I
107TH CONGRESS
1ST SESSION
H. R. 118
To establish a program to provide grants to States to test innovative ways
to increase nursing home staff levels, reduce turnover, and improve
quality of care for residents in nursing homes, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 3, 2001
Mr. HOLT 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 provisions as fall within the juris-
diction of the committee concerned
A BILL
To establish a program to provide grants to States to test
innovative ways to increase nursing home staff levels,
reduce turnover, and improve quality of care for resi-
dents in nursing homes, 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 Staff-
ing and Quality Improvement Act of 2001’’.
SEC. 2. GRANTS TO STATES FOR IMPROVEMENTS IN NURS-
ING HOME STAFFING AND QUALITY.
(a) SECRETARY’S AUTHORITY TO AWARD GRANTS.—
The Secretary of Health and Human Services shall estab-
lish a program of competitive grants to States, in accord-
ance with the provisions of this section, for the purpose
of improving the quality of care furnished in nursing
homes operating in the State.
(b) APPLICATIONS AND ELIGIBILITY FOR GRANTS.—
(1) INITIAL APPLICATION.—A State seeking a
grant to conduct a project under this section shall
submit an application containing such information
and assurances as the Secretary of Health and
Human Services may require, including—
(A) a commitment to submit annual re-
ports describing the State’s progress in increas-
ing staffing levels and making other quality im-
provements in nursing homes in the State; and
(B) a description of a plan for evaluation
of the activities carried out under the grant, in-
cluding a plan for measurement of progress to-
ward the goals and objectives of the program,
consistent with the principles of the Govern-
ment Performance and Results Act.
(2) CONSULTATION WITH PUBLIC.—Before sub-
mitting an application for a grant under this section,
a State shall solicit and consider the views of mem-
bers of the public, nursing home residents or their
representatives, and other persons concerned with
the administration of nursing homes within the
State with respect to the design of the proposed
State program.
(3) ELIGIBILITY.—
(A) INITIAL ELIGIBILITY.—A State shall
not be eligible for a grant award under this sec-
tion unless it makes assurances satisfactory to
the Secretary of Health and Human Services
that the skilled nursing facilities (as defined in
section 1819(a) of the Social Security Act (42
U.S.C. 1395i–3(a))) and nursing facilities (as
defined in section 1919(a) of such Act (42
U.S.C. 1396r(a))) within the State will reach or
exceed the minimum staff level described in
subsection (d)(2) within two years after the
date of the enactment of this Act and will main-
tain such level throughout the remainder of the
grant program.
(B) CONTINUING
ELIGIBILITY.—A State
shall not be eligible for the continuation of
grant funding under a multi-year grant under
this section unless the State demonstrates to
the satisfaction of the Secretary of Health and
Human Services that it continues to meet the
requirement described in subparagraph (A) and
has made sufficient progress in meeting the
goals described in its grant application.
(c) USE OF GRANT FUNDS.—Funds received by a
State under this section may be provided to entities in-
cluding nursing homes, labor management partnerships,
and educational institutions, and may be used for any or
all of the following purposes:
(1) To enable a nursing home to recruit addi-
tional nursing staff or to retain existing nursing
staff (including through the use of reasonable finan-
cial incentives or reasonable benefit enhancements).
(2) To increase education and training of nurs-
ing staff (including designing or implementing pro-
grams to promote the career advancement of cer-
tified nurse aides).
(3) To provide bonuses to nursing homes meet-
ing State quality standards or avoiding serious qual-
ity violations for a period of one or more years.
(4) Such other nursing home staffing and qual-
ity improvement initiatives as the Secretary of
Health and Human Services may approve.
(d) DISTRIBUTION OF FUNDS.—
(1) IN GENERAL.—Subject to subsection (b), in
awarding grants under this section, the Secretary of
Health and Human Services shall award no more
than 25 percent of the funds to States in which, as
of the date of the enactment of this section, skilled
nursing facilities and nursing facilities have reached
or exceeded the minimum staff level specified in
paragraph (2) (as determined by the Secretary).
(2) MINIMUM NURSING HOME STAFF LEVEL.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), for purposes of subsection (b) and
paragraph (1), the level specified in this para-
graph for a skilled nursing facility or nursing
facility is a staff level sufficient to ensure that
each resident receives from a certified nurse
aide at least two hours per day of direct care
(including repositioning the resident and chang-
ing wet clothes, assisting with feeding, exercise,
and toileting, and working to enhance a resi-
dent’s independence with respect to activities of
daily living).
(B) SECRETARY’S
AUTHORITY
TO
IN-
CREASE
MINIMUM
STAFF
LEVEL.—The Sec-
retary of Health and Human Services may es-
tablish a minimum staff level that is higher
Nursing Facility Civil Money Penalties Collection
Account established under section 4.
SEC. 3. ENHANCED NURSING FACILITY REPORTING RE-
QUIREMENTS.
(a) MEDICARE.—
(1) SUBMISSION
OF
NURSING
STAFF
LEVEL
DATA TO THE SECRETARY.—Section 1819(b) of the
Social Security Act (42 U.S.C. 1395i–3(b)), as
amended by section 941(a) of the Medicare, Med-
icaid, and SCHIP Benefits Improvement and Pro-
tection Act of 2000 (as enacted into law by section
1(a)(6) of Public Law 106–554), is amended by add-
ing at the end the following new paragraph:
‘‘(9) DATA ON STAFFING LEVELS.—
‘‘(A) 
SUBMISSION
TO
SECRETARY.—A
skilled nursing facility shall submit to the Sec-
retary, in such form and manner and at such
intervals as the Secretary may require, data
with respect to nursing staff of the facility.
Such data shall include the total number of
nursing staff hours furnished during the period
specified by the Secretary (including totals for
each shift worked during such period) by the
facility to residents for which payment is made
under section 1888(e), broken down by total
certified nurse aide hours, total licensed prac-
tical or vocational nurse hours, and total reg-
istered nurse hours, and shall also include the
average wage rate for each class of nursing
staff employed by the facility.
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet site
of the Department of Health and Human Serv-
ices known as Nursing Home Compare the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.’’.
(2) POSTING OF INFORMATION ON NURSING FA-
CILITY STAFFING.—Section 1819(b)(8)(A) of the So-
cial Security Act (42 U.S.C. 1395i–3(b)(8)(A)), as
added by such section 941(a), is amended by strik-
ing ‘‘for each shift’’ and inserting ‘‘for each nursing
unit of the facility and for each shift’’.
(3) INFORMATION CONCERNING PATIENT CLAS-
SIFICATION.—Section 1819(b)(4)(C) of the Social
Security Act (42 U.S.C. 1395i–3(b)(4)(C)) is
amended by adding at the end the following new
clause:
‘‘(iii) 
INFORMATION
CONCERNING
RESIDENTS.—The skilled nursing facility
shall provide the Secretary, in such form
and manner and at such intervals as the
Secretary may require, a classification of
all residents of the skilled nursing facility
that accords with the patient classification
system 
described 
in 
section
1888(e)(4)(G)(i), or such successor system
as the Secretary may identify.’’.
(b) MEDICAID.—
(1) IN GENERAL.—Section 1919(b) of the So-
cial Security Act (42 U.S.C. 1396r(b)), as amended
by section 941(b) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of
2000 (as enacted into law by section 1(a)(6) of Pub-
lic Law 106–554), is amended by adding at the end
the following new paragraph:
‘‘(9) DATA ON STAFFING LEVELS.—
‘‘(A) 
SUBMISSION
TO
SECRETARY.—A
nursing facility shall submit to the Secretary, in
such form and manner and at such intervals as
the Secretary may require, data with respect to
nursing staff of the facility. Such data shall in-
clude the total number of nursing staff hours
furnished during the period specified by the
Secretary (including totals for each shift
worked during such period) by the facility to
residents for which payment is made under this
title, broken down by total certified nurse aide
hours, total licensed practical or vocational
nurse hours, and total registered nurse hours,
and shall also include the average wage rate for
each class of nursing staff employed by the fa-
cility.
‘‘(B) PUBLICATION.—The Secretary shall
provide for the publication on the Internet Site
of the Department of Health and Human Serv-
ices known as Nursing Home Compare the fa-
cility-specific nursing staff information collected
pursuant to subparagraph (A). The Secretary
shall update such information periodically.’’.
(2) POSTING OF INFORMATION ON NURSING FA-
CILITY STAFFING.—Section 1919(b)(8)(A) of the So-
cial Security Act (42 U.S.C. 1396r(b)(8)(A)), as
added by such section 941(b), is amended by strik-
ing ‘‘for each shift’’ and inserting ‘‘for each nursing
unit of the facility and for each shift’’.
(3) INFORMATION CONCERNING PATIENT CLAS-
SIFICATION.—Section 1919(b)(4)(C) of the Social
Security Act (42 U.S.C. 1396r(b)(4)(C)) is amended
by adding at the end the following new clause:
‘‘(iv) 
INFORMATION
CONCERNING
RESIDENTS.—The nursing facility shall
provide the Secretary, in such form and
manner and at such intervals as the Sec-
retary may require, a classification of all
residents of the nursing facility that ac-
cords with the patient classification system
described in section 1888(e)(4)(G)(i), or
such successor system as the Secretary
may identify.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date that is one year
after the date of the enactment of this Act.
SEC. 4. NURSING FACILITY CIVIL MONEY PENALTY COL-
LECTIONS.
(a) ESTABLISHMENT OF NURSING FACILITY CIVIL
MONEY
PENALTY
COLLECTIONS
ACCOUNT.—Section
1128A of the Social Security Act (42 U.S.C. 1320a–7a)
is amended by adding at the end the following new sub-
section:
‘‘(o) ESTABLISHMENT OF NURSING FACILITY CIVIL
MONEY PENALTY COLLECTIONS ACCOUNT.—There is
hereby established an account to be known as the ‘Nursing
Facility Civil Money Penalties Collection Account’ (here-
after in this subsection referred to as the ‘Account’). Not-
withstanding any other provision of law, there shall be de-
posited into the Account the Secretary’s share of any civil
monetary penalties collected under sections 1819 and
1919, all such amounts to be available without fiscal year
limitation for repaying the Secretary’s share of amounts
owed to skilled nursing facilities or nursing facilities pur-
suant to the final sentence of sections 1819(h)(2)(B)(ii)
and 1919(h)(2)(B)(ii), and for awarding grants under sec-
tion 2 of the Nursing Home Staffing and Quality Improve-
ment Act of 2000.’’.
(b) 
AUTHORITY
TO
COLLECT
CMPS
IMME-
DIATELY.—
(1) MEDICARE.—Section 1819(h)(2)(B)(ii) of
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395i–
3(h)(2)(B)(ii)) is amended by inserting before the
final period ‘‘, except that, notwithstanding section
1128A(c)(2) or any other provision of law, the Sec-
retary, upon determining that a civil money penalty
should be imposed against a skilled nursing facility
pursuant to this paragraph, shall take immediate ac-
tion to collect such penalty (except where the Sec-
retary finds that such action could jeopardize the
health or welfare of residents of the skilled nursing
facility). In collecting such penalty, the Secretary
may deduct the amount of the penalty from amounts
otherwise payable to the facility under this title or
take such other actions as the Secretary considers
appropriate. If the Secretary’s imposition of a pen-
alty under this paragraph is set aside, in whole or
in part, as a result of a hearing under section
1128A(c)(2) (or an appeal therefrom) or by a court
of competent jurisdiction, and the Secretary elects
not to pursue an appeal of such judgment; or has
exhausted all appeals, the Secretary shall repay any
amount owed to the skilled nursing facility with ac-
crued interest’’.
(2) MEDICAID.—Section 1919(h)(3)(B)(ii) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1396r(h)(3)(B)(ii)) is amended by inserting before
the final period ‘‘, except that, notwithstanding sec-
tion 1128A(c)(2) or any other provision of law, the
Secretary, upon determining that a civil money pen-
alty should be imposed against a nursing facility
pursuant to this paragraph, shall take immediate ac-
tion to collect the penalty (except where the Sec-
retary finds that such action could jeopardize the
health or welfare of residents of the nursing facility).
In collecting such penalty, the Secretary may direct
the State to deduct the amount of the penalty from
amounts otherwise payable to the nursing facility
under this title or take such other actions as the
Secretary, in consultation with the State, considers
appropriate. If the Secretary’s imposition of a pen-
alty under this paragraph is set aside, in whole or
in part, as a result of a hearing under section
1128A(c)(2) (or an appeal therefrom) or by a court
of competent jurisdiction, and the Secretary elects
not to pursue an appeal of such judgment, or has
exhausted all appeals, the Secretary shall repay, or
shall direct the State to repay, any amount owed to
the nursing facility with accrued interest’’.
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