imum nurse staffing ratios is not fea-
sible for nursing facilities by the end 
of the 2-year period applicable under 
clause (i), the Secretary may delay the 
implementation of the HHS minimum 
nurse staffing ratios until the date 
that is the end of the 5-year period 
that begins on the date of the enact-
ment of this subparagraph. If the Sec-
retary delays implementation of the 
HHS minimum nurse staffing ratios 
under the previous sentence, the Sec-
retary shall phase in over such 5-year 
period alternative minimum staffing 
standards that gradually increase in 
each of the years of the phase-in until 
the such standards meet the HHS 
minimum nurse staffing ratios. 
‘‘(IV) 
COUNTING.—In 
deter-
mining compliance with the staffing 
levels under this subparagraph, an in-
dividual may not be counted while 
performing services that are not direct 
nursing care, such as administrative 
services, 
food 
preparation, 
house-
keeping, laundry, maintenance serv-
ices, or other activities that are not 
direct nursing care. 
‘‘(iii) HHS MINIMUM NURSE STAFF-
ING
RATIOS.—The term ‘HHS minimum 
nurse staffing ratios’ means the minimum 
staffing levels identified in the report to 
Congress entitled ‘Appropriateness of Min-
imum Nurse Staffing Ratios in Nursing 
Homes, Report to Congress: Phase II 
Final’ submitted by the Secretary on 
March 21, 2002, which require—
‘‘(I) from 2.4 to 2.8 hours of 
care per resident per day by a cer-
tified nurse aide, and 
‘‘(II) from 1.15 to 1.3 hours of 
care per resident per day by a licensed 
practical nurse, a licensed vocational 
nurse, or a registered nurse, of which 
from 0.55 to 0.75 hours of care per 
resident per day shall be provided by 
a registered nurse. 
‘‘(iv) CONSTRUCTION.—
‘‘(I) NONPREEMPTION.—Nothing 
in this subparagraph shall be con-
strued as prohibiting the Secretary or 
a State (in the case of title XIX) from 
imposing higher minimum staffing 
levels 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).’’. 
(b) POSTING OF STAFFING INFORMATION.—
(1) IN GENERAL.—The first sentence of sub-
paragraph 
(A) 
of 
sections 
1819(b)(8) 
and 
1919(b)(8) of the Social Security Act (42 U.S.C. 
1395i–3(b)(8); 1396r(b)(8)) are each amended by
inserting before the period the following: ‘‘, a de-
scription of the minimum staffing requirements 
under paragraph (4)(D), and the average number of 
hours of nursing care that residents of the facility 
have received for each of the four previous calendar 
quarters’’. 
(2) REPORTS.—Such sections are each amended 
by adding at the end the following new subpara-
graph: 
‘‘(C) REPORTS OF STAFFING DATA.—A fa-
cility shall maintain records on nurse staffing, 
and shall submit such reports of such records 
to the Secretary as the Secretary may require 
for the administration and enforcement of this 
section. Such records shall be reviewed for accu-
racy as part of a standard survey required 
under subsection (g)(2)(A).’’. 
SEC. 3. INCREASED RESOURCES. 
(a) REINSTITUTION OF BOREN AMENDMENT PAY-
MENT METHODOLOGY.—
(1) IN GENERAL.—Section 1902(a)(13) of the 
Social Security Act (42 U.S.C. 1396a(a)(13)) is 
amended to read as follows: 
‘‘(13) provide for payment of services through 
the use of rates determined pursuant to the criteria
under this paragraph as in effect on August 1, 
1997;’’. 
(2) 
ESTABLISHMENT
OF
SAFE
HARBOR 
RATES.—Section 1902 of such Act (42 U.S.C. 
1396a) is amended by adding at the end the fol-
lowing: ‘‘The Secretary may, by regulation, promul-
gate standards or methodologies for determining 
rates that comply with paragraph (13), and a State 
that pays rates that meet such standards or meth-
odologies is deemed to be in compliance with para-
graph (13).’’. 
(3) EFFECTIVE DATE.—The amendment made 
by this subsection shall apply to services furnished 
on or after the date that is one year after the date 
of the enactment of this Act. 
(b) PERMANENT 1.5 PERCENT INCREASE OF MED-
ICAID FMAP BEGINNING WITH FISCAL YEAR 2004.—
Section 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)) is amended by adding at the end the following: 
‘‘With respect to calendar quarters beginning after Octo-
ber 1, 2003, the Federal medical assistance percentage for 
a State determined under the first sentence shall be in-
creased by 1.50 percentage points.’’. 
(c) FINANCIAL ACCOUNTABILITY.—
(1) IN
GENERAL.—Sections 1819(g)(2) and 
1919(g)(2) of the Social Security Act (42 U.S.C. 
1395i–3(g)(2); 1396r(g)(2)) are each amended—
(A) by redesignating subparagraphs (C), 
(D), and (E) as subparagraphs (D), (E), and 
(F); and 
(B) by inserting after subparagraph (B) 
the following new subparagraph: 
‘‘(C) 
FINANCIAL
ACCOUNTABILITY.—A 
standard or an extended survey may include an 
examination of the financial records of a facility 
to determine whether payments made to the fa-
cility under this section for services furnished to 
residents are being used in a manner consistent 
with this section.’’. 
(2) 
COMPOSITION
OF
MULTIDISCIPLINARY 
TEAM.—Sections 
1819(g)(2)(E)(i) 
and 
1919(g)(2)(E)(i) of the Social Security Act (42 
U.S.C. 1395i–3(g)(2)(E)(i); 1396r(g)(2)(E)(i)) are 
each amended by inserting after the period the fol-
lowing: ‘‘This multidisciplinary team may include 
professionals trained in financial accounting and au-
diting.’’
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to surveys conducted 
on or after the date of the enactment of this Act.
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