I 
117TH CONGRESS 
2D SESSION 
H. R. 8624 
To amend title XI of the Social Security Act to provide for additional 
requirements for disclosing entities relating to the quality of care fur-
nished at skilled nursing facilties and nursing facilites, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 29, 2022 
Ms. SCHAKOWSKY (for herself and Mr. TAKANO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XI of the Social Security Act to provide 
for additional requirements for disclosing entities relating 
to the quality of care furnished at skilled nursing facilties 
and nursing facilites, 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 ‘‘Linking Investors and 
Nursing Home Quality Act’’ or the ‘‘LINHQ Act’’. 
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SEC. 2. REGULATING OWNERSHIP OF SKILLED NURSING 
FACILITIES AND NURSING FACILITIES. 
(a) REQUIREMENT TO SUBMIT TIMELY DISCLO-
SURES TO ADMIT NEW RESIDENTS OF SKILLED NURSING 
FACILITIES AND NURSING FACILITIES.—Section 1124 of 
the Social Security Act (42 U.S.C. 1320a–3) is amended 
by adding at the end the following new subsection: 
‘‘(d) SUSPENSION OF CERTAIN PAYMENTS FOR CER-
TAIN ENTITIES THAT FAIL TO SUBMIT TIMELY OWNER-
SHIP DISCLOSURES.— 
‘‘(1) IN GENERAL.—In the case of a covered 
nursing facility that fails to submit specified infor-
mation to the Secretary by the date that is 30 days 
after the date that such information is required to 
be submitted pursuant to regulations or contract 
provisions described in subsection (a)(1) (or, in the 
case of a party with an ownership interest in such 
facility that fails to submit information to the Sec-
retary in accordance with paragraph (3))— 
‘‘(A) the Secretary shall suspend payment 
under title XVIII with respect to items and 
services furnished to a specified resident during 
the applicable payment suspension period; and 
‘‘(B) the Secretary shall suspend payment 
under title XIX for medical assistance con-
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with respect to the average number of di-
rect care hours furnished to residents. 
‘‘(ii) SPECIFICATION.—The Secretary 
shall publish on a public website each qual-
ity measure specified under this subpara-
graph at least 180 days prior to such qual-
ity metric being used in a quality review 
under this paragraph, except that, with re-
spect to such reviews beginning during the 
1-year period beginning on the date of the 
enactment of this subsection, the Secretary 
may use any such metric that the Sec-
retary publishes on such a website at least 
14 days prior to the beginning of such re-
view. 
‘‘(C) ESTABLISHMENT OF STANDARDS.— 
The Secretary shall specify standards with re-
spect to quality measures described in subpara-
graph (B), taking into account input from the 
Data Liaison Team so described. Such stand-
ards shall include, with respect to the metric re-
lating to the average number of direct care 
hours furnished to residents, a standard of at 
least 4.1 direct care hours furnished per resi-
dent per day. 
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‘‘(D) NOTIFICATION AND PUBLICATION OF 
FACILITIES
FALLING
BELOW
STANDARDS.—If 
the Secretary determines that a covered nursing 
facility has failed to meet a standard estab-
lished under subparagraph (C) with respect to 
a quality measure described in subparagraph 
(B) pursuant to a review conducted under this 
paragraph, the Secretary shall— 
‘‘(i) notify such facility of such deter-
mination; 
‘‘(ii) publish the name of such facility 
on the Care Compare website (or a suc-
cessor website) described in section 1819(i) 
with an explanation that such facility has 
failed to meet such standard; and 
‘‘(iii) suspend payment under title 
XVIII to such facility, and payment under 
title XIX for medical assistance furnished 
by such facility, until such facility dem-
onstrates that such facility has met such 
standard. 
‘‘(3) SUBMISSION OF THIRD-PARTY INFORMA-
TION.—The Secretary shall establish a process 
under which, with respect to a covered nursing facil-
ity, any party that has an ownership interest in such 
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facility and that also has an ownership interest in an 
entity that contracts with such facility to provide 
any service to such facility submits to the Secretary 
the following information: 
‘‘(A) A balance sheet detailing the assets, 
liabilities, and net worth of the entity. 
‘‘(B) A statement of income, expenses, and 
operating surplus or deficit. 
‘‘(C) A statement of cashflows, including 
ongoing and new capital expenditures and de-
preciation. 
‘‘(4) SUBMISSION OF ADDITIONAL INFO BY FA-
CILITIES.—The Secretary shall require a covered 
nursing facility, as part of the information submitted 
under subsection (a)(1), to provide to the Secretary 
a detailed document outlining a visual representation 
of the facility’s structure that includes both of the 
following: 
‘‘(A) Any entity in which any party that 
has an ownership or control interest in the cov-
ered nursing facility and that also has an own-
ership interest or control interest of 5 percent 
or more in such entity that provides any serv-
ice, facility, or supply to such covered nursing 
facility. 
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‘‘(B) Unrelated parties that provide serv-
ices to such facility or to facilities that are op-
erated, conducted, owned, managed, or main-
tained by the organization, including manage-
ment companies and property companies, and 
that are paid more than $200,000 by such facil-
ity. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE
PAYMENT
SUSPENSION 
PERIOD.—The term ‘applicable payment sus-
pension period’ means, with respect to specified 
information required to be submitted by a cov-
ered nursing facility pursuant to regulations or 
contract provisions described in subsection 
(a)(1) (or with respect to third-party informa-
tion required to be submitted by a party with 
an ownership interest in such facility), the pe-
riod beginning on the day that is 30 days after 
the date that such information is required to be 
so submitted by such facility (or party) and 
ending on the date that is 5 days after such fa-
cility (or party) submits such information. 
‘‘(B) COVERED NURSING FACILITY.—The 
term ‘covered nursing facility’ means a skilled 
nursing 
facility 
(as 
defined 
in 
section 
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1819(a)(1)) or a nursing facility (as defined in 
section 1919(a)(1)). 
‘‘(C) SPECIFIED INFORMATION.—The term 
‘specified information’ means any information 
required to be submitted under subsection 
(a)(1). 
‘‘(D) SPECIFIED
RESIDENT.—The term 
‘specified resident’ means a resident of a cov-
ered nursing facility who is admitted to such fa-
cility during an applicable payment suspension 
period with respect to such facility. 
‘‘(E) OWNERSHIP
INTEREST.—The term 
‘ownership interest’ means a direct or indirect 
interest of at least 5 percent.’’. 
(b) REQUIRING
ANNUAL
REPORTING
FOR
DIS-
CLOSING ENTITIES.—Section 1124(c)(3)(A) of the Social 
Security Act (42 U.S.C. 1320a–3(c)(3)(A)) is amended by 
adding at the end the following new sentence: ‘‘The Sec-
retary shall, not later than 90 days after the date of the 
enactment of this sentence, amend such regulations to 
provide that such information is reported not less fre-
quently than annually.’’. 
(c) INCREASING OVERSIGHT OF FACILITIES.— 
(1) DATA LIAISON TEAM.— 
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(A) IN
GENERAL.—Not later than 180 
days after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices (in this subsection referred to as the ‘‘Sec-
retary’’) shall establish a task force (in this 
paragraph, referred to as the ‘‘Data Liaison 
Team’’) to carry out the activities described in 
subparagraph (B). 
(B) ACTIVITIES
DESCRIBED.—For pur-
poses of subparagraph (A), the activities de-
scribed in this subparagraph are— 
(i) reviewing information submitted 
under section 1124 of the Social Security 
Act (42 U.S.C. 1320a–3) to identify any 
common ownership patterns with respect 
to skilled nursing facilities’ (as defined in 
section 1819(a)(1) of such Act (42 U.S.C. 
1395i–3(a)(1))) and nursing facilities’ (as 
defined in section 1919(a)(1) of such Act 
(42 U.S.C. 1396r(a)(1))) that— 
(I) are at least 30 days delin-
quent in supplying the ownership in-
formation required pursuant to sec-
tion 1124(a)(1) of such Act (42 
U.S.C. 1320a–3(a)(1)); 
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(II) in the preceding quarterly 
reporting period, failed to meet a pay-
roll based journal level of 4.1 hours of 
direct resident care hours (including 
registered nurse, licensed practical 
nurse, and nursing assistant or cer-
tified nursing assistant care) per resi-
dent per day; or 
(III) in the preceding year of re-
porting, failed to meet any quality 
standard established by the Secretary 
under subsection (d) of such section 
or established by the Secretary or a 
State with respect to surveys con-
ducted under section 1819(g) or 
1919(g) of such Act (42 U.S.C. 
1395i–3(g); 42 U.S.C. 1396r(g)); 
(ii) assessing potential misuse of pay-
ments under titles XVIII and XIX of such 
Act (42 U.S.C. 1395 et seq.; 1396 et seq.) 
through review of data collected by the 
Treasury Department, facility organization 
charts, and cost reports submitted under 
such title XVIII; 
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(iii) on a monthly basis, reporting any 
disclosing entities (as defined for purposes 
of section 1124 of such Act (42 U.S.C. 
1320a–3)) with common ownership identi-
fied pursuant to clause (i), or with respect 
to which the Team has found a potential 
misuse of payments pursuant to clause (ii), 
to the Interagency Board, the Office of In-
spector General of the Department of 
Health and Human Services, and the De-
partment of Justice; 
(iv) regularly reviewing skilled nursing 
facilities and nursing facilities with a one- 
star rating in health inspections or staffing 
on the Care Compare website (or a suc-
cessor website) described in section 1819(i) 
of such Act (42 U.S.C. 1395i–3(i)), as well 
as such facilities that are ranked among 
the lowest 20 percent of facilities on such 
website with respect to quality; and 
(v) at the discretion of the Data Liai-
son Team, requiring skilled nursing facili-
ties and nursing facilities to submit to the 
Team information on whether such facili-
ties— 
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(I) do business (including busi-
ness relating to laundry services, 
staffing agencies, food and beverage 
services, medical supplies, or con-
sulting) with any other entity (includ-
ing a specification of such other enti-
ty); 
(II) lease their building or prop-
erty from another entity (including a 
specification of such other entity); or 
(III) share an individual who has 
directly or indirectly (as determined 
by the Secretary pursuant to a notice 
and comment rulemaking) any owner-
ship interest of 5 percent or more in 
an entity described in subclause (II) 
and the skilled nursing facility or 
nursing facility. 
(C) PROVISION OF INFORMATION.— 
(i) TREASURY
INFORMATION.—For 
purposes of subparagraph (B)(ii), the Sec-
retary of the Treasury shall furnish to the 
Data Liaison Team such information as 
such Team may request. 
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(ii) 
FACILITY
INFORMATION.—For 
purposes of subparagraph (B)(v), a skilled 
nursing facility or nursing facility shall 
submit to the Data Liaison Team such in-
formation as may be requested by the 
Team. Any failure to submit such informa-
tion shall be deemed to constitute a viola-
tion of section 1124(a)(1) of such Act (42 
U.S.C. 1320a–3(a)(1)). 
(D) COMPOSITION.— 
(i) IN GENERAL.—The Data Liaison 
Team shall consist of— 
(I) the Administrator of the Cen-
ters for Medicare & Medicaid Services 
of the Department of Health and 
Human Services (or designee); and 
(II) any other employees of the 
agency specified in subclause (I) (as 
determined appropriate by the Sec-
retary). 
(ii) MANAGER.—An employee of the 
Centers for Medicare & Medicaid Services 
of the Department of Health and Human 
Services shall manage the Data Liaison 
Team. 
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(2) INTERAGENCY BOARD.— 
(A) IN
GENERAL.—Not later than 180 
days after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices shall establish a task force (in this para-
graph, referred to as the ‘‘Interagency Board’’) 
to carry out the activities described in subpara-
graph (B). 
(B) ACTIVITIES
DESCRIBED.—For pur-
poses of subparagraph (A), the activities de-
scribed in this subparagraph are— 
(i) reviewing the list of disclosing enti-
ties 
reported 
pursuant 
to 
paragraph 
(1)(B)(iii) to determine which entities to 
refer to the Office of Inspector General of 
the Department of Health and Human 
Services and the Department of Justice for 
further investigation; 
(ii) reporting any such referrals to the 
Data Liaison Team, and the reasoning for 
any such referrals, not later than 7 days 
after such a referral is made; and 
(iii) on an biannual basis, submitting 
to Congress a report on the findings made 
by and results from any referrals made by 
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the Interagency Board, including any rea-
son for not pursuing action on referrals in 
the event that action was not taken (if the 
Interagency Board has been informed of 
such reason). 
(C) COMPOSITION.— 
(i) IN
GENERAL.—The Interagency 
Board shall consist of— 
(I) the Administrator of Centers 
for Medicare & Medicaid Services of 
the 
Department 
of 
Health 
and 
Human Services (or designee); 
(II) the Inspector General of the 
Office of the Inspector General of the 
Department of Health and Human 
Services (or designee); 
(III) the Attorney General of the 
Department of Justice (or designee); 
and 
(IV) any other employees of the 
agencies specified in subclauses (I) 
through (III) (as determined appro-
priate by the Secretary of Health and 
Human Services). 
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(ii) CHAIR.—An employee of the Of-
fice of Inspector General of the Depart-
ment of Health and Human Services shall 
chair the Interagency Board. 
SEC. 
3. 
FUNDING 
FOR 
NATIONAL 
DEMONSTRATION 
PROJECTS ON CULTURE CHANGE AND USE 
OF INFORMATION TECHNOLOGY IN NURSING 
HOMES. 
Section 6114 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 1395i–3 note) is amended— 
(1) in subsection (a), by adding at the end the 
following new sentence: ‘‘Beginning in fiscal year 
2023, the Secretary shall implement 2 additional 
demonstration projects, split in accordance with the 
previous sentence.’’; 
(2) in subsection (b)— 
(A) in paragraph (1), by adding at the end 
the following new sentence: ‘‘For the carrying 
out of the implementation of demonstration 
projects beginning in fiscal year 2023, the Sec-
retary shall award grants (in a number deter-
mined appropriate) in accordance with the pro-
visions of this subsection.’’; and 
(B) by adding at the end the following new 
paragraph: 
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‘‘(3) REQUIREMENT
FOR
ONE
OF
THE
RE-
NEWED DEMONSTRATION PROJECTS.—With respect 
to the grants which are awarded under 1 of the 2 
demonstration projects which is implemented pursu-
ant to the second sentence of subsection (a), all of 
the grants which are so awarded shall be awarded to 
skilled nursing facilities and nursing facilities which 
have a high proportion of residents receiving medical 
assistance under title XIX of the Social Security Act 
for nursing facility services.’’; 
(3) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘The 
demonstration projects’’ and inserting ‘‘Subject 
to paragraph (3), the demonstration projects’’; 
and 
(B) by adding at the end the following new 
paragraph: 
‘‘(3) IMPLEMENTATION
OF
DEMONSTRATION 
PROJECTS.—The demonstration projects described in 
the second sentence of subsection (a) shall be imple-
mented for a period not to exceed 5 years.’’; 
(4) in subsection (d), by adding at the end the 
following new paragraph: 
‘‘(4) CULTURE
CHANGE.—The term ‘culture 
change’ means, with respect to a skilled nursing fa-
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cility or a nursing facility carrying out a demonstra-
tion project under this section, the process of pro-
moting person-centered care and person-centered 
work culture at such facility.’’; and 
(5) in subsection (e), by adding at the end the 
following new sentence: ‘‘With respect to the imple-
mentation of the demonstration projects pursuant to 
the second sentence of subsection (a), there are au-
thorized to be appropriated $50,000,000 to carry 
out the demonstration project relating to culture 
change and $30,000,000 to carry out the demonstra-
tion project relating to information technology for 
the period of fiscal years 2023 through 2027.’’. 
Æ 
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