I 
117TH CONGRESS 
1ST SESSION 
H. R. 828 
To amend title XVIII and title XIX of the Social Security Act to codify 
certain infection control and emergency preparedness regulations, to pro-
hibit a reduction in the frequency of surveys of skilled nursing facilities 
and nursing facilities, to prohibit the waiver of certain reporting require-
ments, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 4, 2021 
Mr. PASCRELL (for himself, Ms. SHERRILL, Mr. PAYNE, Mr. SIRES, Ms. CHU, 
Mr. KILDEE, Mr. PANETTA, and Ms. SA´NCHEZ) introduced the following 
bill; which was referred to the Committee on Ways and Means, and in 
addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To amend title XVIII and title XIX of the Social Security 
Act to codify certain infection control and emergency 
preparedness regulations, to prohibit a reduction in the 
frequency of surveys of skilled nursing facilities and 
nursing facilities, to prohibit the waiver of certain report-
ing requirements, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Promoting Restoration 
of Emergency Preparedness and Advancing Response to 
Epidemics in Long-Term Care Act’’ or the ‘‘PREPARE 
LTC Act’’. 
SEC. 2. CODIFYING INFECTION CONTROL AND EMERGENCY 
PREPAREDNESS REGULATIONS FOR SKILLED 
NURSING FACILITIES AND NURSING FACILI-
TIES AS A REQUIREMENT FOR PARTICIPA-
TION UNDER THE MEDICARE AND MEDICAID 
PROGRAMS. 
(a) INFECTION CONTROL REGULATIONS.— 
(1) MEDICARE.—Section 1819(d)(3) of the So-
cial Security Act (42 U.S.C. 1395i–3(d)(3)) is 
amended— 
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively, and 
moving such clauses 2 ems to the right; 
(B) by striking ‘‘ENVIRONMENT.— A 
skilled nursing facility must—’’ and inserting 
‘‘ENVIRONMENT.— 
‘‘(A) IN GENERAL.—A skilled nursing fa-
cility must—’’; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(B) APPLICATION STATEMENT.—For pur-
poses of carrying out this paragraph, the Sec-
retary shall apply by reference the provisions of 
section 483.80 of title 42, Code of Federal Reg-
ulations (as in effect on the date of the enact-
ment of the Promoting Restoration of Emer-
gency Preparedness and Advancing Response to 
Epidemics in Long-Term Care Act), except in 
applying subsection (g) of such regulation— 
‘‘(i) any reference to COVID-19 shall 
be treated as a reference to an infectious 
disease outbreak, as defined in subpara-
graph (C); and 
‘‘(ii) any reference to ventilator capac-
ity shall be treated as a reference to med-
ical equipment and supplies critical to the 
infectious disease outbreak, including ven-
tilator capacity. 
‘‘(C) INFECTIOUS DISEASE OUTBREAK DE-
FINED.—For purposes of subparagraph (B), 
the term ‘infectious disease outbreak’ means 
any of the following periods: 
‘‘(i) COVID-19 EMERGENCY PERIOD.— 
The emergency period described in section 
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1135(g)(1)(B) of the Social Security Act 
(42 U.S.C. 1320b–5(g)(1)(B)). 
‘‘(ii) OTHER
INFECTIOUS
DISEASE 
OUTBREAK PERIODS.— 
‘‘(I) The period beginning on the 
date a nationwide emergency related 
to a public health emergency is de-
clared pursuant to the Stafford Act, a 
Major Disaster Declaration, or the 
National Emergencies Act and ending 
on the date that is 6 months after the 
date on which the declaration pursu-
ant to the Stafford Act, a Major Dis-
aster Declaration, or the National 
Emergencies Act, as applicable, ends, 
whichever is the latest. 
‘‘(II) The period during which 
there exists a public health emergency 
related to an infectious disease out-
break declared by the Secretary pur-
suant to section 319 of the Public 
Health Service Act. 
‘‘(III) With respect to a skilled 
nursing facility in a State with respect 
to which the Governor has declared an 
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emergency or major disaster (as de-
fined by the State) with respect to an 
infectious disease outbreak, the period 
for which such declaration is in effect 
with respect to such State.’’. 
(2) MEDICAID.—Section 1919(d)(3) of the So-
cial Security Act (42 U.S.C. 1396r(d)(3)) is amend-
ed— 
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively, and 
moving such clauses 2 ems to the right; 
(B) by striking ‘‘ENVIRONMENT.— A nurs-
ing facility must—’’ and inserting ‘‘ENVIRON-
MENT.— 
‘‘(A) IN
GENERAL.—A nursing facility 
must—’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(B) APPLICATION STATEMENT.—For pur-
poses of carrying out this paragraph, the Sec-
retary shall apply by reference the provisions of 
section 483.80 of title 42, Code of Federal Reg-
ulations (as in effect on the date of the enact-
ment of the Promoting Restoration of Emer-
gency Preparedness and Advancing Response to 
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Epidemics in Long-Term Care Act), except in 
applying subsection (g) of such regulation— 
‘‘(i) any reference to COVID-19 shall 
be treated as a reference to an infectious 
disease outbreak, as defined in subpara-
graph (C); and 
‘‘(ii) any reference to ventilator capac-
ity shall be treated as a reference to med-
ical equipment and supplies critical to the 
infectious disease outbreak, including ven-
tilator capacity. 
‘‘(C) INFECTIOUS DISEASE OUTBREAK DE-
FINED.—The term ‘infectious disease outbreak’ 
has the meaning given such term in section 
1819(d)(3)(C).’’. 
(b) EMERGENCY PREPAREDNESS REGULATIONS.— 
(1) MEDICARE.—Section 1819(d) is amended 
by adding at the end the following new paragraph: 
‘‘(5) EMERGENCY
PREPAREDNESS.—A skilled 
nursing facility shall meet the requirements applica-
ble to skilled nursing facilities under the provisions 
of section 483.73 of title 42, Code of Federal Regu-
lations (as in effect on the date of the enactment of 
the Restoring Safety and Transparency for Long- 
Term Care Residents Act).’’. 
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(2) MEDICAID.—Section 1919(d) is amended by 
adding at the end the following new paragraph: 
‘‘(5) EMERGENCY PREPAREDNESS.—A nursing 
facility shall meet the requirements applicable to 
nursing facilities under the provisions of section 
483.73 of title 42, Code of Federal Regulations (as 
in effect on the date of the enactment of the Pro-
moting Restoration of Emergency Preparedness and 
Advancing Response to Epidemics in Long-Term 
Care Act).’’. 
(c) REQUIREMENT TO ISSUE GUIDANCE.—Not later 
than 90 days after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall issue 
guidance to carry out the amendments made by this sec-
tion. 
(d) PUBLIC AVAILABILITY
OF DATA
ON DEFI-
CIENCIES IN INFECTION CONTROL AND DIRECT CARE 
STAFFING IN SKILLED NURSING FACILITIES.—Not later 
than 2 weeks after the beginning of a period of an infec-
tious disease outbreak (as defined in subparagraph (C) of 
subsection (d)(3) of section 1819 of the Social Security 
Act (42 U.S.C. 1395i–3), as added by subsection (a)(1)), 
(or, in the case of the COVID-19 emergency period de-
scribed in section 1135(g)(1)(B) of such Act (42 U.S.C. 
1320b–5(g)(1)(B)), not later than 60 days after the date 
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of the enactment of this Act), the Administrator of the 
Centers for Medicare & Medicaid Services shall make pub-
licly available on the internet website of the Centers for 
Medicare & Medicaid Services data on deficiencies identi-
fied during the survey process described under subsection 
(g) of such section, with respect to infection control and 
direct care staffing in a skilled nursing facility (as defined 
in subsection (a) of such section). Such data so posted, 
with respect to an infectious disease outbreak (as defined 
in subparagraph (C) of such subsection (d)(3)), shall be 
updated every two weeks until the end of the period of 
such outbreak. 
SEC. 3. PROHIBITION ON REDUCING FREQUENCY OF 
STANDARD SURVEYS. 
(a) 
MEDICARE.—Section 
1819(g)(2)(A)(iii) 
is 
amended by adding at the end the following new sub-
clause: 
‘‘(III) PROHIBITION ON REDUC-
ING
FREQUENCY
OF
SURVEYS
CON-
DUCTED DURING AN INFECTIOUS DIS-
EASE
OUTBREAK.—The 
Secretary 
shall not reduce the frequency of sur-
veys conducted under this section dur-
ing an infectious disease outbreak (as 
defined in subsection (d)(3)(C)).’’. 
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(b) MEDICAID.—Section 1919(g)(2)(A)(iii) is amend-
ed by adding at the end the following new subclause: 
‘‘(I) PROHIBITION ON REDUCING 
FREQUENCY OF SURVEYS CONDUCTED 
DURING
AN
INFECTIOUS
DISEASE 
OUTBREAK.—The Secretary shall not 
reduce the frequency of surveys con-
ducted under this section during an 
infectious disease outbreak (as defined 
in section 1819(d)(3)(C)).’’. 
SEC. 4. PROHIBITION ON WAIVING SUBMISSIONS OF DI-
RECT CARE STAFFING INFORMATION. 
Section 1128I(g) of the Social Security Act (42 
U.S.C. 1320a–7j(g)) is amended— 
(1) in paragraph (3), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (4), by striking the period and 
inserting ‘‘; and’’; 
(3) by inserting after paragraph (4) the fol-
lowing new paragraph: 
‘‘(5) shall be submitted not less frequently than 
quarterly, on a schedule specified by the Secretary.’’; 
and 
(4) by adding at the end the following new sen-
tence: ‘‘The Secretary shall not waive the require-
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ments of this subsection in the case of an infectious 
disease 
outbreak 
(as 
defined 
in 
section 
1819(d)(3)(C)).’’. 
SEC. 5. GAO STUDY AND REPORT. 
Not later than one year after the end of the COVID- 
emergency 
period 
(as 
described 
in 
section 
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
1320b–5(g)(1)(B))), the Comptroller General of the 
United States shall submit to the Committee on Ways and 
Means of the House of Representatives and the Committee 
on Finance of the Senate a report analyzing deficiencies 
during such period in infection control measures and di-
rect care staffing requirements for skilled nursing facilities 
(as defined in section 1819(a) of the Social Security Act 
(42 U.S.C. 1395i–3(a))), as reported by the Administrator 
under section 2(d)(1). 
SEC. 6. EFFECTIVE DATE. 
The amendments made by this Act shall apply with 
respect to skilled nursing facilities and nursing facilities 
beginning on the date of the enactment of this Act. 
Æ 
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