by such entities to increase the number 
of nurses, nursing educators, and nurse education 
enrollment slots. 
‘‘(2) ENTITIES DESCRIBED.—An entity is de-
scribed in this paragraph if such entity is— 
‘‘(A) an entity that receives a grant or con-
tract under this title; 
‘‘(B) a school of nursing that receives stu-
dent loan funds under this title; 
‘‘(C) a school of nursing that receives 
nurse faculty student loan funds under this 
title; and 
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‘‘(D) any other entity that receives assist-
ance under this title.’’. 
TITLE III—TAX INCENTIVES 
SEC. 301. 10-YEAR RECOVERY PERIOD FOR QUALIFIED 
LONG-TERM 
CARE 
IMPROVEMENT 
PROP-
ERTY. 
(a) IN GENERAL.—Subparagraph (D) of section 
168(e)(3) of the Internal Revenue Code of 1986 (relating 
to 10-year property) is amended by striking ‘‘and’’ at the 
end of clause (i), by striking the period at the end of 
clause (ii) and inserting ‘‘, and’’, and by adding at the 
end the following new clause: 
‘‘(iii) any qualified long-term care im-
provement property.’’. 
(b) QUALIFIED LONG-TERM CARE IMPROVEMENT 
PROPERTY.—Section 168(e) of the Internal Revenue Code 
of 1986 (relating to classification of property) is amended 
by adding at the end the following new paragraph: 
‘‘(8) QUALIFIED
LONG-TERM
CARE
IMPROVE-
MENT
PROPERTY.—The term ‘qualified long-term 
care improvement property’ means any section 1250 
property which is an improvement to a building if— 
‘‘(A) such improvement is placed in service 
more than 3 years after the date such building 
was first placed in service, and 
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‘‘(B) such building is, or is a part of, a 
nursing facility, assisted living facility, residen-
tial care facility, intermediate care facility for 
the mentally retarded, or similar facility de-
signed to provide housing and healthcare for 
the elderly and disabled.’’. 
(c) ALTERNATIVE SYSTEM.—The table contained in 
section 168(g)(3)(B) of the Internal Revenue Code of 
1986 (relating to special rule for certain property assigned 
to classes) is amended by inserting after the item relating 
to subparagraph (D)(ii) the following: 
‘‘(D)(iii) ...................................................................................
10’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to property placed in service after 
the date of the enactment of this Act. 
Æ 
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