I 
116TH CONGRESS 
2D SESSION 
H. R. 8574 
To amend titles XVIII and XIX of the Social Security Act to increase 
enforcement under Medicare and Medicaid for skilled nursing facilities 
and nursing facilities during the COVID–19 emergency period and other 
infectious disease outbreak periods, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 9, 2020 
Ms. SHERRILL (for herself, Mr. PASCRELL, Mrs. WATSON COLEMAN, Mr. 
SIRES, Mr. BEYER, Mr. PAYNE, Mr. DOGGETT, Ms. SHALALA, Ms. JUDY 
CHU of California, and Mr. KILDEE) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to increase enforcement under Medicare and Medicaid 
for skilled nursing facilities and nursing facilities during 
the COVID–19 emergency period and other infectious 
disease outbreak periods, 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 ‘‘Protecting Residents 
with Oversight, Transparency, and Enforcement for Com-
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passionate Treatment in Long Term Care Facilities Act’’ 
or the ‘‘PROTECT Long Term Care Facilities Act’’. 
SEC. 2. INCREASED ENFORCEMENT UNDER MEDICARE AND 
MEDICAID FOR SKILLED NURSING FACILI-
TIES AND NURSING FACILITIES DURING THE 
COVID–19 EMERGENCY PERIOD AND OTHER 
INFECTIOUS DISEASE OUTBREAK PERIODS. 
(a) ADDITIONAL FUNDING TO STATE SURVEY AGEN-
CIES.— 
(1) APPROPRIATIONS.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Secretary of Health and Human Serv-
ices $100,000,000 for fiscal year 2021 to be pro-
vided, in addition to any funds otherwise made avail-
able and in accordance with paragraph (2), to State 
survey and certification agencies (described in sub-
section (f) of section 1128I of the Social Security 
Act (42 U.S.C. 1320a–7j)) for the following pur-
poses: 
(A) To complete surveys conducted pursu-
ant to the amendments made by subsection (b) 
for facilities (as defined in subsection (a) of 
such section 1128I). 
(B) To increase investigations and surveys 
performed pursuant to sections 1919(g)(4) of 
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such 
Act 
(42 
U.S.C. 
1396r(g)(2)) 
and 
1819(g)(4) of such Act (42 U.S.C. 1395i– 
3(g)(4)) based on criteria developed pursuant to 
paragraph (7)(B) of section 1819(h) of such 
Act, as added by subsection (b)(1)(C), and 
paragraph (10)(B) of section 1919(h) of such 
Act, as added by subsection (b)(2)(C). 
(C) To purchase personal protective equip-
ment for surveyors to conduct surveys and in-
vestigations of facilities (as defined in sub-
section (a) of such section 1128I) to ensure 
worker safety. 
(D) To increase staffing levels at such 
State survey and certification agencies. 
(2) ALLOCATION OF FUNDING.—The Secretary 
shall allocate funds appropriated under paragraph 
(1) based on the following prioritization: 
(A) First to State survey and certification 
agencies (as described in subsection (f) of such 
section 1128I) serving populations with a high 
burden, as defined by the Secretary of Health 
and Human Services, of COVID–19. 
(B) Second to such agencies preparing for, 
or working to mitigate, a COVID–19 surge or 
any similar infectious disease outbreak. 
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(C) Third to such agencies serving a high 
number, as defined by the Secretary, of low-in-
come, uninsured, or under-insured populations, 
including medically underserved populations. 
(D) Fourth to such agencies, as deter-
mined by the Secretary, based on the size of 
their nursing home population. 
(E) Fifth to any other such agencies. 
(b) SPECIAL RULES DURING COVID–19 EMER-
GENCY PERIOD AND OTHER INFECTIOUS DISEASE OUT-
BREAK PERIODS.— 
(1) MEDICARE.— 
(A) IN GENERAL.—Section 1819(g)(2) of 
the Social Security Act (42 U.S.C. 1395i– 
3(g)(2)) is amended by adding at the end the 
following new subparagraph: 
‘‘(F) COVID–19 EMERGENCY PERIOD AND 
OTHER INFECTIOUS DISEASE OUTBREAK PERI-
ODS.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of this paragraph, dur-
ing an infectious disease outbreak period 
(as defined in clause (ii)), with respect to 
a State, the following shall apply: 
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conducted as soon as practical after 
the standard survey for such facility, 
but not later than 4 weeks after the 
date of completion of such standard 
survey. 
‘‘(VI) A skilled nursing facility 
which is found, under a standard sur-
vey or extended survey to have pro-
vided substandard quality of care 
shall be surveyed at least once every 6 
months, thereafter until the infectious 
disease outbreak period ends. 
‘‘(VII) Surveys under this para-
graph shall be conducted in a manner 
that prioritizes skilled nursing facili-
ties located in towns (or counties, if 
municipal-level is not available) with 
higher infection rate, as identified by 
the Secretary, and facilities with pre-
vious violations of requirements of 
this Act. 
‘‘(VIII) Any skilled nursing facil-
ity reporting (as determined by the 
Centers for Medicare & Medicaid 
Services) fewer than three hours of di-
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rect care staff time per resident per 
day, with 1⁄2 hour of registered nurse 
time included or any skilled nursing 
facility that has reported no registered 
nurse for four or more days. 
‘‘(ii) INFECTIOUS DISEASE OUTBREAK 
PERIOD DEFINED.—For purposes of this 
subparagraph, the term ‘infectious disease 
outbreak period’ means any of the fol-
lowing periods: 
‘‘(I) COVID–19 EMERGENCY PE-
RIOD.—The emergency period de-
scribed in section 1135(g)(1)(B). 
‘‘(II) OTHER
INFECTIOUS
DIS-
EASE OUTBREAK PERIODS.— 
‘‘(aa) The period beginning 
on the date a nationwide emer-
gency related to a public health 
emergency is declared pursuant 
to the Stafford Act, a Major Dis-
aster Declaration, or the Na-
tional Emergencies Act and end-
ing on the date that is 6 months 
after the date on which the dec-
laration pursuant to the Stafford 
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Act, a Major Disaster Declara-
tion, or the National Emer-
gencies Act, as applicable, ends, 
whichever is the latest. 
‘‘(bb) The period during 
which there exists a public health 
emergency related to an infec-
tious disease outbreak declared 
by the Secretary pursuant to sec-
tion 319 of the Public Health 
Service Act. 
‘‘(cc) With respect to a 
skilled nursing facility in a State 
with respect to which the Gov-
ernor has declared an emergency 
or major disaster (as defined by 
the State) with respect to an in-
fectious disease outbreak, the pe-
riod for which such declaration is 
in effect with respect to such 
State.’’. 
(B) INTERNET
PORTAL
AND
HOTLINE 
NUMBER.—Section 1819(e) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(e)) is amended by 
adding at the end the following new paragraph: 
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‘‘(6) INTERNET
PORTAL
AND
HOTLINE
NUM-
BER.—By not later than one year after the date of 
the enactment of this paragraph, the State shall 
have in place and maintain an Internet portal and 
hotline number (which may be such a portal or hot-
line in existence before the date of the enactment of 
this paragraph) for staff of nursing facilities, resi-
dents of such facilities, family of such residents, the 
State long-term care ombudsman (established under 
title III or VII of the Older Americans Act of 1965 
in accordance with section 712 of the Act), or the 
general public to report violations of requirements of 
this section by such facilities. The Secretary shall es-
tablish a process under which each violation so re-
ported shall be preliminarily investigated by a State 
survey and certification agency (described in sub-
section (f) of section 1128I) and based on the re-
sults of such preliminary investigation may be sub-
ject to a subsequent more comprehensive investiga-
tion by such agency, in coordination with the Sec-
retary.’’. 
(C) 
INCREASED
PENALTIES.—Section 
1819(h) of the Social Security Act (42 U.S.C. 
1395i–3(h)) is amended by adding at the end 
the following new paragraph: 
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‘‘(7) SPECIAL RULES DURING COVID–19 EMER-
GENCY
PERIOD
AND
OTHER
INFECTIOUS
DISEASE 
OUTBREAK PERIODS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this subsection, during an in-
fectious disease outbreak period (as defined in 
subsection (g)(2)(F)(ii)), with respect to a 
State, the following shall apply: 
‘‘(i) In the cases of an outbreak spe-
cific violation, a civil monetary penalty 
under paragraph (2)(B)(ii)(I) may not be 
waived or reduced by the Secretary. 
‘‘(ii) In the case of a repeat deficiency 
relating to any violation of a skilled nurs-
ing facility during a 15-month period, any 
civil monetary penalty under paragraph 
(2)(B)(ii)(I), shall be doubled. 
‘‘(iii) In the case of a second outbreak 
specific violation of a skilled nursing facil-
ity during such period, the facility shall be 
treated as being identified by the Secretary 
(or may be identified by the top State 
health official, in accordance with a proc-
ess specified by the Secretary) as having 
substantially failed to meet applicable re-
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quirement of this Act for purposes of sub-
section (f)(8) for the remainder of such pe-
riod. 
‘‘(B) OUTBREAK
SPECIFIC
VIOLATION.— 
For purposes of this paragraph, the Secretary, 
through the Centers for Medicare & Medicaid 
Services, shall develop the following: 
‘‘(i) In the case of an infectious dis-
ease outbreak period with respect to 
COVID–19, criteria for determining an 
outbreak specific violation with respect to 
COVID–19, including— 
‘‘(I) criteria specified by the Cen-
ters for Disease Control and Preven-
tion relating to infection rates, mor-
tality rates, and hospitalization rates; 
and 
‘‘(II) criteria for staff shortages, 
overcrowding (and ability to cohort), 
and insufficient personal protective 
equipment. 
‘‘(ii) In the case of an infectious dis-
ease outbreak period other than with re-
spect to COVID–19, criteria for deter-
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mining an outbreak specific violation spe-
cific to such outbreak period.’’. 
(D) REPORTING.—Section 1819(d)(4) of 
the Social Security Act (42 U.S.C. 1395i– 
3(d)(4)) is amended by adding at the end the 
following new subparagraph: 
‘‘(C) COVID–19 AND
INFECTIOUS
DIS-
EASE
OUTBREAK
REPORTING
AND
NOTIFICA-
TION.— 
‘‘(i) IN GENERAL.—A skilled nursing 
facility must, with respect to an infectious 
disease outbreak period (as defined in sub-
section (g)(2)(F)(ii))— 
‘‘(I) electronically submit, at a 
frequency specified by the Secretary, 
but no less than once weekly and in a 
standardized format specified by the 
Secretary, to the National Healthcare 
Safety Network of the Centers for 
Disease Control and Prevention infor-
mation on— 
‘‘(aa) the number of sus-
pected 
and 
confirmed 
cases 
among residents and staff of the 
facility, of— 
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‘‘(AA) in the case of 
the period described in sub-
clause (I) of such section, 
COVID–19 (including with 
respect to residents of the 
facility previously treated for 
COVID–19); and 
‘‘(BB) in the case of 
the period described in sub-
clause (II) of such section, 
the infectious disease that is 
the reason for which such 
period is declared (including 
with respect to residents of 
the facility previously treat-
ed for such infectious dis-
ease); 
‘‘(bb) the number of deaths 
(including residents who die out-
side the facility and deaths re-
lated to COVID–19 or the infec-
tious 
disease, 
as 
applicable) 
among residents and staff of the 
facility; 
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‘‘(cc) the amount of personal 
protective equipment and hand 
hygiene supplies in the facility, 
including how many days supply; 
‘‘(dd) 
ventilator 
capacity 
and related supplies in the facil-
ity; 
‘‘(ee) the number of resident 
beds at the facility and census; 
‘‘(ff) access to COVID–19 
or the infectious disease, as ap-
plicable, testing available in the 
facility for residents of the facil-
ity; 
‘‘(gg) any staffing shortages; 
and 
‘‘(hh) any other information 
specified by the Secretary; and 
‘‘(II) in the case of the occur-
rence at the facility of either a single 
confirmed infection of COVID–19 or 
the infectious disease (as applicable) 
or of three or more residents or staff 
at the facility with new-onset of res-
piratory symptoms occurring within 
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72 hours of each other, inform resi-
dents of the facility, representatives of 
such residents, and families of the 
residents of such occurrence by not 
later than 5 p.m. on the calendar day 
following such occurrence. 
‘‘(ii) INFORMATION.—The information 
provided under clause (ii)(II) must— 
‘‘(I) not include personally identi-
fiable information; 
‘‘(II) include information on miti-
gating actions implemented to prevent 
or reduce the risk of transmission, in-
cluding if normal operations of the fa-
cility will be altered; and 
‘‘(III) include any cumulative up-
dates for residents, representatives, 
and families at least weekly (or, in the 
case of a subsequent occurrence de-
scribed in such clause (ii)(II), by not 
later than 5 p.m. on the calendar day 
following 
such 
subsequent 
occur-
rence). 
‘‘(iii) CMS POSTING.—The informa-
tion submitted under clause (ii)(I) shall be 
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publicly posted on a weekly basis by the 
Centers for Medicare & Medicaid Service 
to support protecting the health and safety 
of residents, personnel, and the general 
public.’’. 
(2) MEDICAID.— 
(A) IN GENERAL.—Section 1919(g)(2) of 
the Social Security Act (42 U.S.C. 1396r(g)(2)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(F) COVID–19 EMERGENCY PERIOD AND 
OTHER INFECTIOUS DISEASE OUTBREAK PERI-
ODS.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of this paragraph, dur-
ing an infectious disease outbreak period 
(as defined in clause (ii)), with respect to 
a State, the following shall apply: 
‘‘(I) Each nursing facility shall 
be subject to a standard survey under 
subparagraph (A) not later than 4 
weeks after the beginning of such pe-
riod and every 6 months after the 
date of the previous standard survey 
conducted under such subparagraph. 
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‘‘(II) Follow-up surveys under 
this paragraph shall be conducted 
based on if the skilled nursing facility 
is found to be— 
‘‘(aa) a facility with sub-
standard quality of care; 
‘‘(bb) a facility not in sub-
stantial compliance; 
‘‘(cc) a facility reporting less 
than three hours of direct care 
staff per resident per day; 
‘‘(dd) a facility that has re-
ported no registered nurses for 
four or more days in a quarter; 
or 
‘‘(ee) a facility with an over-
all score of 2 or less stars on 
nursing home compare. 
‘‘(III) In the case of a nursing 
facility which is found under a stand-
ard survey or extended survey to be in 
substantial compliance, State survey 
and certification agencies (described 
in subsection (f) of section 1128I) 
shall have flexibility with regards to 
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the timing of conducting such a fol-
low-up standard survey. 
‘‘(IV) A nursing facility which is 
found, under a standard survey or ex-
tended survey, to have provided sub-
standard quality of care shall be treat-
ed as being identified by the Secretary 
as having substantially failed to meet 
applicable requirement of this Act for 
purposes of subsection (f)(10). 
‘‘(V) In the case of a nursing fa-
cility that is subject to an extended 
survey under subparagraph (B), such 
extended survey shall be conducted as 
soon as practical after the standard 
survey for such facility, but not later 
than 4 weeks after the date of comple-
tion of such standard survey. 
‘‘(VI) A nursing facility which is 
found, under a standard survey or ex-
tended survey to have provided sub-
standard quality of care shall be sur-
veyed at least once every 6 months, 
thereafter until the infectious disease 
outbreak period ends. 
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‘‘(VII) Surveys under this para-
graph shall be conducted in a manner 
that prioritizes nursing facilities lo-
cated in towns (or counties, if munic-
ipal-level is not available) with higher 
infection rate, as identified by the 
Secretary, and facilities with previous 
violations of requirements of this Act. 
‘‘(VIII) Any skilled nursing facil-
ity reporting (as determined by the 
Centers for Medicare & Medicaid 
Services) fewer than three hours of di-
rect care staff time per resident per 
day, with 1⁄2 hour of registered nurse 
time included or any skilled nursing 
facility that has reported no registered 
nurse for four or more days. 
‘‘(ii) INFECTIOUS DISEASE OUTBREAK 
PERIOD DEFINED.—For purposes of this 
subparagraph, the term ‘infectious disease 
outbreak period’ means any of the fol-
lowing periods: 
‘‘(I) COVID–19 EMERGENCY PE-
RIOD.—The emergency period de-
scribed in section 1135(g)(1)(B). 
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‘‘(II) OTHER
INFECTIOUS
DIS-
EASE OUTBREAK PERIODS.— 
‘‘(aa) The period beginning 
on the date a nationwide emer-
gency related to a public health 
emergency is declared pursuant 
to the Stafford Act, a Major Dis-
aster Declaration, or the Na-
tional Emergencies Act and end-
ing on the date that is 6 months 
after the date on which the dec-
laration pursuant to the Stafford 
Act, a Major Disaster Declara-
tion, or the National Emer-
gencies Act, as applicable, ends, 
whichever is the latest. 
‘‘(bb) The period during 
which there exists a public health 
emergency related to an infec-
tious disease outbreak declared 
by the Secretary pursuant to sec-
tion 319 of the Public Health 
Service Act. 
‘‘(cc) With respect to a 
nursing facility in a State with 
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respect to which the Governor 
has declared an emergency or 
major disaster (as defined by the 
State) with respect to an infec-
tious disease outbreak, the period 
for which such declaration is in 
effect 
with 
respect 
to 
such 
State.’’. 
(B) INTERNET
PORTAL
AND
HOTLINE 
NUMBER.—Section 1919(e) of the Social Secu-
rity Act (42 U.S.C. 1396r(e)) is amended by 
adding at the end the following new paragraph: 
‘‘(9) INTERNET
PORTAL
AND
HOTLINE
NUM-
BER.—By not later than one year after the date of 
the enactment of this paragraph, the State shall 
have in place and maintain an Internet portal and 
hotline number (which may be such a portal or hot-
line in existence before the date of the enactment of 
this paragraph) for staff of nursing facilities, resi-
dents of such facilities, family of such residents, the 
State long-term care ombudsman (established under 
title III or VII of the Older Americans Act of 1965 
in accordance with section 712 of the Act), or the 
general public to report violations of requirements of 
this section by such facilities. The Secretary shall es-
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tablish a process under which each violation so re-
ported shall be preliminarily investigated by a State 
survey and certification agency (described in sub-
section (f) of section 1128I) and based on the re-
sults of such preliminary investigation may be sub-
ject to a subsequent more comprehensive investiga-
tion by such agency, in coordination with the Sec-
retary.’’. 
(C) 
INCREASED
PENALTIES.—Section 
1919(h) of the Social Security Act (42 U.S.C. 
1396r(h)) is amended by adding at the end the 
following new paragraph: 
‘‘(10) SPECIAL RULES DURING COVID–19 EMER-
GENCY
PERIOD
AND
OTHER
INFECTIOUS
DISEASE 
OUTBREAK PERIODS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this subsection, during an in-
fectious disease outbreak period (as defined in 
subsection (g)(2)(F)(ii)), with respect to a 
State, the following shall apply: 
‘‘(i) In the cases of an outbreak spe-
cific violation, a civil monetary penalty 
under paragraph (3)(B)(ii)(I) may not be 
waived or reduced by the Secretary. 
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‘‘(ii) In the case of a repeat deficiency 
relating to any violation of a nursing facil-
ity during a 15-month period, any civil 
monetary 
penalty 
under 
paragraph 
(3)(B)(ii)(I) shall be doubled. 
‘‘(iii) In the case of a second outbreak 
specific violation of a nursing facility dur-
ing such period, the facility shall be treat-
ed as being identified by the Secretary (or 
may be identified by the top State health 
official, in accordance with a process speci-
fied by the Secretary) as having substan-
tially failed to meet applicable requirement 
of this Act for purposes of subsection 
(f)(10) for the remainder of such period. 
‘‘(B) OUTBREAK
SPECIFIC
VIOLATION.— 
For purposes of this paragraph, the Secretary, 
through the Centers for Medicare & Medicaid 
Services, shall develop the following: 
‘‘(i) In the case of an infectious dis-
ease outbreak period with respect to 
COVID–19, criteria for determining an 
outbreak specific violation with respect to 
COVID–19, including— 
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‘‘(I) Criteria specified by the 
Centers for Disease Control and Pre-
vention relating to infection rates, 
mortality rates, and hospitalization 
rates. 
‘‘(II) Criteria for staff shortages, 
overcrowding (and ability to cohort), 
and insufficient personal protective 
equipment. 
‘‘(ii) In the case of an infectious dis-
ease outbreak period other than with re-
spect to COVID–19, criteria for deter-
mining an outbreak specific violation spe-
cific to such outbreak period.’’. 
(D) REPORTING.—Section 1919(d)(4) of 
the Social Security Act (42 U.S.C. 1396r(d)(4)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(C) COVID–19 AND
INFECTIOUS
DIS-
EASE
OUTBREAK
REPORTING
AND
NOTIFICA-
TION.— 
‘‘(i) IN GENERAL.—A nursing facility 
must, with respect to an infectious disease 
outbreak period (as defined in subsection 
(g)(2)(F)(ii))— 
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‘‘(I) electronically submit, at a 
frequency specified by the Secretary, 
but no less than once weekly and in a 
standardized format specified by the 
Secretary, to the National Healthcare 
Safety Network of the Centers for 
Disease Control and Prevention infor-
mation on— 
‘‘(aa) the number of sus-
pected 
and 
confirmed 
cases 
among residents and staff of the 
facility, of— 
‘‘(AA) in the case of 
the period described in sub-
clause (I) of such section, 
COVID–19 (including with 
respect to residents of the 
facility previously treated for 
COVID–19); and 
‘‘(BB) in the case of 
the period described in sub-
clause (II) of such section, 
the infectious disease that is 
the reason for which such 
period is declared (including 
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with respect to residents of 
the facility previously treat-
ed for such infectious dis-
ease); 
‘‘(bb) the number of deaths 
(including residents who die out-
side the facility and deaths re-
lated to COVID–19 or the infec-
tious 
disease, 
as 
applicable) 
among residents and staff of the 
facility; 
‘‘(cc) the amount of personal 
protective equipment and hand 
hygiene supplies in the facility, 
including how many days supply; 
‘‘(dd) 
ventilator 
capacity 
and related supplies in the facil-
ity; 
‘‘(ee) the number of resident 
beds at the facility and census; 
‘‘(ff) access to COVID–19 
or the infectious disease, as ap-
plicable, testing available in the 
facility for residents of the facil-
ity; 
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‘‘(gg) any staffing shortages; 
and 
‘‘(hh) any other information 
specified by the Secretary; and 
‘‘(II) in the case of the occur-
rence at the facility of either a single 
confirmed infection of COVID–19 or 
the infectious disease (as applicable) 
or of three or more residents or staff 
at the facility with new-onset of res-
piratory symptoms occurring within 
72 hours of each other, inform resi-
dents of the facility, representatives of 
such residents, and families of the 
residents of such occurrence by not 
later than 5 p.m. on the calendar day 
following such occurrence. 
‘‘(ii) INFORMATION.—The information 
provided under clause (ii)(II) must— 
‘‘(I) not include personally identi-
fiable information; 
‘‘(II) include information on miti-
gating actions implemented to prevent 
or reduce the risk of transmission, in-
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cluding if normal operations of the fa-
cility will be altered; and 
‘‘(III) include any cumulative up-
dates for residents, representatives, 
and families at least weekly (or, in the 
case of a subsequent occurrence de-
scribed in such clause (ii)(II), by not 
later than 5 p.m. on the calendar day 
following 
such 
subsequent 
occur-
rence). 
‘‘(iii) CMS POSTING.—The informa-
tion submitted under clause (ii)(I) shall be 
publicly posted on a weekly basis by the 
Centers for Medicare & Medicaid Service 
to support protecting the health and safety 
of residents, personnel, and the general 
public’’. 
Æ 
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