‘‘(A) make the information submitted pur-
suant to paragraph (1)(C) publicly available, in-
cluding by publication of such information on 
the Internet site of the Department of Health 
and Human Services; and 
‘‘(B) provide for the auditing of such infor-
mation for accuracy as a part of the process of 
determining whether an institution is a hospital 
for purposes of this title. 
‘‘(d) RECORD-KEEPING; DATA COLLECTION; EVAL-
UATION.—
‘‘(1) 
RECORD-KEEPING.—Each 
participating 
hospital shall maintain for a period of at least 3 
years (or, if longer, until the conclusion of pending 
enforcement activities) such records as the Secretary 
deems necessary to determine to whether the hos-
pital has adopted and implemented a staffing system 
pursuant to subsection (a). 
‘‘(2) DATA
COLLECTION
ON
CERTAIN
OUT-
COMES.—The Secretary shall require the collection, 
maintenance, and submission of data by each par-
ticipating hospital sufficient to establish the link be-
tween the staffing system established pursuant to 
subsection (a) and—
‘‘(A) patient acuity from maintenance of 
acuity data through entries on patients’ charts; 
‘‘(B) patient outcomes that are nursing 
sensitive, such as patient falls, adverse drug 
events, injuries to patients, skin breakdown, 
pneumonia, infection rates, upper gastro-
intestinal bleeding, shock, cardiac arrest, length 
of stay, and patient re-admissions; 
‘‘(C) operational outcomes, such as work-
related injury or illness, vacancy and turnover 
rates, nursing care hours per patient day, on-
call use, overtime rates, and needle-stick inju-
ries; and 
‘‘(D) patient complaints related to staffing 
levels. 
‘‘(3) EVALUATION.—Each participating hospital 
shall annually evaluate its staffing system and estab-
lished minimum registered nurse staffing ratios to 
assure on-going reliability and validity of the system 
and ratios. The evaluation shall be conducted by a 
joint management-staff committee comprised of at 
least 50 percent of registered nurses who provide di-
rect patient care and where nurses are represented, 
with the involvement of the applicable recognized or
certified collective bargaining representatives of the 
registered nurses. 
‘‘(e) ENFORCEMENT.—
‘‘(1) RESPONSIBILITY.—The Secretary shall en-
force the requirements and prohibitions of this sec-
tion. 
‘‘(2) PROCEDURES FOR RECEIVING AND INVES-
TIGATING COMPLAINTS.—The Secretary shall estab-
lish procedures under which—
‘‘(A) any person may file a complaint that 
a participating hospital has violated a require-
ment or a prohibition of this section; and 
‘‘(B) such complaints are investigated by 
the Secretary. 
‘‘(3) REMEDIES.—If the Secretary determines 
that a participating hospital has violated a require-
ment of this section, the Secretary—
‘‘(A) shall require the facility to establish 
a corrective action plan to prevent the recur-
rence of such violation; and 
‘‘(B) may impose civil money penalties 
under paragraph (4). 
‘‘(4) CIVIL MONEY PENALTIES.—
‘‘(A) IN
GENERAL.—In addition to any 
other penalties prescribed by law, the Secretary
may impose a civil money penalty of not more 
than $10,000 for each knowing violation of a 
requirement of this section, except that the Sec-
retary shall impose a civil money penalty of 
more than $10,000 for each such violation in 
the case of a participating hospital that the 
Secretary determines has a pattern or practice 
of such violations (with the amount of such ad-
ditional penalties being determined in accord-
ance with a schedule or methodology specified 
in regulations). 
‘‘(B) PROCEDURES.—The provisions of 
section 1128A (other than subsections (a) and 
(b)) shall apply to a civil money penalty under 
this paragraph in the same manner as such 
provisions apply to a penalty or proceeding 
under section 1128A. 
‘‘(C) PUBLIC NOTICE OF VIOLATIONS.—
‘‘(i) INTERNET SITE.—The Secretary 
shall publish on the Internet site of the 
Department of Health and Human Serv-
ices the names of participating hospitals on 
which civil money penalties have been im-
posed under this section, the violation for 
which the penalty was imposed, and such
additional information as the Secretary de-
termines appropriate. 
‘‘(ii) CHANGE OF OWNERSHIP.—With 
respect to a participating hospital that had 
a change in ownership, as determined by 
the Secretary, penalties imposed on the 
hospital while under previous ownership 
shall no longer be published by the Sec-
retary of such Internet site after the 1-
year period beginning on the date of 
change in ownership. 
‘‘(f) WHISTLE-BLOWER PROTECTIONS.—
‘‘(1) PROHIBITION
OF
DISCRIMINATION
AND 
RETALIATION.—A participating hospital shall not 
discriminate or retaliate in any manner against any 
patient or employee of the hospital because that pa-
tient or employee, or any other person, has pre-
sented a grievance or complaint, or has initiated or 
cooperated in any investigation or proceeding of any 
kind, relating to the staffing system or other re-
quirements and prohibitions of this section. 
‘‘(2) RELIEF FOR PREVAILING EMPLOYEES.—
An employee of a participating hospital who has 
been discriminated or retaliated against in employ-
ment in violation of this subsection may initiate judi-
cial action in a United States District Court and 
shall be entitled to reinstatement, reimbursement for 
lost wages and work benefits caused by the unlawful 
acts of the employing hospital. Prevailing employees 
are entitled to reasonable attorney’s fees and costs 
associated with pursuing the case. 
‘‘(3) RELIEF
FOR
PREVAILING
PATIENTS.—A 
patient who has been discriminated or retaliated 
against in violation of this subsection may initiate 
judicial action in a United States District Court. A 
prevailing patient shall be entitled to liquidated 
damages of $5,000 for a violation of this statute in 
addition to any other damages under other applica-
ble statutes, regulations or common law. Prevailing 
patients are entitled to reasonable attorney’s fees 
and costs associated with pursuing the case. 
‘‘(4) LIMITATION ON ACTIONS.—No action may 
be brought under paragraph (2) or (3) more than 2 
years after the discrimination or retaliation with re-
spect to which the action is brought. 
‘‘(5) TREATMENT
OF
ADVERSE
EMPLOYMENT 
ACTIONS.—For purposes of this subsection—
‘‘(A) an adverse employment action shall 
be treated as ‘retaliation or discrimination’; and
‘‘(B) an adverse employment action in-
cludes—
‘‘(i) the failure to promote an indi-
vidual or provide any other employment-re-
lated benefit for which the individual would 
otherwise be eligible; 
‘‘(ii) an adverse evaluation or decision 
made in relation to accreditation, certifi-
cation, credentialing, or licensing of the in-
dividual; and 
‘‘(iii) a personnel action that is ad-
verse to the individual concerned. 
‘‘(g) RULES OF CONSTRUCTION.—
‘‘(1) RELATIONSHIP TO STATE LAWS.—Nothing 
in this section shall be construed as exempting or re-
lieving any person from any liability, duty, penalty, 
or punishment provided by any present or future law 
of any State or political subdivision of a State, other 
than any such law which purports to require or per-
mit the doing of any act which would be an unlawful 
practice under this title. 
‘‘(2) RELATIONSHIP TO CONDUCT PROHIBITED 
UNDER THE NATIONAL LABOR RELATIONS ACT.—
Nothing in this section shall be construed as permit-
ting conduct prohibited under the National Labor
Relations Act or under any other federal, State, or 
local collective bargaining law. 
‘‘(h) REGULATIONS.—The Secretary shall promul-
gate such regulations as are appropriate and necessary to 
implement this Act. 
‘‘(i) DEFINITIONS.—For purposes of this section—
‘‘(1) the term ‘participating hospital’ means a 
hospital that has entered into a provider agreement 
under section 1866; 
‘‘(2) the term ‘registered nurse’ means an indi-
vidual who has been granted a license to practice as 
a registered nurse in at least one State; 
‘‘(3) the term ‘unit’ of a hospital is an organi-
zational department or separate geographic area of 
a hospital, such as a burn unit, a labor and delivery 
room, a post-anesthesia service area, an emergency 
department, an operating room, a pediatric unit, a 
step-down or intermediate care unit, a specialty care 
unit, a telemetry unit, a general medical care unit, 
a subacute care unit, and a transitional inpatient 
care unit; 
‘‘(4) a ‘shift’ is a scheduled set of hours or duty 
period to be worked at a participating hospital; and
‘‘(5) a ‘person’ includes one or more individ-
uals, associations, corporations, unincorporated or-
ganizations or labor unions.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall become effective on January 1, 2006.
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