I 
111TH CONGRESS 
2D SESSION 
H. R. 6074 
To amend titles XVIII and XIX of the Social Security Act to enhance 
quality under the Medicaid Program through nursing facility survey 
system improvements. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 30, 2010 
Mr. STUPAK introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to enhance quality under the Medicaid Program through 
nursing facility survey system improvements. 
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 ‘‘Enhancing Quality 
through Survey System Improvements Act of 2010’’. 
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SEC. 2. DATA DRIVEN MODERNIZATION OF THE SURVEY 
PROCESS. 
(a) REVIEW OF STATE AND CONTRACTOR SURVEY 
PROCEDURES.— 
(1) MEDICARE.—Section 1819(g)(2)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395i– 
3(g)(2)(A)(i)) is amended— 
(A) by striking ‘‘of’’ before ‘‘not to exceed’’ 
in the second sentence; and 
(B) by striking ‘‘each State’s procedures 
for the scheduling and conduct of standard sur-
veys to assure that the State’’ and inserting 
‘‘the procedures of each State, or other con-
tractor as chosen by the Secretary, for sched-
uling and conducting standard surveys to as-
sure that the State, or other contractor,’’. 
(2) MEDICAID.—Section 1919(g)(2)(A)(i) of the 
Social Security Act (42 U.S.C. 1396r(g)(2)(A)(i)) is 
amended— 
(A) by striking ‘‘of’’ before ‘‘not to exceed’’ 
in the second sentence; and 
(B) by striking ‘‘each State’s procedures 
for the scheduling and conduct of standard sur-
veys to assure that the State’’ and inserting 
‘‘the procedures of each State, or other con-
tractor as chosen by the Secretary, for sched-
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uling and conducting standard surveys to as-
sure that the State, or other contractor,’’. 
(b) FREQUENCY OF SURVEYS OF TOP TIER AND 
OTHER FACILITIES.— 
(1) MEDICARE.—Section 1819(g)(2)(A)(iii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395i– 
3(g)(2)(A)(iii)) is amended— 
(A) by striking subclause (I); 
(B) by redesignating subclause (II) as sub-
clause (III); 
(C) in subclause (III), as so redesignated, 
by striking ‘‘subclause (I)’’ and inserting ‘‘sub-
clauses (I) and (II)’’; and 
(D) by inserting before subclause (III), as 
so redesignated, the following subclauses: 
‘‘(I) SURVEYS OF TOP TIER FA-
CILITIES.—Each skilled nursing facil-
ity in the top tier (as defined by the 
Secretary in regulations) shall be sub-
ject to a complete on-site standard 
survey not later than 36 months after 
the date of the previous standard sur-
vey of such facility conducted under 
this subparagraph. The statewide av-
erage interval between standard sur-
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veys of top tier skilled nursing facili-
ties under this subclause shall not ex-
ceed 39 months. Such facilities will 
also be subject to quarterly off-site re-
view of acuity-adjusted quality indica-
tors (as identified by the Secretary). 
During any year in which a top tier 
skilled nursing facility does not re-
ceive a complete on-site standard sur-
vey, such facility will also be subject 
to an annual half-day on-site review of 
quality of life and safety issues. All 
necessary data in connection with 
such surveys shall be submitted to the 
Secretary by each such top tier skilled 
nursing facility at a time and in such 
a manner as determined by the Sec-
retary. 
‘‘(II) SURVEYS
OF
OTHER
FA-
CILITIES.—Skilled nursing facilities 
not identified in subclause (I) shall be 
subject to a complete standard on-site 
survey not later than 12 months after 
the date of the previous standard sur-
vey of such facility conducted under 
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this subparagraph. The statewide av-
erage interval between standard sur-
veys of such facilities shall not exceed 
15 months. Such facilities also will be 
subject to quarterly off-site review of 
acuity-adjusted quality indicators (as 
identified by the Secretary). All nec-
essary data in connection with such 
surveys shall be submitted to the Sec-
retary by each such facility at a time 
and in such a manner as determined 
by the Secretary.’’. 
(2) MEDICAID.—Section 1919(g)(2)(A)(iii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396r(g)(2)(A)(iii)) is amended— 
(A) by striking subclause (I); 
(B) by redesignating subclause (II) as sub-
clause (III); 
(C) in subclause (III), as so redesignated, 
by striking ‘‘subclause (I)’’ and inserting ‘‘sub-
clauses (I) and (II)’’; and 
(D) by inserting before subclause (III), as 
so redesignated, the following subclauses: 
‘‘(I) SURVEYS OF TOP TIER FA-
CILITIES.—Each nursing facility in 
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the top tier (as defined by the Sec-
retary in regulations) shall be subject 
to a complete on-site standard survey 
not later than 36 months after the 
date of the previous standard survey 
of such facility conducted under this 
subparagraph. The statewide average 
interval between standard surveys of 
top tier nursing facilities under this 
subclause shall not exceed 39 months. 
Such facilities will also be subject to 
quarterly off-site review of acuity-ad-
justed quality indicators (as identified 
by the Secretary). During any year in 
which a top tier nursing facility does 
not receive a complete on-site stand-
ard survey, such facility will also be 
subject to an annual half-day on-site 
review of quality of life and safety 
issues. All necessary data in connec-
tion with such surveys shall be sub-
mitted to the Secretary by each such 
top tier nursing facility at a time and 
in such a manner as determined by 
the Secretary. 
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‘‘(II) SURVEYS
OF
OTHER
FA-
CILITIES.—Nursing facilities not iden-
tified in subclause (I) shall be subject 
to a complete standard on-site survey 
not later than 12 months after the 
date of the previous standard survey 
of such facility conducted under this 
subparagraph. The statewide average 
interval between standard surveys of 
such facilities shall not exceed 15 
months. Such facilities also will be 
subject to quarterly off-site review of 
acuity-adjusted quality indicators (as 
identified by the Secretary). All nec-
essary data in connection with such 
surveys shall be submitted to the Sec-
retary by each such facility at a time 
and in such a manner as determined 
by the Secretary.’’. 
(c) CHANGE IN EFFECTIVE DATES.— 
(1) MEDICARE.—Section 1819(g)(2)(C) of the 
Social Security Act (42 U.S.C. 1395i–3(g)(2)(C)) is 
amended— 
(A) in clause (i)— 
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(i) by inserting ‘‘(I)’’ before ‘‘based on 
a protocol’’; and 
(ii) by striking ‘‘, and’’ and inserting 
‘‘; or 
‘‘(II) with respect to surveys con-
ducted on or after the last day of the 24- 
month period beginning on the date of the 
enactment 
of 
the 
Enhancing 
Quality 
through Survey System Improvements Act 
of 2010, based on a revision of protocol 
under subclause (I) that has been tested 
and validated not later than such last day; 
and’’; and 
(B) in clause (ii), by striking ‘‘such date’’ 
and inserting ‘‘January 1, 1990, or, with re-
spect to surveys conducted on or after the last 
day of the 24-month period beginning on the 
date of the enactment of the Enhancing Quality 
through Survey System Improvements Act of 
2010, by such last day.’’. 
(2) MEDICAID.—Section 1919(g)(2)(C) of the 
Social Security Act (42 U.S.C. 1396r(g)(2)(C)) is 
amended— 
(A) in clause (i)— 
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‘‘(D) CONSISTENCY OF SURVEYS.— 
‘‘(i) IN GENERAL.—Each State shall 
implement programs to measure and re-
duce inconsistency in the application of 
survey results (including the results of 
both health surveys and life safety surveys) 
among surveyors. 
‘‘(ii) SECRETARY
PROVIDES
OVER-
SIGHT.—The Secretary shall take such ac-
tions as necessary to assure that there is 
consistent application, both within States 
and across States, of the survey process 
under this subsection (including the proc-
ess for both health surveys and life safety 
surveys). 
‘‘(iii) APPEALS.—The Secretary will 
assure that there is a fair and timely ap-
peals process for surveys under this sub-
section (including both health surveys and 
life safety surveys) in which each State of-
fice and regional office provides a timely 
resolution of disputes. 
‘‘(iv) REPORT.—The Secretary shall 
report to the Congress annually, by Octo-
ber 30, on the actions taken to ensure the 
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