1950 
cessor form), complaint investigation 
reports, the facility’s plan of correc-
tion, and such other information that 
the State or the Secretary considers 
useful in assisting the public to assess 
the quality of long term care options 
and the quality of care provided by 
individual facilities;’’. 
(3) DEFINITIONS.—In this subsection: 
(A) NURSING
FACILITY.—The term 
‘‘nursing facility’’ has the meaning 
given such term in section 1919(a) of 
the Social Security Act (42 U.S.C. 
1396r(a)). 
(B) SECRETARY.—The term ‘‘Sec-
retary’’ means the Secretary of Health 
and Human Services. 
(C) SKILLED
NURSING
FACILITY.— 
The term ‘‘skilled nursing facility’’ 
has the meaning given such term in 
section 1819(a) of the Social Security 
Act (42 U.S.C. 1395i–3(a)). 
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1951 
SEC. 1414. REPORTING OF EXPENDITURES. 
Section 1888 of the Social Security Act (42 
U.S.C. 1395yy) is amended by adding at the 
end the following new subsection: 
‘‘(f) REPORTING OF DIRECT CARE EXPENDI-
TURES.— 
‘‘(1) IN
GENERAL.—For cost reports 
submitted under this title for cost report-
ing periods beginning on or after the 
date that is 3 years after the date of the 
enactment of this subsection, skilled 
nursing facilities shall separately report 
expenditures for wages and benefits for 
direct care staff (breaking out (at a min-
imum) registered nurses, licensed profes-
sional nurses, certified nurse assistants, 
and other medical and therapy staff). 
‘‘(2) MODIFICATION OF FORM.—The Sec-
retary, in consultation with private sec-
tor accountants experienced with skilled 
nursing facility cost reports, shall rede-
sign such reports to meet the require-
ment of paragraph (1) not later than 1 
year after the date of the enactment of 
this subsection. 
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1952 
‘‘(3) CATEGORIZATION
BY
FUNCTIONAL 
ACCOUNTS.—Not later than 30 months 
after the date of the enactment of this 
subsection, the Secretary, working in 
consultation with the Medicare Payment 
Advisory Commission, the Inspector Gen-
eral of the Department of Health and 
Human Services, and other expert parties 
the Secretary determines appropriate, 
shall take the expenditures listed on cost 
reports, as modified under paragraph (1), 
submitted by skilled nursing facilities 
and categorize such expenditures, re-
gardless of any source of payment for 
such expenditures, for each skilled nurs-
ing facility into the following functional 
accounts on an annual basis: 
‘‘(A) Spending on direct care serv-
ices (including nursing, therapy, and 
medical services). 
‘‘(B) Spending on indirect care 
(including housekeeping and dietary 
services). 
‘‘(C) 
Capital 
assets 
(including 
building and land costs). 
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bajohnson on DSK2BSOYB1PROD with BILLS
1953 
‘‘(D) 
Administrative 
services 
costs. 
‘‘(4) AVAILABILITY OF INFORMATION SUB-
MITTED.—The Secretary shall establish 
procedures to make information on ex-
penditures submitted under this sub-
section readily available to interested 
parties upon request, subject to such re-
quirements as the Secretary may specify 
under the procedures established under 
this paragraph.’’. 
SEC. 1415. STANDARDIZED COMPLAINT FORM. 
(a) SKILLED NURSING FACILITIES.— 
(1) DEVELOPMENT BY THE SECRETARY.— 
Section 1819(f) of the Social Security Act 
(42 U.S.C. 1395i–3(f)), as amended by sec-
tion 1413(a)(3), is amended by adding at 
the end the following new paragraph: 
‘‘(9) STANDARDIZED COMPLAINT FORM.— 
The Secretary shall develop a standard-
ized complaint form for use by a resident 
(or a person acting on the resident’s be-
half) in filing a complaint with a State 
survey and certification agency and a 
State long-term care ombudsman pro-
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bajohnson on DSK2BSOYB1PROD with BILLS
1954 
gram with respect to a skilled nursing fa-
cility.’’. 
(2) 
STATE
REQUIREMENTS.—Section 
1819(e) of the Social Security Act (42 
U.S.C. 1395i–3(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(6) COMPLAINT
PROCESSES
AND
WHIS-
TLE-BLOWER PROTECTION.— 
‘‘(A) COMPLAINT FORMS.—The State 
must make the standardized com-
plaint form developed under sub-
section (f)(9) available upon request 
to— 
‘‘(i) a resident of a skilled 
nursing facility; 
‘‘(ii) any person acting on the 
resident’s behalf; and 
‘‘(iii) any person who works at 
a skilled nursing facility or is a 
representative of such a worker. 
‘‘(B) COMPLAINT RESOLUTION PROC-
ESS.—The State must establish a com-
plaint resolution process in order to 
ensure that a resident, the legal rep-
resentative of a resident of a skilled 
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bajohnson on DSK2BSOYB1PROD with BILLS
1955 
nursing facility, or other responsible 
party is not retaliated against if the 
resident, legal representative, or re-
sponsible party has complained, in 
good faith, about the quality of care 
or other issues relating to the skilled 
nursing facility, that the legal rep-
resentative of a resident of a skilled 
nursing facility or other responsible 
party is not denied access to such 
resident 
or 
otherwise 
retaliated 
against if such representative party 
has complained, in good faith, about 
the quality of care provided by the fa-
cility or other issues relating to the 
facility, and that a person who works 
at a skilled nursing facility is not re-
taliated against if the worker has 
complained, in good faith, about qual-
ity of care or services or an issue re-
lating to the quality of care or serv-
ices provided at the facility, whether 
the 
resident, 
legal 
representative, 
other responsible party, or worker 
used the form developed under sub-
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bajohnson on DSK2BSOYB1PROD with BILLS
1956 
section (f)(9) or some other method 
for submitting the complaint. Such 
complaint resolution process shall in-
clude— 
‘‘(i) procedures to assure accu-
rate tracking of complaints re-
ceived, including notification to 
the complainant that a complaint 
has been received; 
‘‘(ii) procedures to determine 
the likely severity of a complaint 
and for the investigation of the 
complaint; 
‘‘(iii) deadlines for responding 
to a complaint and for notifying 
the complainant of the outcome of 
the investigation; and 
‘‘(iv) 
procedures 
to 
ensure 
that the identity of the complain-
ant will be kept confidential. 
‘‘(C) 
WHISTLEBLOWER
PROTEC-
TION.— 
‘‘(i) PROHIBITION
AGAINST
RE-
TALIATION.—No person who works 
at a skilled nursing facility may 
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bajohnson on DSK2BSOYB1PROD with BILLS
1957 
be penalized, discriminated, or re-
taliated against with respect to 
any aspect of employment, includ-
ing discharge, promotion, com-
pensation, terms, conditions, or 
privileges of employment, or have 
a contract for services termi-
nated, because the person (or 
anyone acting at the person’s re-
quest) complained, in good faith, 
about the quality of care or serv-
ices provided by a nursing facility 
or about other issues relating to 
quality of care or services, wheth-
er 
using 
the 
form 
developed 
under subsection (f)(9) or some 
other method for submitting the 
complaint. 
‘‘(ii) 
RETALIATORY
REPORT-
ING.—A skilled nursing facility 
may not file a complaint or a re-
port against a person who works 
(or has worked at the facility with 
the 
appropriate 
State 
profes-
sional 
disciplinary 
agency 
be-
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bajohnson on DSK2BSOYB1PROD with BILLS
1958 
cause the person (or anyone act-
ing at the person’s request) com-
plained in good faith, as de-
scribed in clause (i). 
‘‘(iii) COMMENCEMENT
OF
AC-
TION.—Any person who believes 
the person has been penalized, 
discriminated 
, 
or 
retaliated 
against or had a contract for serv-
ices terminated in violation of 
clause (i) or against whom a com-
plaint has been filed in violation 
of clause (ii) may bring an action 
at law or equity in the appro-
priate district court of the United 
States, which shall have jurisdic-
tion over such action without re-
gard 
to 
the 
amount 
in 
con-
troversy or the citizenship of the 
parties, and which shall have ju-
risdiction to grant complete re-
lief, including, but not limited to, 
injunctive relief (such as rein-
statement, compensatory damages 
(which may include reimburse-
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bajohnson on DSK2BSOYB1PROD with BILLS
1959 
ment of lost wages, compensation, 
and benefits), costs of litigation 
(including 
reasonable 
attorney 
and expert witness fees), exem-
plary 
damages 
where 
appro-
priate, and such other relief as 
the court deems just and proper. 
‘‘(iv) RIGHTS
NOT
WAIVABLE.— 
The rights protected by this para-
graph may not be diminished by 
contract or other agreement, and 
nothing in this paragraph shall be 
construed to diminish any greater 
or additional protection provided 
by Federal or State law or by con-
tract or other agreement. 
‘‘(v) REQUIREMENT TO POST NO-
TICE
OF
EMPLOYEE
RIGHTS.—Each 
skilled nursing facility shall post 
conspicuously in an appropriate 
location a sign (in a form speci-
fied by the Secretary) specifying 
the rights of persons under this 
paragraph and including a state-
ment that an employee may file a 
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1960 
complaint 
with 
the 
Secretary 
against a skilled nursing facility 
that violates the provisions of this 
paragraph and information with 
respect to the manner of filing 
such a complaint. 
‘‘(D) 
RULE
OF
CONSTRUCTION.— 
Nothing in this paragraph shall be 
construed as preventing a resident of 
a skilled nursing facility (or a person 
acting on the resident’s behalf) from 
submitting a complaint in a manner 
or format other than by using the 
standardized complaint form devel-
oped under subsection (f)(9) (includ-
ing submitting a complaint orally). 
‘‘(E) GOOD
FAITH
DEFINED.—For 
purposes of this paragraph, an indi-
vidual shall be deemed to be acting in 
good faith with respect to the filing of 
a complaint if the individual reason-
ably believes— 
‘‘(i) the information reported 
or disclosed in the complaint is 
true; and 
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bajohnson on DSK2BSOYB1PROD with BILLS
1961 
‘‘(ii) the violation of this title 
has occurred or may occur in re-
lation to such information.’’. 
(b) NURSING FACILITIES.— 
(1) DEVELOPMENT BY THE SECRETARY.— 
Section 1919(f) of the Social Security Act 
(42 U.S.C. 1395i–3(f)), as amended by sec-
tion 1413(b), is amended by adding at the 
end the following new paragraph: 
‘‘(11) 
STANDARDIZED
COMPLAINT 
FORM.—The Secretary shall develop a 
standardized complaint form for use by a 
resident (or a person acting on the resi-
dent’s behalf) in filing a complaint with a 
State survey and certification agency and 
a State long-term care ombudsman pro-
gram with respect to a nursing facility.’’. 
(2) 
STATE
REQUIREMENTS.—Section 
1919(e) of the Social Security Act (42 
U.S.C. 1395i–3(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) COMPLAINT
PROCESSES
AND
WHIS-
TLEBLOWER PROTECTION.— 
‘‘(A) COMPLAINT FORMS.—The State 
must make the standardized com-
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bajohnson on DSK2BSOYB1PROD with BILLS
1962 
plaint form developed under sub-
section (f)(11) available upon request 
to— 
‘‘(i) a resident of a nursing fa-
cility; 
‘‘(ii) any person acting on the 
resident’s behalf; and 
‘‘(iii) any person who works at 
a nursing facility or a representa-
tive of such a worker. 
‘‘(B) COMPLAINT RESOLUTION PROC-
ESS.—The State must establish a com-
plaint resolution process in order to 
ensure that a resident, the legal rep-
resentative of a resident of a nursing 
facility, or other responsible party is 
not retaliated against if the resident, 
legal representative, or responsible 
party has complained, in good faith, 
about the quality of care or other 
issues relating to the nursing facility, 
that the legal representative of a resi-
dent of a nursing facility or other re-
sponsible party is not denied access 
to such resident or otherwise retali-
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