I
107TH CONGRESS
1ST SESSION
H. R. 3331
To amend titles XVIII and XIX of the Social Security Act to impose require-
ments with respect to staffing in nursing facilities receiving payments
under the Medicare or Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 16, 2001
Ms. SCHAKOWSKY (for herself, Mr. WAXMAN, Mr. BLAGOJEVICH, Mr. RUSH,
Mr. EVANS, Mr. FROST, Mrs. MCCARTHY of New York, and Mr. SAND-
ERS) 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
to impose requirements with respect to staffing in nurs-
ing facilities receiving payments under the Medicare or
Medicaid Program.
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 ‘‘Quality Care for Nurs-
ing Home Patients Act of 2001’’.
SEC. 2. NURSE STAFFING REQUIREMENTS.
(a) 
IN
GENERAL.—Sections 
1819(b)(4) 
and
1919(b)(4) of the Social Security Act (42 U.S.C. 1395i–
3(b)(4); 1396r(b)(4)) are each amended by adding at the
end the following new subparagraph:
‘‘(D) 
MINIMUM
STAFFING
REQUIRE-
MENTS.—
‘‘(i) LICENSED
NURSES.—A facility
shall have at least one licensed nurse on
duty on the premises for every—
‘‘(I) 15 residents present during
the day,
‘‘(II) 20 residents present during
the evening, and
‘‘(III) 30 residents present dur-
ing the night.
‘‘(ii) DIRECT CAREGIVERS.—In addi-
tion to the requirement under clause (i), a
facility shall also have at least one direct
caregiver on duty on the premises for
every—
‘‘(I) 5 residents present during
the day,
‘‘(II) 10 residents present during
the evening, and
‘‘(III) 15 residents present dur-
ing the night.
‘‘(iii) 
COUNTING.—In 
determining
compliance with the staffing levels under
this subparagraph, an individual may not
be counted while performing noncaregiving
services, such as administrative services,
food preparation, housekeeping, laundry,
maintenance 
services, 
or 
other
noncaregiving-related activities.
‘‘(iv) 
AUTHORITY
TO
ESTABLISH
HIGHER STANDARDS.—The Secretary may
establish higher minimum staffing require-
ments, for resident case mix and such
other factors as the Secretary determines
appropriate, than those imposed under
clauses (i) and (ii).
‘‘(v) RULES OF CONSTRUCTION.—
‘‘(I) NONPREEMPTION.—Nothing
in this subparagraph shall be con-
strued to prohibit a State from impos-
ing higher minimum staffing require-
ments on facilities than those imposed
under this subparagraph.
‘‘(II) 
MINIMUM
STANDARDS
ONLY.—Compliance with the staffing
requirements imposed under this sub-
paragraph alone shall not be con-
strued as complying with the require-
ment under paragraph (2) to provide
services to attain or maintain the
highest practicable physical, mental,
and psychosocial well-being of each
resident.
‘‘(III) 
SUPPLEMENTARY
RE-
QUIREMENTS.—The staffing require-
ments of this subparagraph are in ad-
dition to the requirements of subpara-
graph (C).
‘‘(vi) DEFINITIONS.—In this subpara-
graph and paragraph (8):
‘‘(I) 
LICENSED
NURSE.—The
term ‘licensed nurse’ means a reg-
istered professional nurse, licensed
practical nurse, or licensed vocational
nurse who meets State licensing re-
quirements, and who furnishes any of
the following services:
‘‘(aa) Direct care (including
treatment and medications).
‘‘(bb) Resident assessment
and observation.
‘‘(cc) Supervision of direct
patient care at the unit level.
‘‘(dd) Planning or coordina-
tion of nursing services with
other resident services.
‘‘(II) DIRECT
CAREGIVER.—The
term ‘direct caregiver’ means a cer-
tified nurse assistant who provides di-
rect care (as defined by the Secretary)
or a licensed nurse who primarily pro-
vides direct care.
‘‘(III) DAY.—The term ‘day’
means an eight-hour period com-
mencing not earlier than 6 a.m. nor
later than 8 a.m.
‘‘(IV) 
EVENING.—The 
term
‘evening’ means an eight-hour period
commencing not earlier than 2 p.m.
nor later than 4 p.m.
‘‘(V) NIGHT.—The term ‘night’
means an eight-hour period com-