I
106TH CONGRESS
2D SESSION
H. R. 5646
To amend titles XVIII and XIX of the Social Security Act to provide for
increased accountability of nursing facilities and adequate nurse staffing
for patient needs in the facilities.
IN THE HOUSE OF REPRESENTATIVES
DECEMBER 7, 2000
Mr. STARK introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend titles XVIII and XIX of the Social Security Act
to provide for increased accountability of nursing facili-
ties and adequate nurse staffing for patient needs in
the facilities.
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 Facility Staff-
ing Improvement Act of 2000’’.
SEC. 2. INTERIM SURVEYS FOR NURSING HOMES FOR DEFI-
CIENCIES ATTRIBUTABLE TO INADEQUATE
NURSE STAFFING.
(a) INTERIM SURVEYS FOR QUALITY DEFICIENCIES
ATTRIBUTABLE TO INADEQUATE NURSE STAFFING.—
(1) ESTABLISHMENT OF REQUIREMENT FOR IN-
TERIM
SURVEYS.—Sections 
1819(g)(2) 
and
1919(g)(2) of the Social Security Act (42 U.S.C.
1395i–3(g)(2) and 1396r(g)(2)) are each amended—
(A) in subparagraph (A)(ii)—
(i) in subclause (II), by striking
‘‘and’’ at the end;
(ii) in subclause (III), by striking the
period and inserting ‘‘, and’’; and
(iii) by adding at the end the fol-
lowing new subclause:
‘‘(IV) for each quality deficiency
identified in the survey that resulted
in actual harm to a resident of the fa-
cility or that posed a risk of imme-
diate jeopardy to the health or safety
of the resident, an assessment of
whether inadequate nurse staffing is a
contributing 
factor 
to 
that 
defi-
ciency.’’; and
staffing at the facility and the contin-
ued compliance of the facility with
such plan of correction.
‘‘(III) CONDUCT
OF
INTERIM
SURVEYS WITHOUT NOTICE TO FACIL-
ITY.—Such surveys shall be conducted
without any prior notice to the facil-
ity. Any individual who notifies (or
causes to be notified) a facility of the
time or date on which such a survey
is scheduled to be conducted is subject
to a civil money penalty in the same
manner as provided for under the sec-
ond and third sentences of subpara-
graph (A)(i).
‘‘(iii) 
FINDING
OF
INADEQUATE
NURSE
STAFFING
IN
AN
INTERIM
SUR-
VEY.—In the case of a finding in a facility
of a quality deficiency that is identified in
an interim survey under clause (ii) to
which inadequate nurse staffing is deter-
mined to be a contributing factor, during
the two-year period beginning on the date
of such finding, the facility shall be subject
to such additional interim surveys as the
State determines appropriate to verify the
maintenance of adequate nurse staffing in
the facility and continued compliance by
the facility with the plan of correction.
‘‘(iv) NURSE STAFFING DEFINED.—In
this paragraph and subsection (b)(1)(B),
the term ‘nurse staffing’ means nursing
staff consisting of registered professional
nurses, licensed practical nurses, or cer-
tified nurse aides.’’.
(2) 
CONFORMING
AMENDMENT.—Section
1864(d) of the Social Security Act (42 U.S.C.
1395aa(d)) is amended by inserting ‘‘(including in-
terim surveys under section 1819(g)(2)(F))’’ after
‘‘section 1819(g)’’.
(b) PROMPT IMPLEMENTATION OF PLANS OF COR-
RECTION FOR DEFICIENCIES ATTRIBUTABLE TO INAD-
EQUATE NURSE STAFFING.—Sections 1819(b)(1)(B) and
1919(b)(1)(B) of the Social Security Act (42 U.S.C.
1395i–3(b)(1)(B) and 1396r(b)(1)(B)) are each amended
by adding at the end the following: ‘‘In the case of a plan
of correction to correct quality deficiencies of a facility
identified in a survey to which inadequate nurse staffing
is determined to be a contributing factor under subsection
(g)(2)(A)(ii)(IV), such plan shall specify the number and
type of additional nurse staff necessary to provide the req-
uisite care required under paragraph (2) for each resident
of the facility and shall be implemented not later than 30
days after receipt of notice of the deficiency.’’.
(c) COLLECTION
OF DATA
ON NURSE STAFFING
LEVELS.—
(1) MEDICARE.—Section 1819(b) of the Social
Security Act (42 U.S.C. 1395i–3(b)) is amended by
adding at the end the following new paragraph:
‘‘(8) COLLECTION OF DATA.—
‘‘(A) SUBMISSION TO SECRETARY.—
‘‘(i) ON STAFFING LEVELS.—A skilled
nursing facility shall submit to the Sec-
retary, in such form and manner and at
such intervals as the Secretary may re-
quire, data with respect to nursing staff of
the facility. Such data shall include the
total number of nursing staff hours fur-
nished during the period specified by the
Secretary (including totals for each shift
worked during such period) by the facility
to residents for which payment is made
under section 1888(e), broken down by
total certified nurse aide hours, total li-
censed practical or vocational nurse hours,
and total registered nurse hours, and shall
also include the average wage rate for each
class of nursing staff employed by the fa-
cility.
‘‘(ii) 
INFORMATION
CONCERNING
RESIDENTS.—The skilled nursing facility
shall provide the Secretary, in such form
and manner and at such intervals as the
Secretary may require, a classification of
all residents of the skilled nursing facility
that accords with the patient classification
system 
described 
in 
section
1888(e)(3)(B)(ii), or such successor system
as the Secretary may identify.
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet site
of the Department of Health and Human Serv-
ices known as ‘Nursing Home Compare’ the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.
‘‘(C) REVIEW
OF
DATA.—The Secretary
shall determine for each year from data col-
lected under subparagraph (A) whether a facil-
ity maintains adequate nurse staffing for resi-
dent care in the facility.’’.
(2) MEDICAID.—Section 1919(b) of the Social
Security Act (42 U.S.C. 1396r(b)) is amended by
adding at the end the following new paragraph:
‘‘(9) SUBMISSION OF DATA.—
‘‘(A) SUBMISSION TO SECRETARY.—
‘‘(i) ON STAFFING LEVELS.—A nurs-
ing facility shall submit to the Secretary,
in such form and manner and at such in-
tervals as the Secretary may require, data
with respect to nursing staff of the facility.
Such data shall include the total number
of nursing staff hours furnished during the
period specified by the Secretary (including
totals for each shift worked during such
period) by the facility to residents for
which payment is made under section
1888(e), broken down by total certified
nurse aide hours, total licensed practical or
vocational nurse hours, and total registered
nurse hours, and shall also include the av-
erage wage rate for each class of nursing
staff employed by the facility.
‘‘(ii) 
INFORMATION
CONCERNING
RESIDENTS.—The nursing facility shall
provide the Secretary, in such form and
manner and at such intervals as the Sec-
retary may require, a classification of all
residents of the skilled nursing facility that
accords with the patient classification sys-
tem described in section 1888(e)(3)(B)(ii),
or such successor system as the Secretary
may identify.
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet site
of the Department of Health and Human Serv-
ices known as ‘Nursing Home Compare’ the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.
‘‘(C) REVIEW
OF
DATA.—The Secretary
shall determine for each year from data col-
lected under subparagraph (A) whether a facil-
ity maintains adequate nurse staffing for resi-
dent care in the facility.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section apply with respect to surveys conducted on
or after the date that is 6 months after the date of the
enactment of this Act.
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