I 
115TH CONGRESS 
2D SESSION 
H. R. 6986 
To amend titles XVIII and XIX of the Social Security Act with respect 
to nursing facility requirements, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 28, 2018 
Mr. DUFFY introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
with respect to nursing facility requirements, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Nursing Home Work-
force Quality Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
(1) Nursing facilities are an integral component 
of the continuum of care for Medicare and Medicaid 
patients. 
(2) Many nursing facilities have in-house edu-
cational programs approved by the Centers for Medi-
care & Medicaid Services to train individuals as cer-
tified nursing aides to provide extensive, direct care. 
(3) The ability to provide this training is crit-
ical for nursing facilities to ensure that— 
(A) residents receive the highest quality 
care; 
(B) caregivers are trained on the most 
timely best practices and clinical standards; and 
(C) facilities can— 
(i) sustain appropriate staffing levels; 
and 
(ii) recruit and retain qualified staff. 
SEC. 3. TRAINING AND COMPETENCY EVALUATION PRO-
GRAMS. 
(a) MEDICARE.—Section 1819 of the Social Security 
Act (42 U.S.C. 1395i–3) is amended— 
(1) in subsection (f)(2)— 
(A) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subpara-
graph (B)(iii)(I))’’; 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
(B) in subparagraph (B)— 
(i) in clause (i)— 
(I) by striking ‘‘(subject to clause 
(iii))’’; and 
(II) by inserting ‘‘and’’ after the 
semicolon; 
(ii) in clause (ii), by striking ‘‘; and’’ 
and inserting a period; 
(iii) by striking clause (iii); and 
(iv) by striking ‘‘A State may not del-
egate (through subcontract or otherwise) 
its responsibility under clause (iii)(II) to 
the skilled nursing facility.’’; 
(C) by striking subparagraphs (C) and 
(D); and 
(D) by adding at the end the following: 
‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN-
ING AND COMPETENCY EVALUATION PROGRAMS 
AND
NURSE
AIDE
COMPETENCY
EVALUATION 
PROGRAMS.— 
‘‘(i) IN GENERAL.—With respect to a 
State, the Secretary may, in consultation 
with such State, disapprove a nurse aide 
training and competency evaluation pro-
gram or a nurse aide competency evalua-
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
tion program offered by or in a skilled 
nursing facility if such facility— 
‘‘(I) has been assessed a civil 
monetary penalty under subsection 
(h)(2)(B)(ii) 
or 
section 
1919(h)(2)(A)(ii) of not less than 
$10,483 for providing substandard 
quality of care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
facility that all deficiencies for which the 
civil monetary penalty described in clause 
(i)(I) was assessed have been remedied.’’; 
and 
(2) in subsection (h)(2)(B)(ii)(I), by striking 
‘‘$10,000’’ and inserting ‘‘$20,628’’. 
(b) MEDICAID.—Section 1919 of the Social Security 
Act (42 U.S.C. 1396r) is amended— 
(1) in subsection (f)(2)— 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
(A) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subpara-
graph (B)(iii)(I))’’; 
(B) in subparagraph (B)— 
(i) in clause (i), by inserting ‘‘and’’ 
after the semicolon; 
(ii) in clause (ii), by striking ‘‘; and’’ 
and inserting a period; 
(iii) by striking clause (iii); and 
(iv) by striking ‘‘A State may not del-
egate (through subcontract or otherwise) 
its responsibility under clause (iii)(II) to 
the nursing facility.’’; 
(C) by striking subparagraphs (C) and 
(D); and 
(D) by adding at the end the following: 
‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN-
ING AND COMPETENCY EVALUATION PROGRAMS 
AND
NURSE
AIDE
COMPETENCY
EVALUATION 
PROGRAMS.— 
‘‘(i) IN GENERAL.—With respect to a 
State, the Secretary may, in consultation 
with such State, disapprove a nurse aide 
training and competency evaluation pro-
gram or a nurse aide competency evalua-
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
tion program offered by or in a nursing fa-
cility if such facility— 
‘‘(I) has been assessed a civil 
monetary 
penalty 
under 
section 
1819(h)(2)(B)(ii) 
or 
subsection 
(h)(2)(A)(ii) of not less than $10,483 
for providing substandard quality of 
care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
facility that all deficiencies for which the 
civil monetary penalty described in clause 
(i)(I) was assessed have been remedied.’’; 
and 
(2) in subsection (h)(3)(C)(ii)(I), by striking 
‘‘$10,000’’ and inserting ‘‘$20,628’’. 
(c) REGULATIONS.—Not later than 180 days after 
the date of enactment of this Act, the Secretary of Health 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
and Human Services shall promulgate regulations as nec-
essary to implement the amendments made by this section. 
(d) APPLICABILITY.— 
(1) IN GENERAL.— 
(A) TIMING
OF
DETERMINATIONS.—The 
amendments made by subsections (a)(1)(D) and 
(b)(1)(D) of this section shall apply only to a 
civil monetary penalty if the relevant covered 
determination was made on or after the date of 
enactment of this Act. 
(B) 
COVERED
DETERMINATION
DE-
FINED.—The term ‘‘covered determination’’ 
means, with respect to a facility in a State, a 
determination by the State or the Secretary of 
Health and Human Services that the facility 
has provided a substandard quality of care for 
which a civil monetary penalty described in sec-
tion 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) 
of the Social Security Act (as such sections 
have been amended by this Act) may be as-
sessed. 
(2) PREVIOUSLY PROHIBITED PROGRAMS.— 
(A) WAIVER.—With respect to a facility 
subject, on the day before the date of enact-
ment of this Act, to a prohibition under item 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS
(a) of either section 1819(f)(2)(B)(iii)(I) or sec-
tion 1919(f)(2)(B)(iii)(I) of the Social Security 
Act (as in effect on the day before such date of 
enactment), such prohibition shall no longer 
apply to the facility on or after such date of en-
actment. 
(B) SURVEY
OR
CIVIL
MONETARY
PEN-
ALTY.—With respect to a facility subject, on 
the day before the date of enactment of this 
Act, to a prohibition under item (b) or (c) of ei-
ther section 1819(f)(2)(B)(iii)(I) or section 
1919(f)(2)(B)(iii)(I) of the Social Security Act 
(as in effect on the day before such date of en-
actment), such prohibition shall no longer apply 
to the facility on or after such date of enact-
ment upon a determination by the Secretary of 
Health and Human Services that the facility 
has corrected the issue that resulted in such 
prohibition. 
Æ 
VerDate Sep 11 2014 
00:05 Oct 10, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6301
E:\BILLS\H6986.IH
H6986
pbinns on DSK79D2C42PROD with BILLS