IB 
Union Calendar No. 805 
118TH CONGRESS 
2D SESSION 
H. R. 8244 
[Report No. 118–956, Part I] 
To amend titles XVIII and XIX of the Social Security Act ensure appropriate 
approval for certain skilled nursing facility and nursing facility nursing 
aide training and competency evaluation programs under the Medicare 
and Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 6, 2024 
Mr. ESTES (for himself and Mr. CONNOLLY) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
DECEMBER 27, 2024 
Additional sponsors: Mr. FEENSTRA, Mrs. FISCHBACH, Mr. GROTHMAN, Mr. 
DAVIS of North Carolina, and Mr. VAN ORDEN 
DECEMBER 27, 2024 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 27, 2024 
Committee on Energy and Commerce discharged; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on May 6, 2024] 
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A BILL 
To amend titles XVIII and XIX of the Social Security Act 
ensure appropriate approval for certain skilled nursing 
facility and nursing facility nursing aide training and 
competency evaluation programs under the Medicare and 
Medicaid program. 
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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 ‘‘Ensuring Seniors’ Ac-
cess to Quality Care Act’’. 
SEC. 2. ENSURING APPROPRIATE APPROVAL FOR CERTAIN 
SKILLED NURSING FACILITY AND NURSING 
FACILITY NURSING AIDE TRAINING AND COM-
PETENCY EVALUATION PROGRAMS UNDER 
THE MEDICARE AND MEDICAID PROGRAM. 
(a) MEDICARE.—Section 1819(f)(2) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(f)(2)) is amended— 
(1) in subparagraph (B)(iii)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘subparagraphs (C) and (D)’’ and 
inserting ‘‘subparagraph (C)’’; and 
(B) in subclause (I)— 
(i) in item (b), by striking ‘‘or’’ at the 
end; 
(ii) by amending item (c) to read as 
follows: 
‘‘(c) has been assessed a civil 
money penalty described in sub-
section (h)(2)(B)(ii) or section 
1919(h)(2)(A)(ii) of not less than 
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$12,924 and has been cited for a 
deficiency relating to the quality 
of care provided to residents of the 
facility; or’’; and 
(iii) by adding at the end the following 
new item: 
‘‘(d) has been subject to a 
remedy described in clause (i) or 
(iii) of subsection (h)(2)(B), sub-
section 
(h)(4), 
section 
1919(h)(1)(B)(i), or in clause (i), 
(iii), 
or 
(iv) 
of 
section 
1919(h)(2)(A), or’’; and 
(2) by striking subparagraph (D). 
(b) MEDICAID.—Section 1919(f)(2) of the Social Secu-
rity Act (42 U.S.C. 1396r(f)(2)) is amended— 
(1) in subparagraph (B)(iii)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘subparagraphs (C) and (D)’’ and 
inserting ‘‘subparagraph (C)’’; and 
(B) in subclause (I)— 
(i) in item (b), by striking ‘‘or’’ at the 
end; 
(ii) by amending item (c) to read as 
follows: 
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