I 
111TH CONGRESS 
1ST SESSION H. R. 2937 
To prevent health care facility-acquired infections. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 18, 2009 
Ms. SPEIER (for herself, Ms. SCHAKOWSKY, Mrs. CAPPS, and Ms. ESHOO) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To prevent health care facility-acquired infections. 
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 ‘‘MRSA Infection Pre-
vention and Patient Protection Act’’. 
SEC. 2. DEFINITIONS. 
In this Act: 
(1) ACUTE CARE HOSPITAL.—The term ‘‘acute 
care hospital’’ means a hospital that maintains and 
operates an emergency room (including a trauma or 
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burn center), surgical unit, birthing facility, and 
such other unit that is highly susceptible to acquir-
ing or transmitting infections, as determined by the 
Secretary through regulations. 
(2) HOSPITAL.—The term ‘‘hospital’’ has the 
meaning given such term in section 1861(e) of the 
Social Security Act (42 U.S.C. 1395x(e)) and in-
cludes critical access hospitals (as defined in section 
1861(mm) of such Act) and other entities deter-
mined to be hospitals by the Secretary. 
(3) 
MRSA.—The 
term 
‘‘MRSA’’ 
means 
Methicillin-resistant Staphylococcus aureus. 
(4) OTHER INFECTION.—The term ‘‘other in-
fection’’ means an infection that the Secretary, after 
consultation with the Director of the Centers for 
Disease Control and Prevention and other public 
health officials, as appropriate, and after public 
hearing, determines to be, or to have the potential 
to become, a serious source of morbidity and mor-
tality in health care facilities. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 3. HOSPITAL INFECTION PREVENTION PROGRAMS. 
(a) REGULATIONS.— 
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(1) IN
GENERAL.—Not later than 150 days 
after the date of enactment of this Act, the Sec-
retary, in consultation with the Director of the Cen-
ters for Disease Control and Prevention and such 
independent experts as the Secretary determines ap-
propriate, shall promulgate regulations that— 
(A) provide a list of best practices for pre-
venting MRSA infections and such other anti-
biotic resistant pathogens as the Secretary de-
termines appropriate; 
(B) define the term ‘‘high risk hospital de-
partments’’ for purposes of applying the best 
practices provided for under subparagraph (A), 
which may include surgical, burn, neonatal, and 
such other departments as the Secretary deter-
mines; 
(C) define the term ‘‘serious source of 
morbidity and mortality’’ in quantitative terms 
for purposes of determining the applicability of 
this Act to other infections, except that such 
definition shall not require morbidity and mor-
tality rates of more than 1 percent of the esti-
mated patient population at risk for a par-
ticular infection in order for an infection to 
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qualify as a serious source of morbidity and 
mortality; and 
(D) provide screening, recordkeeping, and 
other requirements as they relate to reductions 
in MRSA infections. 
(2) CONSISTENCY.—The regulations promul-
gated under this subsection shall be consistent with 
the requirements of this Act. 
(3) EFFECTIVE
DATE.—The regulations pro-
mulgated under paragraph (1) shall take effect on 
the date that is 30 days after the date on which 
such regulations are published in the Federal Reg-
ister, but in no case later than 180 days after the 
date of enactment of this Act. 
(b) SCREENING REQUIREMENTS.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of enactment of this Act, each acute 
care hospital shall screen each patient entering an 
intensive care unit or other high risk hospital de-
partment (as defined in the regulations promulgated 
under subsection (a)(1)(B)). 
(2) EXTENSION OF REQUIREMENTS.— 
(A) IN GENERAL.—The Secretary, in con-
sultation with the Director of the Centers for 
Disease Control and Prevention, shall establish 
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a process and a timetable for extending the 
screening requirements of paragraph (1) to all 
patients admitted to all hospitals. 
(B) REQUIREMENTS
FULLY
APPLIED.— 
The timetable established under subparagraph 
(A), shall require that all patients be covered by 
the screening requirements under paragraph (1) 
by not later than January 1, 2014. 
(C) WAIVER.—The Secretary may waive 
the requirements of this paragraph if the Sec-
retary determines, at the recommendation of 
the Director of the Centers for Disease Control 
and Prevention and after public hearing, that 
the rate of MRSA infections or other infections 
has declined to a level at which further screen-
ing is no longer needed. 
(3) MEDICARE.— 
(A) REQUIREMENT.— 
(i) IN GENERAL.—Section 1866(a)(1) 
of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended— 
(I) by striking ‘‘and’’ at the end 
of subparagraph (U); 
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(II) by striking the period at the 
end of subparagraph (V) and insert-
ing ‘‘, and’’; and 
(III) by inserting after subpara-
graph (V) the following: 
‘‘(W) in the case of an acute care hospital (as 
defined in section 2(1) of the MRSA Infection Pre-
vention and Patient Protection Act), to comply with 
the screening requirements described in section 3 of 
such Act.’’. 
(ii) EFFECTIVE
DATE.—The amend-
ments made by clause (i) shall apply to 
agreements entered into or renewed on or 
after the date that is 180 days after the 
enactment of this Act. 
(B) MEDICARE PAYMENT ADJUSTMENTS.— 
Not later than January 1, 2011, the Secretary 
shall submit to the appropriate committees of 
Congress, a report on whether payment adjust-
ments should be made under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) to 
assist certain hospitals in defraying the cost of 
screening for, and the subsequent treatment of, 
MRSA infections (or other infections). In pre-
paring such report, the Secretary shall give spe-
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cial consideration to the needs of rural, critical 
access, sole community, and Medicare depend-
ent hospitals, and disproportionate share hos-
pitals and other hospitals with a dispropor-
tionate share of immune compromised patients. 
(c) BEST PRACTICES.—In addition to any other best 
practices contained in the regulations promulgated under 
subsection (a)(1)(A), each hospital shall comply with the 
following: 
(1) A hospital shall require contact (barrier) 
precautions, as determined by the Secretary, be 
taken when treating patients who test positive for 
MRSA colonization (as defined by the Centers for 
Disease Control and Prevention). 
(2) Where possible, a hospital shall isolate, with 
the same staffing ratio per bed as in the non-iso-
lated beds of the hospital, or cohort patients colo-
nized or infected with MRSA, or notify patients in 
which the infected patient may room with that such 
patient has tested positive for MRSA, control and 
monitor the movements of such patients within the 
hospital, and take whatever steps are needed to stop 
the transmission of MRSA bacteria to patients who 
did not come into the hospital infected or colonized 
with such bacteria. The Secretary may suspend the 
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application of this paragraph in the case of an emer-
gency. 
(3) All patients who test positive for MRSA 
shall be informed of the results. All MRSA test re-
sults shall be noted in the patient’s medical record. 
(4) Each hospital shall, by January 1, 2010, 
adopt a policy requiring any patient who has a 
MRSA infection to receive oral and written instruc-
tions regarding aftercare and precautions to prevent 
the spread of the infection to others. 
(5) Patients being discharged from intensive 
care units shall be tested again for MRSA, and 
those patients testing positive shall be informed of 
their status, and that status shall be noted in the 
patient’s medical records in case of readmittance to 
a hospital. 
(6) A hospital shall educate its staff concerning 
modes of transmission of MRSA, use of protective 
equipment, disinfection policies and procedures, and 
other preventive measures. 
(7) A hospital shall provide other interventions, 
as the Secretary determines to be necessary, for con-
trol of MRSA infection. 
(d) REPORTING.— 
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(1) IN GENERAL.—Not later than January 1, 
2011, each hospital shall, using the National 
Healthcare Safety Network of the Centers for Dis-
ease Control and Prevention, report hospital-ac-
quired MRSA and other infections that occur in the 
hospital facility. The Secretary shall develop a proc-
ess for the risk adjustment of such reports by hos-
pitals. 
(2) PUBLICATION.—The Secretary shall develop 
a system for the publication of hospital-specific in-
fection rates, including the rate of MRSA infections. 
(e) NON-HOSPITAL MEDICARE PROVIDERS.— 
(1) MRSA INFECTION REPORTING.—The Sec-
retary, using the MRSA infection and other infection 
information identified under subsection (b) and such 
other billing and coding information as necessary, 
shall promulgate regulations to— 
(A) define the term ‘‘infected transferred 
patient’’, to describe a patient who, after dis-
charge from, or treatment at, a non-hospital 
Medicare provider, is admitted to the hospital 
with MRSA infection (or other infection); 
(B) establish a system for identifying in-
fected transferred patients; 
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(C) establish a system to promptly inform 
any facility that has transferred an infected pa-
tient; and 
(D) establish requirements that any non- 
hospital Medicare provider that treats an in-
fected transferred patient described under sub-
paragraph (A) and that cannot provide a rea-
sonable explanation that the infection was not 
acquired in the facility, submit to the Secretary 
an action plan describing how such provider 
plans to reduce the incidence of such infections. 
(2) ASSISTANCE.—The Secretary shall promul-
gate regulations to develop a program to provide 
technical assistance and educational materials to 
non-hospital Medicare providers described in para-
graph (1)(A) in order to assist in preventing subse-
quent MRSA infections. 
(3) PUBLICATION OF CERTAIN INFORMATION.— 
If a non-hospital Medicare provider identified using 
the system established under paragraph (1) fails to 
take steps, as required by the regulations promul-
gated under subparagraph (1)(D), to combat MRSA 
infections, the Secretary shall publish the name of 
the provider and the number of MRSA infections 
from such provider in the previous year. 
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(f) ASSISTANCE.— 
(1) IN GENERAL.—To provide for the rapid im-
plementation of MRSA screening programs and ini-
tiatives through the installation of certified MRSA 
screening equipment and the provision of necessary 
support services, a hospital may submit an applica-
tion to the Secretary for a 1-year increase in the 
amount of the capital-related costs payment made to 
the hospital under the prospective payment system 
under section 1886(g) of the Social Security Act (42 
U.S.C. 1395ww(g)). The Secretary shall approve all 
requests that the Secretary determines are reason-
able and necessary. 
(2) REPAYMENT.—A hospital that receives an 
increase under paragraph (1) shall, not later than 4 
years after the date of receipt of such increase, reim-
burse the Secretary for the costs of such increase. 
Such costs shall include the accrual of interest at 
the rate payable for Federal Treasury notes. Such 
reimbursement may be in the form of reduced cap-
ital-related costs payments to the hospital under the 
system described in paragraph (1) for the years fol-
lowing the year in which the increase was received. 
(3) CERTIFICATION
SYSTEM.—Not later than 
180 days after the date of enactment of this Act, the 
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