‘‘(ii) INFORMATION DESCRIBED.—The 
following information is described in this 
clause: 
‘‘(I) The identity of individuals 
with an ownership or control interest 
(as defined in section 1124(a)(3)) in 
the facility. 
‘‘(II) Information on the mem-
bers of the governing body of the 
nursing facility, including the names, 
titles, and dates of service of such 
members. 
‘‘(III) Information describing the 
organizational structure of any affili-
ated or related parties, including prin-
cipal officers and directors of affili-
ated or related companies, or mem-
bers in the case of a limited liability 
company. 
To the extent that information reported by 
a facility to the Internal Revenue Service 
on Form 990, information submitted by a 
facility to the Securities and Exchange 
Commission, or information otherwise sub-
mitted to the Secretary contains the infor-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
mation described in subclauses (I), (II), 
and (III), the facility may provide such 
Form or such information submitted to 
meet the requirements of clause (i) and 
subparagraph (E)(i). 
‘‘(iii) DEFINITION OF AFFILIATED OR 
RELATED PARTIES.—In this subparagraph, 
the term ‘affiliated or related parties’ 
means companies or individuals that serve 
as operators, landlords, management com-
panies or advisors, real estate or consulting 
companies, members of a limited liability 
company, administrative services compa-
nies, lenders and companies providing fi-
nancial guarantees, captive or affiliated li-
ability insurance companies, and such 
other entities as the Secretary determines 
appropriate. 
‘‘(E) REPORTING.— 
‘‘(i) IN GENERAL.—Not later than 2 
years after the date of enactment of this 
subparagraph, the Secretary shall promul-
gate regulations requiring nursing facilities 
to report the information described in 
clause (ii) of subparagraph (D) to the Sec-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
retary in a standardized format, and such 
other regulations as are necessary to carry 
out such subparagraph. Such regulations 
shall ensure that the facility certifies, as a 
condition of participation and payment 
under the program under this title, that 
the information reported is accurate and 
current. 
‘‘(ii) GUIDANCE.—The Secretary shall 
provide guidance and technical assistance 
to States on how to adopt the standardized 
format under clause (i).’’. 
SEC. 102. ACCOUNTABILITY REQUIREMENTS. 
(a) 
SKILLED
NURSING
FACILITIES.—Section 
1819(d)(1) of the Social Security Act (42 U.S.C. 1395i– 
3(d)(1)), as amended by section 101, is amended by add-
ing at the end the following new subparagraph: 
‘‘(F) ACCOUNTABILITY REQUIREMENTS.— 
‘‘(i) IN GENERAL.—On or after the 
date that is 2 years after the date of enact-
ment of this subparagraph, any skilled 
nursing facility or chain of such facilities 
must meet standards for being an account-
able entity by complying with the criteria 
developed under clause (ii). 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(ii) CRITERIA.—Not later than the 
date that is 2 years after such date of en-
actment, the Secretary, in consultation 
with the General Counsel of the Depart-
ment of Health and Human Services and 
the Inspector General of the Department 
of Health and Human Services, shall de-
velop criteria to define accountability re-
quirements applicable to facilities and 
chains of such facilities. Such criteria 
shall— 
‘‘(I) include standards for sub-
mission of annual independent audits 
for facilities that are part of a group 
under common ownership or control, 
whether publicly or privately held and 
which 
have 
annual 
revenues 
of 
$50,000,000 or more in the aggregate 
as a group; and 
‘‘(II) require new owners of a fa-
cility to provide proof of financial abil-
ity to operate the facility, including 
documentation of projected revenue 
and expenses for the first 12 months 
of operation of the facility. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(iii) RULE OF CONSTRUCTION.—The 
criteria developed under clause (ii), and 
any requirements to submit information 
under such criteria, shall be in addition to 
any information the Secretary otherwise 
requires providers to submit on the owner-
ship and operation of skilled nursing facili-
ties (including information required to be 
submitted or reported under subparagraph 
(D) or (E)).’’. 
(b) NURSING FACILITIES.—Section 1919(d)(1) of the 
Social Security Act (42 U.S.C. 1396r(d)(1)), as amended 
by section 101, is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) ACCOUNTABILITY REQUIREMENTS.— 
‘‘(i) IN GENERAL.—On or after the 
date that is 2 years after the date of enact-
ment of this subparagraph, any nursing fa-
cility or chain of such facilities must meet 
standards for being an accountable entity 
by complying with the criteria developed 
under clause (ii). 
‘‘(ii) CRITERIA.—Not later than the 
date that is 2 years after such date of en-
actment, the Secretary, in consultation 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
with the General Counsel of the Depart-
ment of Health and Human Services and 
the Inspector General of the Department 
of Health and Human Services, shall de-
velop criteria to define accountability re-
quirements applicable to facilities and 
chains of such facilities. Such criteria 
shall— 
‘‘(I) include standards for sub-
mission of annual independent audits 
for facilities that are part of a group 
under common ownership or control, 
whether publicly or privately held and 
which 
have 
annual 
revenues 
of 
$50,000,000 or more in the aggregate 
as a group; and 
‘‘(II) require new owners of a fa-
cility to provide proof of financial abil-
ity to operate the facility, including 
documentation of projected revenue 
and expenses for the first 12 months 
of operation of the facility. 
‘‘(iii) RULE OF CONSTRUCTION.—The 
criteria developed under clause (ii), and 
any requirements to submit information 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
under such criteria, shall be in addition to 
any information the Secretary otherwise 
requires providers to submit on the owner-
ship and operation of nursing facilities (in-
cluding information required to be sub-
mitted or reported under subparagraph 
(D) or (E)).’’. 
SEC. 103. NURSING HOME COMPARE MEDICARE WEBSITE. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819 of the Social 
Security Act (42 U.S.C. 1395i–3) is amended— 
(A) by redesignating subsection (i) as sub-
section (j); and 
(B) by inserting after subsection (h) the 
following new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION
OF
ADDITIONAL
INFORMA-
TION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
ensure that the Department of Health and 
Human Services includes, as part of the infor-
mation 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 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
Compare’ Medicare website) (or a successor 
website), the following information in a manner 
that is prominent, easily accessible, readily un-
derstandable to consumers of long-term care 
services, and searchable: 
‘‘(i) Information that is reported to 
the Secretary under subparagraph (E) of 
subsection (d)(1) and information sub-
mitted with respect to accountability re-
quirements applicable to facilities and 
chains of facilities under subparagraph (F) 
of such subsection. 
‘‘(ii) Information on the ‘Special 
Focus Facility program’ (or a successor 
program) established by the Centers for 
Medicare & Medicaid Services, according to 
procedures established by the Secretary. 
Such procedures shall provide for the in-
clusion of information with respect to, and 
the names and locations of, those facilities 
that— 
‘‘(I) have been enrolled in the 
program; 
‘‘(II) are enrolled in the program 
and have failed to make significant 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
progress within 18 months after such 
enrollment; and 
‘‘(III) have closed voluntarily or 
whose participation under this title 
has been terminated by the Secretary. 
‘‘(iii) Staffing data for each facility 
(including resident census data and data 
on the hours of care provided per resident 
per day) based on data submitted under 
subsection (b)(8)(C)(ii), including informa-
tion 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 dif-
ferences in staffing between facilities. 
‘‘(iv) Links to State Internet websites 
with information 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. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(v) The standardized complaint form 
developed under subsection (f)(8), includ-
ing explanatory material on what com-
plaint forms are, how they are used, and 
how to file a complaint with the State sur-
vey and certification program and the 
State long-term care ombudsman program. 
‘‘(vi) A summary of information on 
enforcement that includes remedies pro-
posed and imposed by the Secretary with 
respect to a skilled nursing facility during 
the preceding 3 years. 
‘‘(B) DEADLINE FOR PROVISION OF INFOR-
MATION.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the Secretary shall en-
sure that the information described in sub-
paragraph (A) is included on such website 
(or a successor website) not later than 1 
year after the date of enactment of this 
subsection. 
‘‘(ii) EXCEPTIONS.— 
‘‘(I) OWNERSHIP
AND
AFFILI-
ATED PARTIES AND ACCOUNTABILITY 
REQUIREMENTS
INFORMATION.—The 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
Secretary shall ensure that the infor-
mation described in subparagraph 
(A)(i) is included on such website (or 
a successor website) not later than the 
date on which the requirements under 
subparagraphs (E) and (F), respec-
tively, of subsection (d)(1) are imple-
mented. 
‘‘(II) STAFFING DATA.—The Sec-
retary shall ensure that the informa-
tion 
described 
in 
subparagraph 
(A)(iii) is included on such website (or 
a successor website) not later than the 
date on which the requirement under 
subsection 
(b)(8)(C)(ii) 
is 
imple-
mented. 
‘‘(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 comprehen-
siveness of information reported on such 
website as of the day before the date of en-
actment of this subsection; and 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(ii) not later than 1 year after the 
date of enactment of this subsection, to 
modify or revamp such website in accord-
ance with the review conducted under 
clause (i). 
‘‘(B) CONSULTATION.—In conducting the 
review under subparagraph (A)(i), the Sec-
retary shall consult with— 
‘‘(i) State long-term care ombudsman 
programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; and 
‘‘(iv) any other representatives of pro-
grams or groups the Secretary determines 
appropriate.’’. 
(2) TIMELINESS
OF
SUBMISSION
OF
SURVEY 
AND CERTIFICATION INFORMATION.— 
(A) IN GENERAL.—Section 1819(g)(5) of 
the Social Security 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 CER-
TIFICATION
INFORMATION
TO
THE
SEC-
RETARY.—In order to improve the timeliness of 
information made available to the public under 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
subparagraph (A) and provided on the Nursing 
Home Compare Medicare website under sub-
section (i), each State shall submit information 
respecting any survey or certification made re-
specting a skilled 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 sub-
mitted under the preceding sentence to update 
the information provided on the Nursing Home 
Compare Medicare website as expeditiously as 
practicable.’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by this paragraph shall take effect 1 year 
after the date of enactment of this Act. 
(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 sub-
section (j); and 
(B) by inserting after subsection (h) the 
following new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(1) INCLUSION
OF
ADDITIONAL
INFORMA-
TION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
ensure that the Department of Health and 
Human Services includes, as part of the infor-
mation 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, easily accessible, readily un-
derstandable to consumers of long-term care 
services, and searchable: 
‘‘(i) Information that is reported to 
the Secretary under subparagraph (E) of 
subsection (d)(1) and information sub-
mitted with respect to accountability re-
quirements applicable to facilities and 
chains of facilities under subparagraph (F) 
of such subsection. 
‘‘(ii) Information on the ‘Special 
Focus Facility program’ (or a successor 
program) established by the Centers for 
Medicare & Medicaid Services, according to 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
procedures established by the Secretary. 
Such procedures shall provide for the in-
clusion of information with respect to, and 
the names and locations of, those facilities 
that— 
‘‘(I) have been enrolled in the 
program; 
‘‘(II) are enrolled in the program 
and have failed to make significant 
progress within 18 months after such 
enrollment; and 
‘‘(III) have closed voluntarily or 
whose participation under this title 
has been terminated by the Secretary. 
‘‘(iii) Staffing data for each facility 
(including resident census data and data 
on the hours of care provided per resident 
per day) based on data submitted under 
subsection (b)(8)(C)(ii), including informa-
tion 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 dif-
ferences in staffing between facilities. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(iv) Links to State Internet websites 
with information 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. 
‘‘(v) The standardized complaint form 
developed under subsection (f)(10), includ-
ing explanatory material on what com-
plaint forms are, how they are used, and 
how to file a complaint with the State sur-
vey and certification program and the 
State long-term care ombudsman program. 
‘‘(vi) A summary of information on 
enforcement that includes remedies pro-
posed and imposed by the Secretary or a 
State with respect to a nursing facility 
during the preceding 3 years. 
‘‘(B) DEADLINE FOR PROVISION OF INFOR-
MATION.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the Secretary shall en-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
sure that the information described in sub-
paragraph (A) is included on such website 
(or a successor website) not later than 1 
year after the date of enactment of this 
subsection. 
‘‘(ii) EXCEPTIONS.— 
‘‘(I) OWNERSHIP
AND
AFFILI-
ATED PARTIES AND ACCOUNTABILITY 
REQUIREMENTS
INFORMATION.—The 
Secretary shall ensure that the infor-
mation described in subparagraph 
(A)(i) is included on such website (or 
a successor website) not later than the 
date on which the requirements under 
subparagraph (E) and (F), respec-
tively, of subsection (d)(1) are imple-
mented. 
‘‘(II) STAFFING DATA.—The Sec-
retary shall ensure that the informa-
tion 
described 
in 
subparagraph 
(A)(iii) is included on such website (or 
a successor website) not later than the 
date on which the requirement under 
subsection 
(b)(8)(C)(ii) 
is 
imple-
mented. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(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 comprehen-
siveness of information reported on such 
website as of the day before the date of en-
actment of this subsection; and 
‘‘(ii) not later than 1 year after the 
date of enactment of this subsection, to 
modify or revamp such website in accord-
ance with the review conducted under 
clause (i). 
‘‘(B) CONSULTATION.—In conducting the 
review under subparagraph (A)(i), the Sec-
retary shall consult with— 
‘‘(i) State long-term care ombudsman 
programs; 
‘‘(ii) consumer advocacy groups; 
‘‘(iii) provider stakeholder groups; and 
‘‘(iv) any other representatives of pro-
grams or groups the Secretary determines 
appropriate.’’. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
(2) TIMELINESS
OF
SUBMISSION
OF
SURVEY 
AND CERTIFICATION INFORMATION.— 
(A) IN GENERAL.—Section 1919(g)(5) of 
the Social Security Act (42 U.S.C. 1396r(g)(5)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(E) SUBMISSION OF SURVEY AND CER-
TIFICATION
INFORMATION
TO
THE
SEC-
RETARY.—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 sub-
section (i), each State shall submit information 
respecting any survey or certification made re-
specting a nursing facility (including any en-
forcement 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 sub-
mitted under the preceding sentence to update 
the information provided on the Nursing Home 
Compare Medicare website as expeditiously as 
practicable.’’. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
(B) EFFECTIVE
DATE.—The amendment 
made by this paragraph shall take effect 1 year 
after the date of enactment of this Act. 
(c) AVAILABILITY OF REPORTS ON SURVEYS, CER-
TIFICATIONS, 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 102, is 
amended by adding at the end the following new 
subparagraph: 
‘‘(G) AVAILABILITY OF SURVEY, CERTIFI-
CATION, AND COMPLAINT INVESTIGATION RE-
PORTS.—A skilled nursing facility must— 
‘‘(i) have reports with respect to any 
surveys, certifications, and complaint in-
vestigations 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 accessible to the pub-
lic.’’. 
(2) NURSING FACILITIES.—Section 1919(d)(1) 
of the Social Security Act (42 U.S.C. 1396r(d)(1)), 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
as amended by section 102, is amended by adding 
at the end the following new subparagraph: 
‘‘(G) AVAILABILITY OF SURVEY, CERTIFI-
CATION, AND COMPLAINT INVESTIGATION RE-
PORTS.—A nursing facility must— 
‘‘(i) have reports with respect to any 
surveys, certifications, and complaint in-
vestigations 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 accessible to the pub-
lic.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect 1 year after the 
date of enactment of this Act. 
(d) GUIDANCE TO STATES ON FORM 2567 STATE IN-
SPECTION REPORTS AND COMPLAINT INVESTIGATION RE-
PORTS.— 
(1) GUIDANCE.—The Secretary shall provide 
guidance to States on how States can establish elec-
tronic links to Form 2567 State inspection reports 
(or a successor form), complaint investigation re-
ports, and a facility’s plan of correction or other re-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
sponse 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. 
(2) DEFINITIONS.—In this subsection: 
(A) NURSING FACILITY.—The term ‘‘nurs-
ing 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 Secretary of Health and Human 
Services. 
(C) 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. 1395i–3(a)). 
SEC. 104. 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 EXPENDITURES.— 
‘‘(1) IN GENERAL.—For cost reports submitted 
for cost reporting periods beginning on or after the 
date that is 1 year after the date of enactment of 
this subsection, skilled nursing facilities shall sepa-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
rately report expenditures for wages and benefits for 
nursing staff (by staff level, breaking out (at a min-
imum) 
registered 
nurses, 
licensed 
professional 
nurses, and certified nurse assistants). 
‘‘(2) MODIFICATION OF FORM.—The Secretary, 
in consultation with private sector accountants expe-
rienced with Medicare and Medicaid nursing facility 
home cost reports, shall redesign such reports to 
meet the requirement of paragraph (1). 
‘‘(3) CATEGORIZATION.—The Secretary, work-
ing in consultation with the Medicare Payment Advi-
sory Commission, the Inspector General of the De-
partment of Health and Human Services, and other 
expert parties the Secretary determines appropriate, 
shall take the expenditures listed on cost reports 
submitted by skilled nursing facilities and categorize 
such expenditures into the following categories on an 
annual basis: 
‘‘(A) Spending on direct care services (in-
cluding nursing, therapy, and non-ancillary 
therapy services). 
‘‘(B) Spending on indirect care (including 
housekeeping, dietary, and other related serv-
ices). 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(C) Capital costs (including building and 
land costs). 
‘‘(D) Administrative costs. 
‘‘(4) AVAILABILITY
OF
INFORMATION
SUB-
MITTED.—The Secretary 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. 105. STANDARDIZED COMPLAINT FORM. 
(a) SKILLED NURSING FACILITIES.— 
(1) DEVELOPMENT BY THE SECRETARY.—Sec-
tion 1819(f) of the Social Security Act (42 U.S.C. 
1395i–3(f)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) STANDARDIZED
COMPLAINT
FORM.—The 
Secretary shall develop a standardized complaint 
form for use by a resident (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 
skilled nursing facility.’’. 
(2) STATE
REQUIREMENTS.—Section 1819(e) 
of the Social Security Act (42 U.S.C. 1395i–3(e)) is 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
amended by adding at the end the following new 
paragraph: 
‘‘(6) COMPLAINT
FORMS
AND
RESOLUTION 
PROCESSES.— 
‘‘(A) COMPLAINT FORMS.—The State must 
make the standardized complaint form devel-
oped under subsection (f)(8) available upon re-
quest to— 
‘‘(i) a resident of a skilled nursing fa-
cility; and 
‘‘(ii) any person acting on the resi-
dent’s behalf. 
‘‘(B) COMPLAINT RESOLUTION PROCESS.— 
The State must establish a complaint resolution 
process in order to ensure that the legal rep-
resentative of a resident of a skilled nursing fa-
cility or other responsible party is not denied 
access to such resident or otherwise retaliated 
against if they have complained about the qual-
ity 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 complaints received, including 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
notification to the complainant that a com-
plaint has been received; 
‘‘(ii) procedures to determine the like-
ly severity of a complaint and for the in-
vestigation of the complaint; and 
‘‘(iii) deadlines for responding to a 
complaint and for notifying the complain-
ant of the outcome of the investigation. 
‘‘(C) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as pre-
venting a resident of a skilled nursing 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 subsection 
(f)(8) (including submitting a complaint oral-
ly).’’. 
(b) NURSING FACILITIES.— 
(1) DEVELOPMENT BY THE SECRETARY.—Sec-
tion 1919(f) of the Social Security Act (42 U.S.C. 
1395i–3(f)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(10) STANDARDIZED COMPLAINT FORM.—The 
Secretary shall develop a standardized complaint 
form for use by a resident (or a person acting on the 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
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 
nursing facility.’’. 
(2) STATE
REQUIREMENTS.—Section 1919(e) 
of the Social Security Act (42 U.S.C. 1395i–3(e)) is 
amended by adding at the end the following new 
paragraph: 
‘‘(8) COMPLAINT
FORMS
AND
RESOLUTION 
PROCESSES.— 
‘‘(A) COMPLAINT FORMS.—The State must 
make the standardized complaint form devel-
oped under subsection (f)(10) available upon re-
quest to— 
‘‘(i) a resident of a nursing facility; 
and 
‘‘(ii) any person acting on the resi-
dent’s behalf. 
‘‘(B) COMPLAINT RESOLUTION PROCESS.— 
The State must establish a complaint resolution 
process in order to ensure that the legal rep-
resentative of a resident of a nursing facility or 
other responsible party is not denied access to 
such resident or otherwise retaliated against if 
they have complained about the quality of care 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
provided by the facility or other issues relating 
to the facility. Such complaint resolution proc-
ess shall include— 
‘‘(i) procedures to assure accurate 
tracking of complaints received, including 
notification to the complainant that a com-
plaint has been received; 
‘‘(ii) procedures to determine the like-
ly severity of a complaint and for the in-
vestigation of the complaint; and 
‘‘(iii) deadlines for responding to a 
complaint and for notifying the complain-
ant of the outcome of the investigation. 
‘‘(C) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as pre-
venting a resident of a nursing 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 subsection (f)(10) (in-
cluding submitting a complaint orally).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect 1 year after the date of enact-
ment of this Act. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
SEC. 106. ENSURING STAFFING ACCOUNTABILITY. 
(a) 
SKILLED
NURSING
FACILITIES.—Section 
1819(b)(8) of the Social Security Act (42 U.S.C. 1395i– 
3(b)(8)) is amended by adding at the end the following 
new subparagraph: 
‘‘(C) SUBMISSION OF STAFFING INFORMA-
TION BASED ON PAYROLL DATA IN A UNIFORM 
FORMAT.— 
‘‘(i) DESIGN PHASE.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall establish a program for 
skilled nursing facilities to report 
staffing information (including infor-
mation with respect to agency and 
contract staff) based on payroll data. 
Such program shall be conducted for 
a 1-year period beginning on the date 
of enactment of this subparagraph. 
‘‘(II) REPORT.—Not later than 6 
months after the completion of the 
program established under subclause 
(I), the Secretary shall submit a re-
port to Congress containing the re-
sults of the program. 
‘‘(ii) SUBMISSION
OF
STAFFING
IN-
FORMATION.—Beginning not later than 1 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
year after the completion of the program 
established under clause (i)(I), the Sec-
retary shall require a skilled nursing facil-
ity to electronically submit to the Secretary 
nurse staffing information (including infor-
mation with respect to agency and contract 
staff) based on payroll data in a uniform 
format (according to specifications estab-
lished by the Secretary). Such specifica-
tions shall require that the information 
submitted under the preceding sentence— 
‘‘(I) specify the category of work 
a certified employee performs (such as 
whether the employee is a registered 
nurse, licensed practical nurse, li-
censed vocational nurse, or certified 
nursing assistant); 
‘‘(II) include resident census 
data; 
‘‘(III) include a regular reporting 
schedule; and 
‘‘(IV) include information on em-
ployee turnover and tenure and on the 
hours of care provided by each cat-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
egory of certified employees referenced 
in subclause (I) per resident per day.’’ 
(b) NURSING FACILITIES.—Section 1919(b)(8) of the 
Social Security Act (42 U.S.C. 1396r(b)(8)) is amended 
by adding at the end the following new subparagraph: 
‘‘(C) SUBMISSION OF STAFFING INFORMA-
TION BASED ON PAYROLL DATA IN A UNIFORM 
FORMAT.— 
‘‘(i) DESIGN PHASE.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall establish a program for 
nursing facilities to report staffing in-
formation (including information with 
respect to agency and contract staff) 
based on payroll data. Such program 
shall be conducted for a 1-year period 
beginning on the date of enactment of 
this subparagraph. 
‘‘(II) REPORT.—Not later than 6 
months after the completion of the 
program established under subclause 
(I), the Secretary shall submit a re-
port to Congress containing the re-
sults of the program. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(ii) SUBMISSION
OF
STAFFING
IN-
FORMATION.—Beginning not later than 1 
year after the completion of the program 
established under clause (i)(I), the Sec-
retary shall require a nursing facility to 
electronically submit to the Secretary 
nurse staffing information (including infor-
mation with respect to agency and contract 
staff) based on payroll data in a uniform 
format (according to specifications estab-
lished by the Secretary). Such specifica-
tions shall require that the information 
submitted under the preceding sentence— 
‘‘(I) specify the category of work 
a certified employee performs (such as 
whether the employee is a registered 
nurse, licensed practical nurse, li-
censed vocational nurse, or certified 
nursing assistant); 
‘‘(II) include resident census 
data; 
‘‘(III) include a regular reporting 
schedule; and 
‘‘(IV) include information on em-
ployee turnover and tenure and on the 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
hours of care provided by each cat-
egory of certified employees referenced 
in subclause (I) per resident per day.’’ 
TITLE II—TARGETING 
ENFORCEMENT 
SEC. 201. 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 to read as follows: 
‘‘(ii) AUTHORITY WITH RESPECT TO 
CIVIL MONEY PENALTIES.— 
‘‘(I) AMOUNT.—Subject to sub-
clause (III), the Secretary may impose 
a civil money penalty in the applicable 
amount (as defined in subclause (II)) 
for each day or each instance of non-
compliance (as determined appro-
priate by the Secretary). 
‘‘(II) APPLICABLE AMOUNT.—In 
this clause, the term ‘applicable 
amount’ means— 
‘‘(aa) in the case where the 
deficiency results in the death of 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00040
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
a resident of the facility, an 
amount not to exceed $100,000; 
‘‘(bb) in the case of a defi-
ciency where the facility is cited 
for actual harm or immediate 
jeopardy, an amount not less 
than $3,000 and not more than 
$25,000; and 
‘‘(cc) in the case of any 
other deficiency, an amount not 
to exceed $3,000. 
‘‘(III) 
REDUCTION
OF
CIVIL 
MONEY PENALTIES IN CERTAIN CIR-
CUMSTANCES.—Subject to subclause 
(IV), in the case where a facility self- 
reports and promptly corrects a defi-
ciency for which a penalty was im-
posed under this clause not later than 
10 calendar days after the date of 
such imposition, the Secretary may 
reduce the amount of the penalty im-
posed by not more than 50 percent. 
‘‘(IV) PROHIBITIONS ON REDUC-
TION FOR CERTAIN DEFICIENCIES.— 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(aa) 
REPEAT
DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (III) if the 
Secretary had reduced a penalty 
imposed on the facility in the 
preceding year under such sub-
clause with respect to a repeat 
deficiency. 
‘‘(bb) CERTAIN OTHER DE-
FICIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (III) if the 
penalty is imposed for a defi-
ciency described in subclause 
(II)(bb) and the actual harm is 
found to result in a pattern of 
harm or widespread harm that 
immediately 
jeopardizes 
the 
health or safety of a resident or 
residents of the facility, or if the 
penalty is imposed for a defi-
ciency described in subclause 
(II)(aa). 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00042
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(V) 
COLLECTION
OF
CIVIL 
MONEY PENALTIES.—In the case of a 
civil money penalty imposed under 
this clause for a deficiency described 
in item (aa) or (bb) of subclause (II), 
the Secretary— 
‘‘(aa) subject to item (bb), 
shall provide the opportunity for 
the facility to participate in an 
informal dispute resolution proc-
ess prior to the collection of such 
penalty; 
‘‘(bb) may provide for the 
collection of such civil money 
penalty and the placement of 
such amounts collected in an es-
crow account on the earlier of the 
date on which the informal dis-
pute resolution process under 
item (aa) is completed or the 
date that is 90 days after the 
date of the imposition of the pen-
alty; 
‘‘(cc) may provide that such 
amounts collected are kept in 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00043
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
such account pending the resolu-
tion of any appeals; 
‘‘(dd) in the case where the 
facility successfully appeals the 
penalty, may provide for the re-
turn of such amounts collected 
(plus interest) to the facility; and 
‘‘(ee) in the case where all 
such appeals are unsuccessful, 
may provide that some portion of 
such amounts collected may be 
used to support activities that 
benefit residents, including as-
sistance to support and protect 
residents who reside in a facility 
that closes (voluntarily or invol-
untarily) or is decertified (includ-
ing offsetting costs of relocating 
residents to home and commu-
nity-based settings or another fa-
cility), and projects that support 
resident and family councils and 
other consumer involvement in 
assuring quality care in facilities. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00044
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(VI) PROCEDURE.—The provi-
sions of section 1128A (other than 
subsections (a) and (b) and except to 
the extent that such provisions require 
a hearing prior to the imposition of a 
civil money penalty in the case de-
scribed in subclause (V)) shall apply 
to a civil money penalty under this 
clause in the same manner as such 
provisions apply to a penalty or pro-
ceeding under section 1128A(a).’’. 
(2) CONFORMING
AMENDMENT.—The second 
sentence of section 1819(h)(5) of the Social Security 
Act (42 U.S.C. 1395i–3(h)(5)) is amended by insert-
ing ‘‘(ii)(V),’’ after ‘‘(i),’’. 
(b) NURSING FACILITIES.— 
(1) PENALTIES IMPOSED BY THE STATE.— 
(A) IN GENERAL.—Section 1919(h)(2) of 
the Social Security Act (42 U.S.C. 1396r(h)(2)) 
is amended— 
(i) in subparagraph (A)(ii), by strik-
ing the first sentence and inserting the fol-
lowing: ‘‘A civil money penalty in accord-
ance with subparagraph (G).’’; and 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00045
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
(ii) by adding at the end the following 
new subparagraph: 
‘‘(G) CIVIL MONEY PENALTIES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(iii), the State may impose a civil money 
penalty under subparagraph (A)(ii) in the 
applicable amount for each day or each in-
stance of noncompliance (as determined 
appropriate by the State). 
‘‘(ii) DEFINITION
OF
APPLICABLE 
AMOUNT.—In this subparagraph, the term 
‘applicable amount’ means— 
‘‘(I) in the case where the defi-
ciency results in the death of a resi-
dent of the facility, an amount not to 
exceed $100,000; 
‘‘(II) in the case of a deficiency 
where the facility is cited for actual 
harm or immediate jeopardy, an 
amount not less than $3,000 and not 
more than $25,000; and 
‘‘(III) in the case of any other 
deficiency, an amount not to exceed 
$3,000. 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00046
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(iii) REDUCTION
OF
CIVIL
MONEY 
PENALTIES
IN
CERTAIN
CIR-
CUMSTANCES.—Subject to clause (iv), in 
the case where a facility self-reports and 
promptly corrects a deficiency for which a 
penalty was imposed under subparagraph 
(A)(ii) not later than 10 calendar days 
after the date of such imposition, the State 
may reduce the amount of the penalty im-
posed by not more than 50 percent. 
‘‘(iv) PROHIBITION
ON
REDUCTION 
FOR CERTAIN DEFICIENCIES.— 
‘‘(I) REPEAT
DEFICIENCIES.— 
The State may not reduce the amount 
of a penalty under clause (iii) if the 
State had reduced a penalty imposed 
on the facility in the preceding year 
under such clause with respect to a 
repeat deficiency. 
‘‘(II) CERTAIN
OTHER
DEFI-
CIENCIES.—The State may not reduce 
the amount of a penalty under clause 
(iii) if the penalty is imposed for a de-
ficiency described in clause (ii)(II) 
and the actual harm is found to result 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00047
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
in a pattern of harm or widespread 
harm that immediately jeopardizes the 
health or safety of a resident or resi-
dents of the facility, or if the penalty 
is imposed for a deficiency described 
in clause (ii)(I). 
‘‘(v) COLLECTION
OF
CIVIL
MONEY 
PENALTIES.—In the case of a civil money 
penalty 
imposed 
under 
subparagraph 
(A)(ii) for a deficiency described in sub-
clause (I) or (II) of clause (ii), the State— 
‘‘(I) subject to subclause (II), 
shall provide the opportunity for the 
facility to participate in an informal 
dispute resolution process prior to the 
collection of such penalty; 
‘‘(II) may provide for the collec-
tion of such civil money penalty and 
the placement of such amounts col-
lected in an escrow account on the 
earlier of the date on which the infor-
mal dispute resolution process under 
subclause (I) is completed or the date 
that is 90 days after the date of the 
imposition of the penalty; 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00048
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(III) may provide that such 
amounts collected are kept in such ac-
count pending the resolution of any 
appeals; 
‘‘(IV) in the case where the facil-
ity successfully appeals the penalty, 
may provide for the return of such 
amounts collected (plus interest) to 
the facility; and 
‘‘(V) in the case where all such 
appeals are unsuccessful, may provide 
that such funds collected shall be used 
for the purposes described in the sec-
ond 
sentence 
of 
subparagraph 
(A)(ii).’’. 
(B) CONFORMING AMENDMENT.—The sec-
ond sentence of section 1919(h)(2)(A)(ii) is 
amended by inserting ‘‘, and some portion of 
such funds may be used to support activities 
that benefit residents, including assistance to 
support and protect residents who reside in a 
facility that closes (voluntarily or involuntarily) 
or is decertified (including offsetting costs of re-
locating residents to home and community- 
based settings or another facility), and projects 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00049
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
that support resident and family councils and 
other consumer involvement in assuring quality 
care in facilities’’ before the period at the end. 
(2) 
PENALTIES
IMPOSED
BY
THE
SEC-
RETARY.— 
(A) 
IN
GENERAL.—Section 
1919(h)(3)(C)(ii) of the Social Security Act (42 
U.S.C. 1396r(h)(3)(C)) is amended to read as 
follows: 
‘‘(ii) AUTHORITY WITH RESPECT TO 
CIVIL MONEY PENALTIES.— 
‘‘(I) AMOUNT.—Subject to sub-
clause (III), the Secretary may impose 
a civil money penalty in the applicable 
amount (as defined in subclause (II)) 
for each day or each instance of non-
compliance (as determined appro-
priate by the Secretary). 
‘‘(II) APPLICABLE AMOUNT.—In 
this clause, the term ‘applicable 
amount’ means— 
‘‘(aa) in the case where the 
deficiency results in the death of 
a resident of the facility, an 
amount not to exceed $100,000; 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00050
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
‘‘(bb) in the case of a defi-
ciency where the facility is cited 
for actual harm or immediate 
jeopardy, an amount not less 
than $3,000 and not more than 
$25,000; and 
‘‘(cc) in the case of any 
other deficiency, an amount not 
to exceed $3,000. 
‘‘(III) 
REDUCTION
OF
CIVIL 
MONEY PENALTIES IN CERTAIN CIR-
CUMSTANCES.—Subject to subclause 
(IV), in the case where a facility self- 
reports and promptly corrects a defi-
ciency for which a penalty was im-
posed under this clause not later than 
10 calendar days after the date of 
such imposition, the Secretary may 
reduce the amount of the penalty im-
posed by not more than 50 percent. 
‘‘(IV) PROHIBITIONS ON REDUC-
TION FOR CERTAIN DEFICIENCIES.— 
‘‘(aa) 
REPEAT
DEFI-
CIENCIES.—The Secretary may 
not reduce the amount of a pen-
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
alty under subclause (III) if the 
Secretary had reduced a penalty 
imposed on the facility in the 
preceding year under such sub-
clause with respect to a repeat 
deficiency. 
‘‘(bb) CERTAIN OTHER DE-
FICIENCIES.—The Secretary may 
not reduce the amount of a pen-
alty under subclause (III) if the 
penalty is imposed for a defi-
ciency described in subclause 
(II)(bb) and the actual harm is 
found to result in a pattern of 
harm or widespread harm that 
immediately 
jeopardizes 
the 
health or safety of a resident or 
residents of the facility, or if the 
penalty is imposed for a defi-
ciency described in subclause 
(II)(aa). 
‘‘(V) 
COLLECTION
OF
CIVIL 
MONEY PENALTIES.—In the case of a 
civil money penalty imposed under 
this clause for a deficiency described 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00052
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
in item (aa) or (bb) of subclause (II), 
the Secretary— 
‘‘(aa) subject to item (bb), 
shall provide the opportunity for 
the facility to participate in an 
informal dispute resolution proc-
ess prior to the collection of such 
penalty; 
‘‘(bb) may provide for the 
collection of such civil money 
penalty and the placement of 
such amounts collected in an es-
crow account on the earlier of the 
date on which the informal dis-
pute resolution process under 
item (aa) is completed or the 
date that is 90 days after the 
date of the imposition of the pen-
alty; 
‘‘(cc) may provide that such 
amounts collected are kept in 
such account pending the resolu-
tion of any appeals; 
‘‘(dd) in the case where the 
facility successfully appeals the 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
penalty, may provide for the re-
turn of such amounts collected 
(plus interest) to the facility; and 
‘‘(ee) in the case where all 
such appeals are unsuccessful, 
may provide that some portion of 
such amounts collected may be 
used to support activities that 
benefit residents, including as-
sistance to support and protect 
residents who reside in a facility 
that closes (voluntarily or invol-
untarily) or is decertified (includ-
ing offsetting costs of relocating 
residents to home and commu-
nity-based settings or another fa-
cility), and projects that support 
resident and family councils and 
other consumer involvement in 
assuring quality care in facilities. 
‘‘(VI) PROCEDURE.—The provi-
sions of section 1128A (other than 
subsections (a) and (b) and except to 
the extent that such provisions require 
a hearing prior to the imposition of a 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS
civil money penalty in the case de-
scribed in subclause (V)) shall apply 
to a civil money penalty under this 
clause in the same manner as such 
provisions apply to a penalty or pro-
ceeding under section 1128A(a).’’. 
(B) 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)(V),’’ after ‘‘(i),’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect 1 year after the date of enact-
ment of this Act. 
SEC. 202. GAO STUDY AND REPORT ON THE RELATIVE FI-
NANCIAL STATUS AND PERFORMANCE OF 
SPECIAL FOCUS FACILITIES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on the fi-
nancial status, resident care, and performance of 
skilled nursing facilities and nursing facilities in the 
Special Focus Facility program (or a successor pro-
gram) established by the Centers for Medicare & 
Medicaid Services relative to a comparable sample of 
facilities that are not in such program. Such study 
VerDate Aug 31 2005 
05:14 Apr 17, 2008
Jkt 069200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6201
E:\BILLS\H5799.IH
H5799
wwoods2 on PRODPC68 with BILLS