I 
111TH CONGRESS 
2D SESSION 
H. R. 6261 
To amend titles XVIII and XIX of the Social Security Act to improve 
oversight of nursing facilities under the Medicare and Medicaid programs 
by ensuring adequate, trained surveyors, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2010 
Ms. ROYBAL-ALLARD introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and 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 improve oversight of nursing facilities under the Medi-
care and Medicaid programs by ensuring adequate, 
trained surveyors, 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 Patient 
Protection and Standards Act’’. 
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SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SUR-
VEYORS. 
(a) MEDICARE.—Section 1819(g)(2)(E)(iii) of the 
Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)(iii)) is 
amended by adding the following at the end: ‘‘The testing 
program must be sufficiently rigorous (as determined by 
the Secretary) to ensure that surveyors are adequately 
prepared to survey and certify facilities in a consistent and 
accurate manner.’’ 
(b) MEDICAID.—Section 1919(g)(2)(E)(iii) of the So-
cial Security Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is 
amended by adding the following at the end: ‘‘The testing 
program must be sufficiently rigorous (as determined by 
the Secretary) to ensure that surveyors are adequately 
prepared to survey and certify facilities in a consistent and 
accurate manner.’’ 
SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING 
FOR STATE SURVEYS OF NURSING HOMES. 
(a) MEDICARE.—Section 1819(g)(2)(E) of the Social 
Security Act (42 U.S.C. 1395i–3(g)(2)(E)) is amended by 
adding at the end the following: 
‘‘(iv) ADEQUATE
QUALIFIED
STAFF 
FOR
SURVEY
TEAMS.—The Secretary, in 
consultation with the advisory committee 
under subparagraph (F), shall establish re-
quirements— 
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‘‘(I) for the qualifications and 
compensation of members of a survey 
team under this subsection; and 
‘‘(II) that a State employs an 
adequate number of individuals as 
members of survey teams to ensure 
adequate oversight of skilled nursing 
facilities. 
‘‘(v) CONTINUING
EDUCATION.—In 
addition to the training and testing pro-
gram required under clause (iii), the Sec-
retary shall require that State and Federal 
surveyors regularly complete an adequate 
amount (as determined by the Secretary) 
of continuing education courses that meet 
requirements determined by the Secretary 
for content and the rigor of the material 
covered by such courses. An individual 
shall not serve as a member of a survey 
team unless the individual is in compliance 
with the requirements of this clause.’’. 
(b) MEDICAID.—Section 1919(g)(2)(E) of the Social 
Security Act (42 U.S.C. 1396r(g)(2)(E)) is amended by 
adding at the end the following: 
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‘‘(iv) ADEQUATE
QUALIFED
STAFF 
FOR
SURVEY
TEAMS.—The Secretary, in 
consultation with the advisory committee 
under subparagraph (F), shall establish re-
quirements— 
‘‘(I) for the qualifications and 
compensation of members of a survey 
team under this subsection; and 
‘‘(II) that a State employs an 
adequate number of individuals as 
members of survey teams to ensure 
adequate oversight of nursing facili-
ties. 
‘‘(v) CONTINUING
EDUCATION.—In 
addition to the training and testing pro-
gram required under clause (iii), the Sec-
retary shall require that State and Federal 
surveyors regularly complete an adequate 
amount (as determined by the Secretary) 
of continuing education courses that meet 
requirements determined by the Secretary 
for content and the rigor of the material 
covered by such courses. No individual 
shall serve as a member of a survey team 
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unless the individual is in compliance with 
the requirements of this clause.’’. 
SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY 
OF SURVEYORS. 
(a) WHISTLE BLOWER PROTECTIONS.— 
(1) MEDICARE.—Section 1819(g) of the Social 
Security Act (42 U.S.C. 1395i–3(g)) is amended by 
adding the following at the end: 
‘‘(6) REPORTING OF INACCURACIES.— 
‘‘(A) REPORTING REQUIREMENT.—A cov-
ered individual shall report to the Secretary any 
instance in which the individual suspects that— 
‘‘(i) a survey under this subsection 
fails to report or under reports an issue in 
a facility that could impact the safety or 
quality of care of the residents in such fa-
cility; or 
‘‘(ii) a member of the survey team or 
an employee of the State survey agency 
was inappropriately induced (through the 
offering of monetary awards or through 
undue pressure) to alter the results of the 
survey. 
‘‘(B) RESPONSES TO REPORT.—If the Sec-
retary receives a report under subparagraph 
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(A), the Secretary shall take appropriate action, 
as determined by the Secretary, to ensure the 
accuracy of the survey. 
‘‘(C) WHISTLE BLOWER PROTECTIONS.— 
With respect to a covered individual, a State 
may not— 
‘‘(i) 
discharge, 
demote, 
suspend, 
threaten, harass, or deny a promotion or 
other employment-related benefit to such 
individual, or in any other manner dis-
criminate against an individual in the 
terms and conditions of employment be-
cause the individual submitted a report 
under subparagraph (A); or 
‘‘(ii) file a complaint or a report 
against the individual with the appropriate 
State professional disciplinary agency be-
cause the individual submitted a report 
under subparagraph (A). 
‘‘(D) REMEDY
FOR
VIOLATIONS.—If the 
Secretary finds that a State has violated the 
prohibitions under subparagraph (C), the Sec-
retary shall provide for an appropriate remedy. 
‘‘(E) REQUIREMENT TO POST NOTICE.— 
Each State shall post conspicuously in an ap-
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propriate location a sign (in a form specified by 
the Secretary) specifying the rights of covered 
individuals under this section. Such sign shall 
include a statement that a covered individual 
may file a complaint with the Secretary against 
the State for violating the provisions of this 
paragraph and information with respect to the 
manner of filing such a complaint. 
‘‘(F) COVERED
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘cov-
ered individual’ means an individual— 
‘‘(i) who is a member of a State sur-
vey team under this subsection; or 
‘‘(ii) who is an employee of the State 
department or agency that conducts sur-
veys under this section.’’. 
(2) MEDICAID.—Section 1919(g) of the Social 
Security Act (42 U.S.C. 1396r(g)) is amended by 
adding the following at the end: 
‘‘(6) REPORTING OF INACCURACIES.— 
‘‘(A) REPORTING REQUIREMENT.—A cov-
ered individual shall report to the Secretary any 
instance in which the individual suspects that— 
‘‘(i) a survey under this subsection 
fails to report or under reports an issue in 
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a facility that could impact the safety or 
quality of care of the residents in such fa-
cility; or 
‘‘(ii) a member of the survey team or 
an employee of the State survey agency 
was inappropriately induced (through the 
offering of monetary awards or through 
undue pressure) to alter the results of the 
survey. 
‘‘(B) RESPONSE TO REPORTS.—If the Sec-
retary receives a report under subparagraph 
(A), the Secretary shall take appropriate action, 
as determined by the Secretary, to ensure the 
accuracy of the survey. 
‘‘(C) WHISTLE BLOWER PROTECTIONS.— 
With respect to a covered individual, a State 
may not— 
‘‘(i) 
discharge, 
demote, 
suspend, 
threaten, harass, or deny a promotion or 
other employment-related benefit to such 
individual, or in any other manner dis-
criminate against an individual in the 
terms and conditions of employment be-
cause the individual submitted a report 
under subparagraph (A); or 
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‘‘(ii) file a complaint or a report 
against the individual with the appropriate 
State professional disciplinary agency be-
cause the individual submitted a report 
under subparagraph (A). 
‘‘(D) PENALTIES
FOR
RETALIATION.—If 
the Secretary finds that a State has violated the 
prohibitions under subparagraph (C), the Sec-
retary shall provide for a reduction of the pay-
ment otherwise made to the State under section 
1903(a)(7), with respect to a quarter, equal to 
5 percent. A State that is dissatisfied with the 
Secretary’s findings under this subparagraph 
may obtain reconsideration and review of the 
findings under section 1116 in the same man-
ner as a State may seek reconsideration and re-
view under that section of the Secretary’s deter-
mination under section 1116(a)(1). 
‘‘(E) REQUIREMENT TO POST NOTICE.— 
Each State shall post conspicuously in an ap-
propriate location a sign (in a form specified by 
the Secretary) specifying the rights of covered 
individuals under this section. Such sign shall 
include a statement that a covered individual 
may file a complaint with the Secretary against 
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the State for violating the provisions of this 
paragraph and information with respect to the 
manner of filing such a complaint. 
‘‘(F) COVERED
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘cov-
ered individual’ means an individual— 
‘‘(i) who is a member of a State sur-
vey team under this subsection; or 
‘‘(ii) who is an employee of the State 
department or agency that conducts sur-
veys under this section.’’. 
(b) PENALTIES
FOR
INAPPROPRIATELY
INFLU-
ENCING A SURVEYOR.— 
(1) MEDICARE.—Section 1819(g)(2)(E) of the 
Social Security Act (42 U.S.C. 1395i–3(g)(2)(E)), 
as amended by section 3(a), is further amended by 
adding the following at the end: 
‘‘(vi) PENALTIES
FOR
INAPPROPRI-
ATELY
INFLUENCING
A
SURVEYOR.—Any 
individual (including an employee of a 
skilled nursing facility or any affiliated 
corporate entity, a representative of the 
skilled nursing facility industry, a member 
of a State survey team, an employee of the 
State department or agency that conducts 
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surveys under this section, or an elected 
official) who attempts to inappropriately 
influence, as determined by the Secretary 
through regulations, the results of a survey 
under this subsection or the actions of a 
member of a survey team or an employee 
of a survey agency under this subsection 
shall be subject to a civil money penalty 
not to exceed $10,000. The provisions of 
section 1128A (other than subsections (a) 
and (b)) shall apply to a civil money pen-
alty under the previous sentence in the 
same manner as such provisions apply to a 
penalty 
or 
proceeding 
under 
section 
1128A(a).’’. 
(2) MEDICAID.—Section 1919(g)(2)(E) of the 
Social Security Act (42 U.S.C. 1396r(g)(2)(E)), as 
amended by section 3(b), is further amended by add-
ing at the end the following: 
‘‘(vi) PENALTIES
FOR
INAPPROPRI-
ATELY
INFLUENCING
A
SURVEYOR.—Any 
individual (including an employee of a 
nursing facility or any affiliated corporate 
entity, a representative of the nursing fa-
cility industry, a member of a State survey 
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team, an employee of the State department 
or agency that conducts surveys under this 
section, or an elected official) who at-
tempts to inappropriately influence, as de-
termined by the Secretary through regula-
tions, the results of a survey under this 
subsection or the actions of a member of a 
survey team or an employee of a survey 
agency under this subsection shall be sub-
ject to a civil money penalty not to exceed 
$10,000. The provisions of section 1128A 
(other than subsections (a) and (b)) shall 
apply to a civil money penalty under the 
previous sentence in the same manner as 
such provisions apply to a penalty or pro-
ceeding under section 1128A(a).’’. 
(3) CONFORMING AMENDMENTS.— 
(A) Section 1819(f)(2)(B)(iii)(I)(c) of the 
Social Security Act is amended by inserting ‘‘, 
a civil monetary penalty described in section 
1919(g)(2)(E)(vi) of not less than $10,000’’ 
after ‘‘of not less than $5,000’’. 
(B) Section 1919(f)(2)(B)(iii)(I)(c) of the 
Social Security Act is amended by inserting ‘‘, 
a 
civil 
monetary 
penalty 
described 
in 
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(g)(2)(E)(vi) of not less than $10,000’’ after 
‘‘of not less than $5,000’’. 
SEC. 5. ADVISORY COMMITTEE. 
(a) MEDICARE.—Section 1819(g)(2) of the Social Se-
curity Act (42 U.S.C. 1395i–3(g)(2)) is amended by add-
ing at the end the following: 
‘‘(F) ADVISORY COMMITTEE.— 
‘‘(i) ESTABLISHMENT.—The Secretary 
shall establish an advisory committee on 
surveys under this paragraph. 
‘‘(ii) MEMBERSHIP.—The membership 
of the advisory committee under clause (i) 
shall include advocates for residents of 
skilled nursing facilities, members of sur-
vey teams under this subsection, and nurs-
ing home administrators, directors of nurs-
ing, registered nurses, and other skilled 
nursing facility stakeholders. 
‘‘(iii) RECOMMENDED
STANDARDS.— 
The advisory committee under clause (i) 
shall make recommendations to the Sec-
retary on standards for— 
‘‘(I) the adequate staffing of sur-
vey teams under this subsection; 
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‘‘(II) the training of members of 
such teams; and 
‘‘(III) disclosing any contact be-
tween such members and individuals 
associated with skilled nursing facili-
ties, and limiting such contact to pre-
vent inappropriate influence of such 
members by such individuals. 
‘‘(iv) OTHER
RECOMMENDATIONS.— 
The advisory committee under clause (i) 
may also make recommendations to the 
Secretary on any other issue that would 
improve the survey process under this 
paragraph.’’. 
(b) MEDICAID.—Section 1919(g)(2) of the Social Se-
curity Act (42 U.S.C. 1396r(g)(2)) is amended by adding 
at the end the following: 
‘‘(F) ADVISORY COMMITTEE.— 
‘‘(i) ESTABLISHMENT.—The Secretary 
shall establish an advisory committee on 
surveys under this paragraph. 
‘‘(ii) MEMBERSHIP.—The membership 
of the advisory committee under clause (i) 
shall include advocates for residents of 
nursing facilities, members of survey teams 
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under this subsection, and nursing home 
administrators. 
‘‘(iii) RECOMMENDED
STANDARDS.— 
The advisory committee under clause (i) 
shall make recommendations to the Sec-
retary on standards for— 
‘‘(I) the adequate staffing of sur-
vey teams under this subsection; 
‘‘(II) the training of members of 
such teams; and 
‘‘(III) disclosing any contact be-
tween such members and individuals 
associated with nursing facilities, and 
limiting such contact to prevent inap-
propriate influence of such members 
by such individuals. 
‘‘(iv) OTHER
RECOMMENDATIONS.— 
The advisory committee under clause (i) 
may also make recommendations to the 
Secretary on any other issue that would 
improve the survey process under this 
paragraph.’’. 
SEC. 6. REVIEW OF SURVEYS. 
(a) MEDICARE.—Section 1819(g)(2)(D) of the Social 
Security Act (42 U.S.C. 1395i–3(g)(2)(D)) is amended— 
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(1) by striking ‘‘Each State’’ and inserting the 
following: 
‘‘(i) IN GENERAL.—Each State’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) REVIEW OF SURVEYS.—The su-
pervisors of the survey teams shall review 
each survey conducted under this sub-
section to ensure that any issues that im-
pact quality of care that are identified by 
such surveys are consistently and appro-
priately described and rated by the survey 
teams.’’. 
(b) MEDICAID.—Section 1919(g)(2)(D) of the Social 
Security Act (42 U.S.C. 1396r(g)(2)(D)) is amended— 
(1) by striking ‘‘Each State’’ and inserting the 
following: 
‘‘(i) IN GENERAL.—Each State’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) REVIEW OF SURVEYS.—The su-
pervisors of the survey teams shall review 
each survey conducted under this sub-
section to ensure that any issues that im-
pact quality of care that are identified by 
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such surveys are consistently and appro-
priately described and rated by the survey 
teams.’’. 
Æ 
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