H. R. 3590—587 
‘‘(A) IN GENERAL.—The Secretary shall ensure that the 
Department of Health and Human Services includes, as 
part of the information provided for comparison of nursing 
homes on the official Internet website of the Federal 
Government for Medicare beneficiaries (commonly referred 
to as the ‘Nursing Home Compare’ Medicare website) (or 
a successor website), the following information in a manner 
that is prominent, updated on a timely basis, easily acces-
sible, readily understandable to consumers of long-term 
care services, and searchable: 
‘‘(i) Staffing data for each facility (including resi-
dent census data and data on the hours of care pro-
vided per resident per day) based on data submitted 
under section 1128I(g), including information on 
staffing turnover and tenure, in a format that is clearly 
understandable to consumers of long-term care services 
and allows such consumers to compare differences in 
staffing between facilities and State and national aver-
ages for the facilities. Such format shall include— 
‘‘(I) concise explanations of how to interpret 
the data (such as a plain English explanation of 
data reflecting ‘nursing home staff hours per resi-
dent day’); 
‘‘(II) differences in types of staff (such as 
training associated with different categories of 
staff); 
‘‘(III) the relationship between nurse staffing 
levels and quality of care; and 
‘‘(IV) an explanation that appropriate staffing 
levels vary based on patient case mix. 
‘‘(ii) Links to State Internet websites with informa-
tion regarding State survey and certification programs, 
links to Form 2567 State inspection reports (or a suc-
cessor form) on such websites, information to guide 
consumers in how to interpret and understand such 
reports, and the facility plan of correction or other 
response to such report. Any such links shall be posted 
on a timely basis. 
‘‘(iii) The standardized complaint form developed 
under section 1128I(f), including explanatory material 
on what complaint forms are, how they are used, and 
how to file a complaint with the State survey and 
certification program and the State long-term care 
ombudsman program. 
‘‘(iv) Summary information on the number, type, 
severity, and outcome of substantiated complaints. 
‘‘(v) The number of adjudicated instances of 
criminal violations by a facility or the employees of 
a facility— 
‘‘(I) that were committed inside the facility; 
‘‘(II) with respect to such instances of viola-
tions or crimes committed inside of the facility 
that were the violations or crimes of abuse, neglect, 
and exploitation, criminal sexual abuse, or other 
violations or crimes that resulted in serious bodily 
injury; and
H. R. 3590—588 
‘‘(III) the number of civil monetary penalties 
levied against the facility, employees, contractors, 
and other agents. 
‘‘(B) DEADLINE FOR PROVISION OF INFORMATION.— 
‘‘(i) IN
GENERAL.—Except as provided in clause 
(ii), the Secretary shall ensure that the information 
described in subparagraph (A) is included on such 
website (or a successor website) not later than 1 year 
after the date of the enactment of this subsection. 
‘‘(ii) EXCEPTION.—The Secretary shall ensure that 
the information described in subparagraph (A)(i) is 
included on such website (or a successor website) not 
later than the date on which the requirements under 
section 1128I(g) are implemented. 
‘‘(2) REVIEW AND MODIFICATION OF WEBSITE.— 
‘‘(A) IN
GENERAL.—The Secretary shall establish a 
process— 
‘‘(i) to review the accuracy, clarity of presentation, 
timeliness, and comprehensiveness of information 
reported on such website as of the day before the 
date of the enactment of this subsection; and 
‘‘(ii) not later than 1 year after the date of the 
enactment of this subsection, to modify or revamp such 
website in accordance with the review conducted under 
clause (i). 
‘‘(B) CONSULTATION.—In conducting the review under 
subparagraph (A)(i), the Secretary shall consult with— 
‘‘(i) State long-term care ombudsman programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; and 
‘‘(iv) any other representatives of programs or 
groups the Secretary determines appropriate.’’. 
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFI-
CATION INFORMATION.— 
(A) IN GENERAL.—Section 1819(g)(5) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(g)(5)) is amended by adding 
at the end the following new subparagraph: 
‘‘(E) SUBMISSION
OF
SURVEY
AND
CERTIFICATION 
INFORMATION TO THE SECRETARY.—In order to improve the 
timeliness of information made available to the public 
under subparagraph (A) and provided on the Nursing Home 
Compare Medicare website under subsection (i), each State 
shall submit information respecting any survey or certifi-
cation made respecting a skilled nursing facility (including 
any enforcement actions taken by the State) to the Sec-
retary not later than the date on which the State sends 
such information to the facility. The Secretary shall use 
the information submitted under the preceding sentence 
to update the information provided on the Nursing Home 
Compare Medicare website as expeditiously as practicable 
but not less frequently than quarterly.’’. 
(B) EFFECTIVE DATE.—The amendment made by this 
paragraph shall take effect 1 year after the date of the 
enactment of this Act. 
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1819(f) of 
the Social Security Act (42 U.S.C. 1395i–3(f)) is amended by 
adding at the end the following new paragraph:
H. R. 3590—589 
‘‘(8) SPECIAL FOCUS FACILITY PROGRAM.— 
‘‘(A) IN GENERAL.—The Secretary shall conduct a spe-
cial focus facility program for enforcement of requirements 
for skilled nursing facilities that the Secretary has identi-
fied as having substantially failed to meet applicable 
requirement of this Act. 
‘‘(B) PERIODIC SURVEYS.—Under such program the Sec-
retary shall conduct surveys of each facility in the program 
not less than once every 6 months.’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919 of the Social Security Act 
(42 U.S.C. 1396r) is amended— 
(A) by redesignating subsection (i) as subsection (j); 
and 
(B) by inserting after subsection (h) the following new 
subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMATION.— 
‘‘(A) IN GENERAL.—The Secretary shall ensure that the 
Department of Health and Human Services includes, as 
part of the information provided for comparison of nursing 
homes on the official Internet website of the Federal 
Government for Medicare beneficiaries (commonly referred 
to as the ‘Nursing Home Compare’ Medicare website) (or 
a successor website), the following information in a manner 
that is prominent, updated on a timely basis, easily acces-
sible, readily understandable to consumers of long-term 
care services, and searchable: 
‘‘(i) Staffing data for each facility (including resi-
dent census data and data on the hours of care pro-
vided per resident per day) based on data submitted 
under section 1128I(g), including information on 
staffing turnover and tenure, in a format that is clearly 
understandable to consumers of long-term care services 
and allows such consumers to compare differences in 
staffing between facilities and State and national aver-
ages for the facilities. Such format shall include— 
‘‘(I) concise explanations of how to interpret 
the data (such as plain English explanation of 
data reflecting ‘nursing home staff hours per resi-
dent day’); 
‘‘(II) differences in types of staff (such as 
training associated with different categories of 
staff); 
‘‘(III) the relationship between nurse staffing 
levels and quality of care; and 
‘‘(IV) an explanation that appropriate staffing 
levels vary based on patient case mix. 
‘‘(ii) Links to State Internet websites with informa-
tion regarding State survey and certification programs, 
links to Form 2567 State inspection reports (or a suc-
cessor form) on such websites, information to guide 
consumers in how to interpret and understand such 
reports, and the facility plan of correction or other 
response to such report. Any such links shall be posted 
on a timely basis.
H. R. 3590—590 
‘‘(iii) The standardized complaint form developed 
under section 1128I(f), including explanatory material 
on what complaint forms are, how they are used, and 
how to file a complaint with the State survey and 
certification program and the State long-term care 
ombudsman program. 
‘‘(iv) Summary information on the number, type, 
severity, and outcome of substantiated complaints. 
‘‘(v) The number of adjudicated instances of 
criminal violations by a facility or the employees of 
a facility— 
‘‘(I) that were committed inside of the facility; 
and 
‘‘(II) with respect to such instances of viola-
tions or crimes committed outside of the facility, 
that were violations or crimes that resulted in 
the serious bodily injury of an elder. 
‘‘(B) DEADLINE FOR PROVISION OF INFORMATION.— 
‘‘(i) IN
GENERAL.—Except as provided in clause 
(ii), the Secretary shall ensure that the information 
described in subparagraph (A) is included on such 
website (or a successor website) not later than 1 year 
after the date of the enactment of this subsection. 
‘‘(ii) EXCEPTION.—The Secretary shall ensure that 
the information described in subparagraph (A)(i) is 
included on such website (or a successor website) not 
later than the date on which the requirements under 
section 1128I(g) are implemented. 
‘‘(2) REVIEW AND MODIFICATION OF WEBSITE.— 
‘‘(A) IN
GENERAL.—The Secretary shall establish a 
process— 
‘‘(i) to review the accuracy, clarity of presentation, 
timeliness, and comprehensiveness of information 
reported on such website as of the day before the 
date of the enactment of this subsection; and 
‘‘(ii) not later than 1 year after the date of the 
enactment of this subsection, to modify or revamp such 
website in accordance with the review conducted under 
clause (i). 
‘‘(B) CONSULTATION.—In conducting the review under 
subparagraph (A)(i), the Secretary shall consult with— 
‘‘(i) State long-term care ombudsman programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; 
‘‘(iv) skilled nursing facility employees and their 
representatives; and 
‘‘(v) any other representatives of programs or 
groups the Secretary determines appropriate.’’. 
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFI-
CATION INFORMATION.— 
(A) IN GENERAL.—Section 1919(g)(5) of the Social Secu-
rity Act (42 U.S.C. 1396r(g)(5)) is amended by adding at 
the end the following new subparagraph: 
‘‘(E) SUBMISSION
OF
SURVEY
AND
CERTIFICATION 
INFORMATION TO THE SECRETARY.—In order to improve the 
timeliness of information made available to the public 
under subparagraph (A) and provided on the Nursing Home
H. R. 3590—591 
Compare Medicare website under subsection (i), each State 
shall submit information respecting any survey or certifi-
cation made respecting a nursing facility (including any 
enforcement actions taken by the State) to the Secretary 
not later than the date on which the State sends such 
information to the facility. The Secretary shall use the 
information submitted under the preceding sentence to 
update the information provided on the Nursing Home 
Compare Medicare website as expeditiously as practicable 
but not less frequently than quarterly.’’. 
(B) EFFECTIVE DATE.—The amendment made by this 
paragraph shall take effect 1 year after the date of the 
enactment of this Act. 
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1919(f) of 
the Social Security Act (42 U.S.C. 1396r(f)) is amended by 
adding at the end of the following new paragraph: 
‘‘(10) SPECIAL FOCUS FACILITY PROGRAM.— 
‘‘(A) IN GENERAL.—The Secretary shall conduct a spe-
cial focus facility program for enforcement of requirements 
for nursing facilities that the Secretary has identified as 
having substantially failed to meet applicable requirements 
of this Act. 
‘‘(B) PERIODIC SURVEYS.—Under such program the Sec-
retary shall conduct surveys of each facility in the program 
not less often than once every 6 months.’’. 
(c) AVAILABILITY OF REPORTS ON SURVEYS, CERTIFICATIONS, AND 
COMPLAINT INVESTIGATIONS.— 
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the 
Social Security Act (42 U.S.C. 1395i–3(d)(1)), as amended by 
section 6101, is amended by adding at the end the following 
new subparagraph: 
‘‘(C) AVAILABILITY OF SURVEY, CERTIFICATION, AND COM-
PLAINT INVESTIGATION REPORTS.—A skilled nursing facility 
must— 
‘‘(i) have reports with respect to any surveys, cer-
tifications, 
and 
complaint 
investigations 
made 
respecting the facility during the 3 preceding years 
available for any individual to review upon request; 
and 
‘‘(ii) post notice of the availability of such reports 
in areas of the facility that are prominent and acces-
sible to the public. 
The facility shall not make available under clause (i) identi-
fying information about complainants or residents.’’. 
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social 
Security Act (42 U.S.C. 1396r(d)(1)), as amended by section 
6101, is amended by adding at the end the following new 
subparagraph: 
‘‘(V) AVAILABILITY OF SURVEY, CERTIFICATION, AND COM-
PLAINT INVESTIGATION REPORTS.—A nursing facility must— 
‘‘(i) have reports with respect to any surveys, cer-
tifications, 
and 
complaint 
investigations 
made 
respecting the facility during the 3 preceding years 
available for any individual to review upon request; 
and
H. R. 3590—592 
‘‘(ii) post notice of the availability of such reports 
in areas of the facility that are prominent and acces-
sible to the public. 
The facility shall not make available under clause (i) identi-
fying information about complainants or residents.’’. 
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall take effect 1 year after the date of the enactment 
of this Act. 
(d) GUIDANCE TO STATES ON FORM 2567 STATE INSPECTION 
REPORTS AND COMPLAINT INVESTIGATION REPORTS.— 
(1) GUIDANCE.—The Secretary of Health and Human Serv-
ices (in this subtitle referred to as the ‘‘Secretary’’) shall provide 
guidance to States on how States can establish electronic links 
to Form 2567 State inspection reports (or a successor form), 
complaint investigation reports, and a facility’s plan of correc-
tion or other response to such Form 2567 State inspection 
reports (or a successor form) on the Internet website of the 
State that provides information on skilled nursing facilities 
and nursing facilities and the Secretary shall, if possible, 
include such information on Nursing Home Compare. 
(2) REQUIREMENT.—Section 1902(a)(9) of the Social Security 
Act (42 U.S.C. 1396a(a)(9)) is amended— 
(A) by striking ‘‘and’’ at the end of subparagraph (B); 
(B) by striking the semicolon at the end of subpara-
graph (C) and inserting ‘‘, and’’; and 
(C) by adding at the end the following new subpara-
graph: 
‘‘(D) that the State maintain a consumer-oriented 
website 
providing 
useful 
information 
to 
consumers 
regarding all skilled nursing facilities and all nursing facili-
ties in the State, including for each facility, Form 2567 
State inspection reports (or a successor form), complaint 
investigation reports, the facility’s plan of correction, and 
such other information that the State or the Secretary 
considers useful in assisting the public to assess the quality 
of long term care options and the quality of care provided 
by individual facilities;’’. 
(3) DEFINITIONS.—In this subsection: 
(A) NURSING FACILITY.—The term ‘‘nursing facility’’ has 
the meaning given such term in section 1919(a) of the 
Social Security Act (42 U.S.C. 1396r(a)). 
(B) SECRETARY.—The term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services. 
(C) SKILLED
NURSING
FACILITY.—The term ‘‘skilled 
nursing facility’’ has the meaning given such term in sec-
tion 1819(a) of the Social Security Act (42 U.S.C. 1395i– 
3(a)). 
(e) DEVELOPMENT OF CONSUMER RIGHTS INFORMATION PAGE 
ON NURSING HOME COMPARE WEBSITE.—Not later than 1 year 
after the date of enactment of this Act, the Secretary shall ensure 
that the Department of Health and Human Services, as part of 
the information provided for comparison of nursing facilities on 
the Nursing Home Compare Medicare website develops and includes 
a consumer rights information page that contains links to descrip-
tions of, and information with respect to, the following: 
(1) The documentation on nursing facilities that is available 
to the public.
H. R. 3590—593 
(2) General information and tips on choosing a nursing 
facility that meets the needs of the individual. 
(3) General information on consumer rights with respect 
to nursing facilities. 
(4) The nursing facility survey process (on a national and 
State-specific basis). 
(5) On a State-specific basis, the services available through 
the State long-term care ombudsman for such State. 
SEC. 6104. REPORTING OF EXPENDITURES. 
Section 1888 of the Social Security Act (42 U.S.C. 1395yy) 
is amended by adding at the end the following new subsection: 
‘‘(f) REPORTING OF DIRECT CARE EXPENDITURES.— 
‘‘(1) IN GENERAL.—For cost reports submitted under this 
title for cost reporting periods beginning on or after the date 
that is 2 years after the date of the enactment of this subsection, 
skilled nursing facilities shall separately report expenditures 
for wages and benefits for direct care staff (breaking out (at 
a minimum) registered nurses, licensed professional nurses, 
certified nurse assistants, and other medical and therapy staff). 
‘‘(2) MODIFICATION OF FORM.—The Secretary, in consulta-
tion with private sector accountants experienced with Medicare 
and Medicaid nursing facility home cost reports, shall redesign 
such reports to meet the requirement of paragraph (1) not 
later than 1 year after the date of the enactment of this sub-
section. 
‘‘(3) CATEGORIZATION BY FUNCTIONAL ACCOUNTS.—Not later 
than 30 months after the date of the enactment of this sub-
section, the Secretary, working in consultation with the Medi-
care Payment Advisory Commission, the Medicaid and CHIP 
Payment and Access Commission, the Inspector General of 
the Department of Health and Human Services, and other 
expert parties the Secretary determines appropriate, shall take 
the expenditures listed on cost reports, as modified under para-
graph (1), submitted by skilled nursing facilities and categorize 
such expenditures, regardless of any source of payment for 
such expenditures, for each skilled nursing facility into the 
following functional accounts on an annual basis: 
‘‘(A) Spending on direct care services (including 
nursing, therapy, and medical services). 
‘‘(B) Spending on indirect care (including housekeeping 
and dietary services). 
‘‘(C) Capital assets (including building and land costs). 
‘‘(D) Administrative services costs. 
‘‘(4) AVAILABILITY OF INFORMATION SUBMITTED.—The Sec-
retary shall establish procedures to make information on 
expenditures submitted under this subsection readily available 
to interested parties upon request, subject to such requirements 
as the Secretary may specify under the procedures established 
under this paragraph.’’. 
SEC. 6105. STANDARDIZED COMPLAINT FORM. 
(a) IN GENERAL.—Section 1128I of the Social Security Act, 
as added and amended by this Act, is amended by adding at 
the end the following new subsection: 
‘‘(f) STANDARDIZED COMPLAINT FORM.— 
‘‘(1) DEVELOPMENT BY THE SECRETARY.—The Secretary shall 
develop a standardized complaint form for use by a resident
H. R. 3590—594 
(or a person acting on the resident’s behalf) in filing a complaint 
with a State survey and certification agency and a State long- 
term care ombudsman program with respect to a facility. 
‘‘(2) COMPLAINT FORMS AND RESOLUTION PROCESSES.— 
‘‘(A) COMPLAINT
FORMS.—The State must make the 
standardized complaint form developed under paragraph 
(1) available upon request to— 
‘‘(i) a resident of a facility; and 
‘‘(ii) any person acting on the resident’s behalf. 
‘‘(B) COMPLAINT RESOLUTION PROCESS.—The State must 
establish a complaint resolution process in order to ensure 
that the legal representative of a resident of a facility 
or other responsible party is not denied access to such 
resident or otherwise retaliated against if they have com-
plained about the quality of care provided by the facility 
or other issues relating to the facility. Such complaint 
resolution process shall include— 
‘‘(i) procedures to assure accurate tracking of com-
plaints received, including notification to the complain-
ant that a complaint has been received; 
‘‘(ii) procedures to determine the likely severity 
of a complaint and for the investigation of the com-
plaint; and 
‘‘(iii) deadlines for responding to a complaint and 
for notifying the complainant of the outcome of the 
investigation. 
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this subsection 
shall be construed as preventing a resident of a facility (or 
a person acting on the resident’s behalf) from submitting a 
complaint in a manner or format other than by using the 
standardized complaint form developed under paragraph (1) 
(including submitting a complaint orally).’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect 1 year after the date of the enactment of this 
Act. 
SEC. 6106. ENSURING STAFFING ACCOUNTABILITY. 
Section 1128I of the Social Security Act, as added and amended 
by this Act, is amended by adding at the end the following new 
subsection: 
‘‘(g) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL 
DATA IN A UNIFORM FORMAT.—Beginning not later than 2 years 
after the date of the enactment of this subsection, and after con-
sulting with State long-term care ombudsman programs, consumer 
advocacy groups, provider stakeholder groups, employees and their 
representatives, and other parties the Secretary deems appropriate, 
the Secretary shall require a facility to electronically submit to 
the Secretary direct care staffing information (including information 
with respect to agency and contract staff) based on payroll and 
other verifiable and auditable data in a uniform format (according 
to specifications established by the Secretary in consultation with 
such programs, groups, and parties). Such specifications shall 
require that the information submitted under the preceding sen-
tence— 
‘‘(1) specify the category of work a certified employee per-
forms (such as whether the employee is a registered nurse,
H. R. 3590—595 
licensed practical nurse, licensed vocational nurse, certified 
nursing assistant, therapist, or other medical personnel); 
‘‘(2) include resident census data and information on resi-
dent case mix; 
‘‘(3) include a regular reporting schedule; and 
‘‘(4) include information on employee turnover and tenure 
and on the hours of care provided by each category of certified 
employees referenced in paragraph (1) per resident per day. 
Nothing in this subsection shall be construed as preventing the 
Secretary from requiring submission of such information with 
respect to specific categories, such as nursing staff, before other 
categories of certified employees. Information under this subsection 
with respect to agency and contract staff shall be kept separate 
from information on employee staffing.’’. 
SEC. 6107. GAO STUDY AND REPORT ON FIVE-STAR QUALITY RATING 
SYSTEM. 
(a) STUDY.—The Comptroller General of the United States (in 
this section referred to as the ‘‘Comptroller General’’) shall conduct 
a study on the Five-Star Quality Rating System for nursing homes 
of the Centers for Medicare & Medicaid Services. Such study shall 
include an analysis of— 
(1) how such system is being implemented; 
(2) any problems associated with such system or its 
implementation; and 
(3) how such system could be improved. 
(b) REPORT.—Not later than 2 years after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a 
report containing the results of the study conducted under sub-
section (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines appro-
priate. 
PART II—TARGETING ENFORCEMENT 
SEC. 6111. CIVIL MONEY PENALTIES. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN
GENERAL.—Section 1819(h)(2)(B)(ii) of the Social 
Security Act (42 U.S.C. 1395i–3(h)(2)(B)(ii)) is amended— 
(A) by striking ‘‘PENALTIES.—The Secretary’’ and 
inserting ‘‘PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to subclause (II), 
the Secretary’’; and 
(B) by adding at the end the following new subclauses: 
‘‘(II) REDUCTION
OF
CIVIL
MONEY
PENALTIES 
IN CERTAIN CIRCUMSTANCES.—Subject to subclause 
(III), in the case where a facility self-reports and 
promptly corrects a deficiency for which a penalty 
was imposed under this clause not later than 10 
calendar days after the date of such imposition, 
the Secretary may reduce the amount of the pen-
alty imposed by not more than 50 percent. 
‘‘(III) PROHIBITIONS ON REDUCTION FOR CER-
TAIN DEFICIENCIES.— 
‘‘(aa) REPEAT
DEFICIENCIES.—The Sec-
retary may not reduce the amount of a penalty 
under subclause (II) if the Secretary had
H. R. 3590—596 
reduced a penalty imposed on the facility in 
the preceding year under such subclause with 
respect to a repeat deficiency. 
‘‘(bb) CERTAIN OTHER DEFICIENCIES.—The 
Secretary may not reduce the amount of a 
penalty under subclause (II) if the penalty 
is imposed on the facility for a deficiency that 
is found to result in a pattern of harm or 
widespread harm, immediately jeopardizes the 
health or safety of a resident or residents of 
the facility, or results in the death of a resi-
dent of the facility. 
‘‘(IV) COLLECTION
OF
CIVIL
MONEY
PEN-
ALTIES.—In the case of a civil money penalty 
imposed under this clause, the Secretary shall 
issue regulations that— 
‘‘(aa) subject to item (cc), not later than 
30 days after the imposition of the penalty, 
provide for the facility to have the opportunity 
to participate in an independent informal dis-
pute resolution process which generates a 
written record prior to the collection of such 
penalty; 
‘‘(bb) in the case where the penalty is 
imposed for each day of noncompliance, pro-
vide that a penalty may not be imposed for 
any day during the period beginning on the 
initial day of the imposition of the penalty 
and ending on the day on which the informal 
dispute resolution process under item (aa) is 
completed; 
‘‘(cc) may provide for the collection of such 
civil money penalty and the placement of such 
amounts collected in an escrow account under 
the direction of the Secretary on the earlier 
of the date on which the informal dispute reso-
lution process under item (aa) is completed 
or the date that is 90 days after the date 
of the imposition of the penalty; 
‘‘(dd) may provide that such amounts col-
lected are kept in such account pending the 
resolution of any subsequent appeals; 
‘‘(ee) in the case where the facility success-
fully appeals the penalty, may provide for the 
return 
of 
such 
amounts 
collected 
(plus 
interest) to the facility; and 
‘‘(ff) in the case where all such appeals 
are unsuccessful, may provide that some por-
tion of such amounts collected may be used 
to support activities that benefit residents, 
including assistance to support and protect 
residents of a facility that closes (voluntarily 
or involuntarily) or is decertified (including 
offsetting costs of relocating residents to home 
and community-based settings or another 
facility), projects that support resident and
H. R. 3590—597 
family councils and other consumer involve-
ment in assuring quality care in facilities, and 
facility improvement initiatives approved by 
the Secretary (including joint training of 
facility staff and surveyors, technical assist-
ance for facilities implementing quality assur-
ance programs, the appointment of temporary 
management 
firms, 
and 
other 
activities 
approved by the Secretary).’’. 
(2) CONFORMING AMENDMENT.—The second sentence of sec-
tion 1819(h)(5) of the Social Security Act (42 U.S.C. 1395i– 
3(h)(5)) is amended by inserting ‘‘(ii)(IV),’’ after ‘‘(i),’’. 
(b) NURSING FACILITIES.— 
(1) IN
GENERAL.—Section 1919(h)(3)(C)(ii) of the Social 
Security Act (42 U.S.C. 1396r(h)(3)(C)) is amended— 
(A) by striking ‘‘PENALTIES.—The Secretary’’ and 
inserting ‘‘PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to subclause (II), 
the Secretary’’; and 
(B) by adding at the end the following new subclauses: 
‘‘(II) REDUCTION
OF
CIVIL
MONEY
PENALTIES 
IN CERTAIN CIRCUMSTANCES.—Subject to subclause 
(III), in the case where a facility self-reports and 
promptly corrects a deficiency for which a penalty 
was imposed under this clause not later than 10 
calendar days after the date of such imposition, 
the Secretary may reduce the amount of the pen-
alty imposed by not more than 50 percent. 
‘‘(III) PROHIBITIONS ON REDUCTION FOR CER-
TAIN DEFICIENCIES.— 
‘‘(aa) REPEAT
DEFICIENCIES.—The Sec-
retary may not reduce the amount of a penalty 
under subclause (II) if the Secretary had 
reduced a penalty imposed on the facility in 
the preceding year under such subclause with 
respect to a repeat deficiency. 
‘‘(bb) CERTAIN OTHER DEFICIENCIES.—The 
Secretary may not reduce the amount of a 
penalty under subclause (II) if the penalty 
is imposed on the facility for a deficiency that 
is found to result in a pattern of harm or 
widespread harm, immediately jeopardizes the 
health or safety of a resident or residents of 
the facility, or results in the death of a resi-
dent of the facility. 
‘‘(IV) COLLECTION
OF
CIVIL
MONEY
PEN-
ALTIES.—In the case of a civil money penalty 
imposed under this clause, the Secretary shall 
issue regulations that— 
‘‘(aa) subject to item (cc), not later than 
30 days after the imposition of the penalty, 
provide for the facility to have the opportunity 
to participate in an independent informal dis-
pute resolution process which generates a 
written record prior to the collection of such 
penalty;
H. R. 3590—598 
‘‘(bb) in the case where the penalty is 
imposed for each day of noncompliance, pro-
vide that a penalty may not be imposed for 
any day during the period beginning on the 
initial day of the imposition of the penalty 
and ending on the day on which the informal 
dispute resolution process under item (aa) is 
completed; 
‘‘(cc) may provide for the collection of such 
civil money penalty and the placement of such 
amounts collected in an escrow account under 
the direction of the Secretary on the earlier 
of the date on which the informal dispute reso-
lution process under item (aa) is completed 
or the date that is 90 days after the date 
of the imposition of the penalty; 
‘‘(dd) may provide that such amounts col-
lected are kept in such account pending the 
resolution of any subsequent appeals; 
‘‘(ee) in the case where the facility success-
fully appeals the penalty, may provide for the 
return 
of 
such 
amounts 
collected 
(plus 
interest) to the facility; and 
‘‘(ff) in the case where all such appeals 
are unsuccessful, may provide that some por-
tion of such amounts collected may be used 
to support activities that benefit residents, 
including assistance to support and protect 
residents of a facility that closes (voluntarily 
or involuntarily) or is decertified (including 
offsetting costs of relocating residents to home 
and community-based settings or another 
facility), projects that support resident and 
family councils and other consumer involve-
ment in assuring quality care in facilities, and 
facility improvement initiatives approved by 
the Secretary (including joint training of 
facility staff and surveyors, technical assist-
ance for facilities implementing quality assur-
ance programs, the appointment of temporary 
management 
firms, 
and 
other 
activities 
approved by the Secretary).’’. 
(2) CONFORMING AMENDMENT.—Section 1919(h)(5)(8) of the 
Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is amended by 
inserting ‘‘(ii)(IV),’’ after ‘‘(i),’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect 1 year after the date of the enactment of this 
Act. 
SEC. 6112. NATIONAL INDEPENDENT MONITOR DEMONSTRATION 
PROJECT. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—The Secretary, in consultation with the 
Inspector General of the Department of Health and Human 
Services, shall conduct a demonstration project to develop, test, 
and implement an independent monitor program to oversee
H. R. 3590—599 
interstate and large intrastate chains of skilled nursing facili-
ties and nursing facilities. 
(2) SELECTION.—The Secretary shall select chains of skilled 
nursing facilities and nursing facilities described in paragraph 
(1) to participate in the demonstration project under this section 
from among those chains that submit an application to the 
Secretary at such time, in such manner, and containing such 
information as the Secretary may require. 
(3) DURATION.—The Secretary shall conduct the demonstra-
tion project under this section for a 2-year period. 
(4) IMPLEMENTATION.—The Secretary shall implement the 
demonstration project under this section not later than 1 year 
after the date of the enactment of this Act. 
(b) REQUIREMENTS.—The Secretary shall evaluate chains 
selected to participate in the demonstration project under this sec-
tion based on criteria selected by the Secretary, including where 
evidence suggests that a number of the facilities of the chain are 
experiencing serious safety and quality of care problems. Such 
criteria may include the evaluation of a chain that includes a 
number of facilities participating in the ‘‘Special Focus Facility’’ 
program (or a successor program) or multiple facilities with a record 
of repeated serious safety and quality of care deficiencies. 
(c) RESPONSIBILITIES.—An independent monitor that enters into 
a contract with the Secretary to participate in the conduct of the 
demonstration project under this section shall— 
(1) conduct periodic reviews and prepare root-cause quality 
and deficiency analyses of a chain to assess if facilities of 
the chain are in compliance with State and Federal laws and 
regulations applicable to the facilities; 
(2) conduct sustained oversight of the efforts of the chain, 
whether publicly or privately held, to achieve compliance by 
facilities of the chain with State and Federal laws and regula-
tions applicable to the facilities; 
(3) analyze the management structure, distribution of 
expenditures, and nurse staffing levels of facilities of the chain 
in relation to resident census, staff turnover rates, and tenure; 
(4) report findings and recommendations with respect to 
such reviews, analyses, and oversight to the chain and facilities 
of the chain, to the Secretary, and to relevant States; and 
(5) publish the results of such reviews, analyses, and over-
sight. 
(d) IMPLEMENTATION OF RECOMMENDATIONS.— 
(1) RECEIPT OF FINDING BY CHAIN.—Not later than 10 days 
after receipt of a finding of an independent monitor under 
subsection (c)(4), a chain participating in the demonstration 
project shall submit to the independent monitor a report— 
(A) outlining corrective actions the chain will take 
to implement the recommendations in such report; or 
(B) indicating that the chain will not implement such 
recommendations, and why it will not do so. 
(2) RECEIPT OF REPORT BY INDEPENDENT MONITOR.—Not 
later than 10 days after receipt of a report submitted by a 
chain under paragraph (1), an independent monitor shall 
finalize its recommendations and submit a report to the chain 
and facilities of the chain, the Secretary, and the State or 
States, as appropriate, containing such final recommendations.
H. R. 3590—600 
(e) COST OF APPOINTMENT.—A chain shall be responsible for 
a portion of the costs associated with the appointment of inde-
pendent monitors under the demonstration project under this sec-
tion. The chain shall pay such portion to the Secretary (in an 
amount and in accordance with procedures established by the Sec-
retary). 
(f) WAIVER AUTHORITY.—The Secretary may waive such require-
ments of titles XVIII and XIX of the Social Security Act (42 U.S.C. 
1395 et seq.; 1396 et seq.) as may be necessary for the purpose 
of carrying out the demonstration project under this section. 
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated such sums as may be necessary to carry out 
this section. 
(h) DEFINITIONS.—In this section: 
(1) ADDITIONAL DISCLOSABLE PARTY.—The term ‘‘additional 
disclosable party’’ has the meaning given such term in section 
1124(c)(5)(A) of the Social Security Act, as added by section 
4201(a). 
(2) FACILITY.—The term ‘‘facility’’ means a skilled nursing 
facility or a nursing facility. 
(3) NURSING
FACILITY.—The term ‘‘nursing facility’’ has 
the meaning given such term in section 1919(a) of the Social 
Security Act (42 U.S.C. 1396r(a)). 
(4) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services, acting through the Assistant 
Secretary for Planning and Evaluation. 
(5) SKILLED NURSING FACILITY.—The term ‘‘skilled nursing 
facility’’ has the meaning given such term in section 1819(a) 
of the Social Security Act (42 U.S.C. 1395(a)). 
(i) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary, in consultation with the 
Inspector General of the Department of Health and Human 
Services, shall evaluate the demonstration project conducted 
under this section. 
(2) REPORT.—Not later than 180 days after the completion 
of the demonstration project under this section, the Secretary 
shall submit to Congress a report containing the results of 
the evaluation conducted under paragraph (1), together with 
recommendations— 
(A) as to whether the independent monitor program 
should be established on a permanent basis; 
(B) if the Secretary recommends that such program 
be so established, on appropriate procedures and mecha-
nisms for such establishment; and 
(C) for such legislation and administrative action as 
the Secretary determines appropriate. 
SEC. 6113. NOTIFICATION OF FACILITY CLOSURE. 
(a) IN GENERAL.—Section 1128I of the Social Security Act, 
as added and amended by this Act, is amended by adding at 
the end the following new subsection: 
‘‘(h) NOTIFICATION OF FACILITY CLOSURE.— 
‘‘(1) IN GENERAL.—Any individual who is the administrator 
of a facility must—