I 
110TH CONGRESS 
1ST SESSION H. R. 4082 
To improve the quality of, and access to, long-term care. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 6, 2007 
Mr. POMEROY (for himself, Mrs. CAPITO, and Mr. ALLEN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration 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 
2007’’. 
(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. Demonstration program for joint training of surveyors and providers 
in nursing facilities. 
Sec. 102. Resumption of nurse aide training program after correction of defi-
ciencies. 
Sec. 103. 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. 104. Exclusion of all ambulance services from the Medicare prospective 
payment system for skilled nursing facilities. 
Sec. 105. Authority to exclude additional items and services from the Medicare 
prospective payment system for skilled nursing facilities. 
Sec. 106. Payment for blood glucose tests administered as part of a physician, 
nurse practitioner, or clinical nurse specialist prescribed pro-
tocol of blood glucose monitoring. 
Sec. 107. Counting of observation days for purposes of applying the Medicare 
post-hospital requirement for coverage of skilled nursing facil-
ity care. 
Sec. 108. Payment for therapy services. 
Sec. 109. Expansion of telehealth services to skilled nursing facilities. 
Sec. 110. Physical therapy grant program. 
Sec. 111. Long-Term Care Quality Advisory Commission and demonstration 
projects. 
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. 15-year recovery period for qualified long-term care improvement 
property. 
TITLE I—MEDICARE AND 
MEDICAID MODERNIZATION 
SEC. 101. DEMONSTRATION PROGRAM FOR JOINT TRAIN-
ING OF SURVEYORS AND PROVIDERS IN 
NURSING FACILITIES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall conduct a demonstration program under 
which the Secretary, under sections 1819(e) and 1919(e) 
of the Social Security Act (42 U.S.C. 1395i–3(e), 
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1396r(e)), shall require a State to establish a process for 
joint training and education of surveyors and providers for 
skilled nursing facilities and nursing facilities at least an-
nually and periodically as changes to regulations, guide-
lines, and policy governing nursing facility operations are 
implemented and used in surveys of participating facili-
ties. 
(b) DEMONSTRATION STATES.—The demonstration 
program under this section shall be conducted in 5 States. 
In selecting the States in which to conduct the demonstra-
tion program, the Secretary shall ensure that the States 
vary in geographic location and include States with high 
levels of deficiencies as well as States with low levels of 
deficiencies. 
(c) DURATION.—The Secretary shall conduct the 
demonstration program under this section for a 2-year pe-
riod. 
(d) WAIVER AUTHORITY.—The Secretary may waiver 
such requirements of titles XI, XVIII, and XIX of the So-
cial Security Act as may be necessary for purposes of car-
rying out the demonstration program under this section. 
(e) REPORT.— 
(1) IN
GENERAL.—Not later than 6 months 
after the completion of the demonstration program 
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under this section, the Secretary shall submit a re-
port to Congress on the project. 
(2) REQUIREMENTS.—The report submitted 
under paragraph (1) shall include— 
(A) the results of the demonstration pro-
gram as they relate to the rate and type of defi-
ciencies in skilled nursing facilities and nursing 
facilities in the States selected under subsection 
(b) compared to those States not so selected; 
(B) an evaluation of added efficiencies or 
deficiencies in care for patients in skilled nurs-
ing facilities and nursing facilities that directly 
resulted from the demonstration program; and 
(C) recommendations for such legislation 
and administrative action as the Secretary de-
termines appropriate. 
The results and evaluation under subparagraphs (A) 
and (B) shall include an examination of the current 
baseline. 
SEC. 102. 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 subparagraph (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 subparagraph (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) demonstrated compliance 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, 2008. 
SEC. 103. 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 
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SEC. 105. 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. 
‘‘(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.’’. 
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(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, 2008. 
SEC. 106. PAYMENT FOR BLOOD GLUCOSE TESTS ADMINIS-
TERED AS PART OF A PHYSICIAN, NURSE 
PRACTITIONER, OR CLINICAL NURSE SPE-
CIALIST PRESCRIBED PROTOCOL OF BLOOD 
GLUCOSE MONITORING. 
Section 1835(a) of the Social Security Act (42 U.S.C. 
1395n(a)) is amended— 
(1) in paragraph (2), in the matter preceding 
subparagraph (A), by inserting ‘‘, or, as provided in 
the last 2 sentences of this subsection with respect 
to blood glucose tests, a physician, a nurse practi-
tioner, or a clinical nurse specialist,’’ after ‘‘physi-
cian’’; and 
(2) by adding at the end the following new sen-
tences: ‘‘With respect to paragraph (2)(B), a physi-
cian, or a nurse practitioner or a clinical nurse spe-
cialist in accordance with State law, may certify that 
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a prescribed series of blood glucose tests, furnished 
over a specified and limited period of time to mon-
itor an individual’s blood glucose levels, are medi-
cally required. For purposes of the preceding sen-
tence, neither a physician’s, a nurse practitioner’s, 
or a clinical nurse specialist’s order for a prescribed 
series of blood glucose tests nor a physician’s, a 
nurse practitioner’s, or a clinical nurse specialist’s 
certification that such tests are medically required 
constitutes a standing order.’’. 
SEC. 107. COUNTING OF OBSERVATION DAYS FOR PUR-
POSES OF APPLYING THE MEDICARE POST- 
HOSPITAL REQUIREMENT FOR COVERAGE OF 
SKILLED NURSING FACILITY CARE. 
(a) IN GENERAL.—Section 1861(i) of the Social Se-
curity Act (42 U.S.C. 1395x(i)) is amended by adding at 
the end the following: ‘‘For purposes of this subsection, 
an individual shall be treated as an inpatient of a hospital 
for a day if the individual is staying as an inpatient in 
the hospital overnight for observation for that day.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to observation days occurring 
on or after the first day of the month beginning more than 
60 days after the date of the enactment of this Act. 
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SEC. 108. PAYMENT FOR THERAPY SERVICES. 
(a) EXTENSION
OF
EXCEPTIONS
PROCESS
FOR 
MEDICARE THERAPY CAPS.—Section 1833(g)(5) of the 
Social Security Act (42 U.S.C. 1395l(g)(5)), as amended 
by section 201 of the Medicare Improvements and Exten-
sion Act of 2006 (division B of Public Law 109–432), is 
amended by striking ‘‘2007’’ and inserting ‘‘2009’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services, in consultation with appropriate 
stakeholders, including the national professional as-
sociations representing long-term care providers and 
each therapy discipline (including physical therapy, 
speech-language pathology, and occupational ther-
apy), shall conduct a study or studies to develop uti-
lization management alternatives to the Medicare 
payment cap under section 1833(g) of the Social Se-
curity Act (42 U.S.C. 1395l(g)) for physical therapy 
services and speech-language pathology services, de-
scribed in paragraph (1) of such section and occupa-
tional therapy services described in paragraph (3) of 
such section. 
(2) CONSIDERATIONS.—Such study or studies 
shall— 
(A) identify, test, and utilize standardized 
patient assessment instruments that can collect 
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general and discipline-specific data elements, in-
cluding rehabilitation diagnosis, age, illness, 
caregiver support, setting, co-morbidities, and 
functional status; 
(B) assure that assessment instruments 
are compatible with a uniform electronic health 
record to collect the data and keep discipline- 
specific data; and 
(C) utilize such assessment instruments 
and resulting data to develop a utilization man-
agement system that— 
(i) assures appropriate access to medi-
cally necessary services; 
(ii) employs the use of practice guide-
lines, 
(iii) outcomes tracking and other ap-
propriate quality measurement mecha-
nisms; 
(iv) includes, with respect to Medicare 
reimbursement for outpatient therapy serv-
ices, the development of the systems de-
scribed in paragraph (3); and 
(v) applies the extension and the re-
finement of an exceptions process and 
other methods of utilization control, such 
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as the creation of multiple payment classi-
fications based on the clinical diagnosis 
(including comorbidities), setting, rehabili-
tation potential, functional status and 
other patient characteristics; and 
(D) include a variety of geographic sites 
and practice settings, including all settings or 
facilities in which the therapy disciplines fur-
nish services under part B of the Medicare pro-
gram. 
(3) SYSTEMS.—The systems described in this 
paragraph are the following: 
(A) A utilization management system 
based on classifying the individual beneficiary’s 
need for therapy. 
(B) A prospective payment system, includ-
ing an episode-based utilization management 
system, for services described in paragraph (1). 
(4) REPORT.—Not later than January 1, 2009, 
the Secretary shall submit to Congress a report on 
the study conducted under paragraph (1). 
SEC. 109. EXPANSION OF TELEHEALTH SERVICES TO 
SKILLED NURSING FACILITIES. 
(a) IN GENERAL.—Section 1834(m)(4)(C)(ii) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is 
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amended by adding at the end the following new sub-
clause: 
‘‘(IV) A skilled nursing facility 
(as defined in section 1819(a)).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to telehealth services furnished 
on or after January 1, 2009. 
SEC. 110. PHYSICAL THERAPY GRANT PROGRAM. 
Subpart 2 of part E of title VII of the Public Health 
Service Act (42 U.S.C. 295 et seq.) is amended by insert-
ing after section 769, the following: 
‘‘SEC. 769A. PHYSICAL THERAPY. 
‘‘(a) IN GENERAL.—The Secretary may make grants 
to, and enter into contracts with, programs of physical 
therapy for the purpose of planning and implementing 
projects to recruit and retain faculty and students, develop 
curriculum, support the distribution of physical therapy 
practitioners in underserved areas, or support the con-
tinuing development of these professions. 
‘‘(b) PREFERENCE IN MAKING GRANTS.—In making 
grants under subsection (a), the Secretary shall give pref-
erence to qualified applicants that seek to educate physical 
therapists in rural or urban medically underserved com-
munities, or to expand post-professional programs for the 
advanced education of physical therapist practitioners. 
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‘‘(c) PEER REVIEW.—Each peer review group under 
section 799(f) that is reviewing proposals for grants or 
contracts under subsection (a) shall include not fewer than 
2 physical therapists. 
‘‘(d) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—The Secretary shall pre-
pare a report that— 
‘‘(A) summarizes the applications sub-
mitted to the Secretary for grants or contracts 
under subsection (a); 
‘‘(B) specifies the identity of entities re-
ceiving the grants or contracts; and 
‘‘(C) evaluates the effectiveness of the pro-
gram based upon the objectives established by 
the entities receiving the grants or contracts. 
‘‘(2) DATE
CERTAIN
FOR
SUBMISSION.—Not 
later than February 1, 2009, the Secretary shall 
submit the report prepared under paragraph (1) to 
the Committee on Energy and Commerce and the 
Committee on Appropriations of the House of Rep-
resentatives, the Committee on Health, Education, 
Labor, and Pensions and the Committee on Appro-
priations of the Senate.’’. 
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SEC. 111. LONG-TERM CARE QUALITY ADVISORY COMMIS-
SION AND DEMONSTRATION PROJECTS. 
(a) LONG-TERM CARE QUALITY ADVISORY COMMIS-
SION.— 
(1) 
ESTABLISHMENT.—Not 
later 
than 
months after the date of the enactment of this sec-
tion, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall 
establish a commission to be known as the Long 
Term Care Quality Advisory Commission (in this 
section referred to as the ‘‘Commission’’). 
(2) DUTIES OF COMMISSION.— 
(A) NATIONAL
PLAN.—The Commission 
shall develop, coordinate, and facilitate imple-
mentation of a national plan for long-term care 
quality improvement. The national plan shall— 
(i) identify objectives for long-term 
care quality improvement; 
(ii) identify strategies to eliminate 
known gaps in long-term care health sys-
tem capacity and improve long-term care 
quality; and 
(iii) provide for Federal programs to 
identify opportunities for strengthening 
and aligning policies and programs to im-
prove long-term care quality. 
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(B) 
DEMONSTRATION
PROJECTS.—The 
Commission shall design demonstration projects 
to test alternative models for long-term care 
quality improvement, including with respect to 
both personal and population health. 
(C) MONITORING.—The Commission shall 
monitor progress toward the objectives identi-
fied pursuant to paragraph (1)(A). 
(3) MEMBERSHIP.— 
(A) NUMBER.—The Commission shall be 
composed of 11 members appointed by the Sec-
retary. 
(B) SELECTION.—The Secretary shall se-
lect the members of the Commission from 
among individuals with significant long-term 
care and health care quality expertise, including 
expertise in clinical health care, health care 
quality research, population or public health, re-
habilitation care, or consumer organizations. 
(4) CONTRACTING AUTHORITY.—Subject to the 
availability of funds, the Commission may enter into 
contracts and make other arrangements, as may be 
necessary to carry out the duties described in para-
graph (2). 
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