whether a provider is eligible for continued partici-
pation in the medicare program. 
(g) DEFINITIONS.—For purposes of this section: 
(1) LICENSED PRACTICAL NURSE OR LICENSED 
VOCATIONAL NURSE.—The term ‘‘licensed practical 
nurse or licensed vocational nurse’’ means an indi-
vidual who is entitled under State law or regulation 
to practice as a licensed practical nurse or a licensed 
vocational nurse. 
(2) PUBLICLY AVAILABLE.—The term ‘‘publicly 
available’’ means, with respect to information of a 
provider, information that is— 
(A) provided to the Secretary and to any 
State agency responsible for licensing or accred-
iting the provider; 
(B) provided to any State agency which 
approves or oversees health care services deliv-
ered by the provider directly or through an in-
suring entity or corporation; and 
(C) provided to any member of the public 
which requests such information directly from 
the provider. 
(3) MEDICARE PROGRAM.—The term ‘‘medicare 
program’’ means the programs under title XVIII of 
the Social Security Act.
(4) PROVIDER.—The term ‘‘provider’’ means an 
entity that is— 
(A) a psychiatric hospital described in sec-
tion 1861(f) of the Social Security Act (42 
U.S.C. 1395x(f)); 
(B) a provider of services described in sec-
tion 1861(u) of such Act (42 U.S.C. 1395x(u)), 
other than a skilled nursing facility, as defined 
in section 1819(a) of such Act (42 U.S.C. 
1395i–3(a)); 
(C) a rural health clinic described in sec-
tion 1861(aa)(2) of such Act (42 U.S.C. 
1395x(aa)(2)); 
(D) an ambulatory surgical center de-
scribed in section 1832(a)(2)(F)(i) of such Act 
(42 U.S.C. 1395k(a)(2)(F)(i)); or 
(E) a renal dialysis facility described in 
section 1881(b)(1)(A) of such Act (42 U.S.C. 
1395rr(b)(1)(A)). 
(5) REGISTERED
NURSE.—The term ‘‘reg-
istered nurse’’ means an individual who is entitled 
under State law or regulation to practice as a reg-
istered nurse. 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services.
SEC. 4. PUBLIC DISCLOSURE OF ACCURATE DATA ON 
NURSING FACILITY STAFFING. 
(a) MEDICARE.—Section 1819(b)(8) of the Social Se-
curity Act (42 U.S.C. 1395i–3(b)) is amended— 
(1) in subparagraph (A), by adding at the end 
the following new sentence: ‘‘The information posted 
under this subparagraph shall include information 
regarding nurse staffing with respect to beds made 
available by reason of an agreement under section 
1883.’’; and 
(2) by adding at the end the following new sub-
paragraphs: 
‘‘(C) 
SUBMISSION
AND
POSTING
OF 
DATA.— 
‘‘(i) IN GENERAL.—Beginning on Jan-
uary 1, 2006, a skilled nursing facility 
shall submit to the Secretary in a uniform 
manner (as prescribed by the Secretary) 
the nursing staff data described in section 
3(a) of the Patient Safety Act of 2005 
through electronic means not less fre-
quently than quarterly and the Secretary 
shall make such data publicly available (as 
defined in section 3(g)(2) of such Act), in-
cluding by posting such data on an Inter-
net website.
‘‘(ii) 
INFORMATION
ON
NURSE 
AIDES.—In addition to the nursing staff 
data described in clause (i), a skilled nurs-
ing facility shall submit to the Secretary 
the numbers of nurse aides (as defined in 
paragraph (5))(F)) utilized to provide di-
rect patient care. This information shall be 
expressed both in raw numbers and as a 
percentage of nursing staff and shall be 
broken down in terms of the total nursing 
staff, each unit, and each shift. 
‘‘(D) AUDIT OF DATA.—As part of each 
standard survey conducted under subsection 
(g)(2)(A), there shall be an audit of the nursing 
staff data reported under subparagraph (C) to 
ensure that such data are accurate.’’. 
(b) MEDICAID.—Section 1919(b)(8) of the Social Se-
curity Act (42 U.S.C. 1395r(b)(8)) is amended— 
(1) in subparagraph (A), by adding at the end 
the following new sentence: ‘‘The information posted 
under this subparagraph shall include information 
regarding nurse staffing with respect to beds made 
available by reason of an agreement under section 
1883.’’; and
(2) by adding at the end the following new sub-
paragraphs: 
‘‘(C) 
SUBMISSION
AND
POSTING
OF 
DATA.— 
‘‘(i) IN GENERAL.—Beginning on Jan-
uary 1, 2006, a nursing facility shall sub-
mit to the Secretary in a uniform manner 
(as prescribed by the Secretary) the nurs-
ing staff data described in section 3(a) of 
the Patient Safety Act of 2005 through 
electronic means not less frequently than 
quarterly and the Secretary shall make 
such data publicly available (as defined in 
section 3(g)(2) of such Act), including by 
posting such data on an Internet website. 
‘‘(ii) 
INFORMATION
ON
NURSE 
AIDES.—In addition to the nursing staff 
data described in clause (i), a skilled nurs-
ing facility shall submit to the Secretary 
the numbers of nurse aides (as defined in 
paragraph (5))(F)) utilized to provide di-
rect patient care. This information shall be 
expressed both in raw numbers and as a 
percentage of nursing staff and shall be
broken down in terms of the total nursing 
staff, each unit, and each shift. 
‘‘(D) AUDIT OF DATA.—As part of each 
standard survey conducted under subsection 
(g)(2)(A), there shall be an audit of the nursing 
staff data reported under subparagraph (C) to 
ensure that such data are accurate.’’. 
SEC. 5. CREATING A STAFFING QUALITY MEASURE FOR 
CONSUMERS TO COMPARE NURSING FACILI-
TIES. 
(a) IN GENERAL.—Beginning no later than 90 days 
after the date of the enactment of this Act, and for as 
long as the Secretary of Health and Human Services pub-
lishes quality measures to help the public compare the 
quality of care that nursing facilities provide, these quality 
measures shall include a quality measure for nursing staff 
that— 
(1) reflects the average daily total nursing 
hours worked for the quarterly reporting period for 
which 
data 
are 
submitted 
under 
sections 
1819(b)(8)(C) and 1919(b)(8)(C) of the Social Secu-
rity Act (as added by subsections (a)(2) and (b)(2), 
respectively, of section 4), as well as, in the case of 
a skilled nursing facility, other information required 
to be reported under section 3(a);
(2) is sensitive to case mix and quality out-
comes; 
(3) indicates the percentile in which each nurs-
ing facility falls compared with other nursing facili-
ties in the State; 
(4) indicates the rate of retention of registered 
nurses, licensed practical nurses, and certified nurse 
assistants; and 
(5) includes such other measures as the Sec-
retary determines to be appropriate. 
The Secretary shall not be required to comply with the 
requirements of paragraph (2) to the extent that the devel-
opment of a methodology to comply with such requirement 
would delay the implementation of this section. 
(b) FORM AND MANNER.—The nursing facility com-
parative staffing measure described in subsection (a) shall 
be displayed in the same form and manner as information 
that the Secretary displays to help the public compare the 
quality of care that nursing facilities provide. 
SEC. 6. PROTECTION OF CERTAIN ACTIVITIES BY EMPLOY-
EES OF MEDICARE PROVIDERS. 
(a) IN GENERAL.—Subject to subsection (c), no pro-
vider under the medicare program shall terminate or take 
other adverse employment action (including the failure to 
promote an individual or provide any employment-related
benefit, an adverse evaluation or decision made in relation 
to accreditation, certification, credentialing or licensing of 
an individual, or other adverse personnel action) against 
any employee or group of employees for actions taken for 
the purpose of— 
(1) notifying the provider of conditions which 
the employee or group of employees identifies, in 
communications with the provider, as dangerous or 
potentially dangerous or injurious to— 
(A) patients who currently receive services 
from the provider; 
(B) individuals who are likely to receive 
services from the provider; or 
(C) employees of the provider; 
(2) notifying a Federal or State agency or an 
accreditation agency, compliance with the standards 
of which have been deemed to demonstrate compli-
ance with conditions of participation under the medi-
care program, of such conditions as are identified in 
paragraph (1); 
(3) notifying other individuals of conditions 
which the employee or group of employees reason-
ably believe to be such as are described in paragraph 
(1);
(4) discussing such conditions as are identified 
in paragraph (1) with other employees for the pur-
poses of initiating action described in paragraph (1), 
(2), or (3); or 
(5) other related activities as specified in regu-
lations promulgated by the Secretary of Health and 
Human Services. 
(b) SANCTION.—A provider that takes an action in 
violation of subsection (a) is subject to a civil money pen-
alty of not more than $20,000 for each such action. The 
provisions of section 1128A of the Social Security Act 
(other than subsections (a) and (b)) shall apply to civil 
money penalties under this subsection in the same manner 
as they apply to a penalty or proceeding under section 
1128A(a) of such Act. 
(c) EXCEPTION.—The provisions of subsection (a) 
shall not apply to the knowing or reckless provision of sub-
stantially false information by an employee or group of 
employees. 
SEC. 7. REPORT. 
Not later than 90 days after the date of the enact-
ment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on— 
(1) the manner in which the Secretary intends 
to implement reporting of additional nurse staffing
variables such as unit worked, day of week (weekday 
and weekend), and type of care (direct or adminis-
trative) provided; and 
(2) the most effective mechanisms for auditing 
nurse staffing data under sections 1819(b)(8)(D) 
and 1919(b)(8)(D) of the Social Security Act (as 
added by subsections (a)(2) and (b)(2), respectively, 
of section 4) and for auditing nurse staffing date 
under section 3(f)(2). 
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