I 
108TH CONGRESS 
1ST SESSION 
H. R. 787
To amend titles XVIII and XIX of the Social Security Act with respect 
to reform of Federal survey and certification process of nursing facilities 
under the Medicare and Medicaid Programs. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 13, 2003
Mr. CAMP 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 reform of Federal survey and certification 
process of nursing facilities under the Medicare and Med-
icaid Programs.
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 ‘‘Medicare and Medicaid 
Nursing Facility Quality Improvement Act of 2003’’.
(B) by adding at the end the following new 
subparagraph: 
‘‘(D) 
RESTORATION
OF
NURSE
AIDE 
TRAINING UPON DEMONSTRATION OF COMPLI-
ANCE.—The prohibition on program approval 
described in subparagraph (B)(iii)(I) shall not 
be continued when the facility involved through 
on-site verification demonstrates compliance 
with the applicable standards.’’. 
(b) REQUIREMENTS FOR NURSE AIDE TRAINING.—
(1) 
MEDICARE
PROGRAM.—Section 
1819(f)(2)(B)(iii)(I) of such Act (42 U.S.C. 1395i–
3(f)(2)(B)(iii)(I)) is amended—
(A) in the matter before subdivision (a), by 
striking ‘‘, within the previous 2 years’’; 
(B) in subdivision (a), by striking ‘‘has op-
erated’’ and inserting ‘‘is operating’’; 
(C) in subdivision (b), by striking ‘‘has 
been subject’’ and inserting ‘‘is subject’’; and 
(D) in subdivision (c), by inserting ‘‘within 
the previous 2 years’’ after ‘‘(c)’’.
(2) 
MEDICAID
PROGRAM.—Section 
1919(f)(2)(B)(iii)(I) 
of 
such 
Act 
(42 
U.S.C. 
1396r(f)(2)(B)(iii)(I)) is amended—
(A) in the matter before subdivision (a), by 
striking ‘‘, within the previous 2 years’’; 
(B) in subdivision (a), by striking ‘‘has op-
erated’’ and inserting ‘‘is operating’’; 
(C) in subdivision (b), by striking ‘‘has 
been subject’’ and inserting ‘‘is subject’’; and 
(D) in subdivision (c), by inserting ‘‘within 
the previous 2 years’’ after ‘‘(c)’’. 
(c) PROMOTING INNOVATION
AND QUALITY IM-
PROVEMENT THROUGH STATE WAIVERS.—
(1) MEDICARE PROGRAM.—Section 1819(g) of 
such Act (42 U.S.C. 1395i–3(g)) is amended by add-
ing at the end the following new paragraph: 
‘‘(6) WAIVER DEMONSTRATION AUTHORITY TO 
PROMOTE
INNOVATION
AND
QUALITY
IMPROVE-
MENT.—
‘‘(A) IN GENERAL.—At the request of a 
State, but not to exceed a total of 8 States, the 
Secretary may waive provisions of this sub-
section relating to survey and certification pro-
cedures in order to test and implement innova-
tive alternatives to the survey process otherwise 
applicable. The Secretary shall provide special 
consideration to the application of alternative 
procedures that increase the use of outcome
measures, the incorporation of quality of life 
measures, and improve consistency and accu-
racy in deficiency determinations and survey re-
sults. The Secretary shall approve a waiver re-
quest if applicant demonstrates significant po-
tential for improving the quality of care, quality 
of life, and safety of residents. 
‘‘(B) 
CONSIDERATION
OF
VIEWS
OF 
STAKEHOLDERS.—The Secretary shall only con-
sider waiver applications under this paragraph 
from a State under this paragraph if the State 
has convened and consulted with appropriate 
stakeholders in the State, including representa-
tives of nursing facilities, consumers groups, 
the State long term care ombudsman, labor or-
ganizations (and where such organizations are 
not present in the industry, other employee rep-
resentatives), and licensed health care pro-
viders, to assist in developing their alternative 
system. In determining whether to grant such 
waivers the Secretary shall take into consider-
ation the views of the stakeholders convened by 
the State.’’.
(2) MEDICAID PROGRAM.—Section 1919(g) of 
such Act (42 U.S.C. 1396r(g)) is amended by add-
ing at the end the following new paragraph: 
‘‘(6) WAIVER DEMONSTRATION AUTHORITY TO 
PROMOTE
INNOVATION
AND
QUALITY
IMPROVE-
MENT.—
‘‘(A) IN GENERAL.—At the request of a 
State, but not to exceed a total of 8 States, the 
Secretary may waive provisions of this sub-
section relating to survey and certification pro-
cedures in order to test and implement innova-
tive alternatives to the survey process otherwise 
applicable. The Secretary shall provide special 
consideration to the application of alternative 
procedures that increase the use of outcome 
measures, the incorporation of quality of life 
measures, and improve consistency and accu-
racy in deficiency determinations and survey re-
sults. The Secretary shall approve a waiver re-
quest if it demonstrates significant potential for 
improving the quality of care, quality of life, 
and safety of residents. 
‘‘(B) 
CONSIDERATION
OF
VIEWS
OF 
STAKEHOLDERS.—The Secretary shall only con-
sider waiver applications under this paragraph
from a State under this paragraph if the State 
has convened and consulted with appropriate 
stakeholders in the State, including representa-
tives of nursing facilities, consumers groups, 
the State long term care ombudsman, labor or-
ganizations (and where such organizations are 
not present in the industry, other employee rep-
resentatives), and licensed health care pro-
viders, to assist in developing their alternative 
system. In determining whether to grant such 
waivers the Secretary shall take into consider-
ation the views of the stakeholders convened by 
the State.’’. 
(d) REMOVAL OF INFLEXIBILITY IN PROVIDER TER-
MINATION.—
(1) MEDICARE PROGRAM.—Section 1819(h)(2) 
of such Act (42 U.S.C. 1395i–3(h)(2)) is amended—
(A) in subparagraph (D), by striking ‘‘If’’ 
and inserting ‘‘Subject to subparagraph (F), 
if’’; 
(B) in subparagraph (E), by striking ‘‘In’’ 
and inserting ‘‘Subject to subparagraph (F), 
in’’; and 
(C) by adding at the end the following new 
subparagraph: