I 
116TH CONGRESS 
1ST SESSION H. R. 4468 
To amend titles XVIII and XIX of the Social Security Act with respect 
to nursing facility requirements, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 24, 2019 
Mr. EVANS (for himself and Mr. ESTES) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
with respect to nursing facility 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, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Nursing Home Work-
force Quality Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Nursing facilities are an integral component 
of the continuum of care for Medicare and Medicaid 
patients. 
(2) Many nursing facilities have in-house edu-
cational programs approved by the Centers for Medi-
care & Medicaid Services to train individuals as cer-
tified nursing aides to provide extensive, direct care. 
(3) The ability to provide this training is crit-
ical for nursing facilities to ensure that— 
(A) residents receive the highest quality 
care; 
(B) caregivers are trained on the most 
timely best practices and clinical standards; and 
(C) facilities can— 
(i) sustain appropriate staffing levels; 
and 
(ii) recruit and retain qualified staff. 
SEC. 3. TRAINING AND COMPETENCY EVALUATION PRO-
GRAMS. 
(a) MEDICARE.—Section 1819 of the Social Security 
Act (42 U.S.C. 1395i–3) is amended— 
(1) in subsection (f)(2)— 
(A) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subpara-
graph (B)(iii)(I))’’; 
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a nurse aide competency evaluation pro-
gram offered by or in a skilled nursing fa-
cility if such facility— 
‘‘(I) has been assessed a civil 
monetary penalty under subsection 
(h)(2)(B)(ii) 
or 
section 
1919(h)(2)(A)(ii) of not less than 
$10,697 for providing substandard 
quality of care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
skilled nursing facility that all deficiencies 
for which the civil monetary penalty de-
scribed in clause (i)(I) was assessed have 
been remedied. For purposes of rescinding 
disapproval under the previous sentence, 
the Secretary may require additional over-
sight of the skilled nursing facility for a 
period not to exceed the period of dis-
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approval imposed under clause (i) with re-
spect to such facility.’’; and 
(2) in subsection (h)(2)(B)(ii)(I), by striking 
‘‘$10,000’’ and inserting ‘‘$21,393’’. 
(b) MEDICAID.—Section 1919 of the Social Security 
Act (42 U.S.C. 1396r) is amended— 
(1) in subsection (f)(2)— 
(A) in subparagraph (A)(iv)(I), by striking 
‘‘(unless the facility is described in subpara-
graph (B)(iii)(I))’’; 
(B) in subparagraph (B)— 
(i) in clause (i), by inserting ‘‘and’’ 
after the semicolon; 
(ii) in clause (ii), by striking ‘‘; and’’ 
and inserting a period; 
(iii) by striking clause (iii); and 
(iv) by striking ‘‘A State may not del-
egate (through subcontract or otherwise) 
its responsibility under clause (iii)(II) to 
the nursing facility.’’; 
(C) by striking subparagraphs (C) and 
(D); and 
(D) by adding at the end the following: 
‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN-
ING AND COMPETENCY EVALUATION PROGRAMS 
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AND
NURSE
AIDE
COMPETENCY
EVALUATION 
PROGRAMS.— 
‘‘(i) IN GENERAL.—With respect to a 
State, the Secretary shall, in consultation 
with such State, disapprove, for a period 
not to exceed two years, a nurse aide train-
ing and competency evaluation program or 
a nurse aide competency evaluation pro-
gram offered by or in a nursing facility if 
such facility— 
‘‘(I) has been assessed a civil 
monetary 
penalty 
under 
section 
1819(h)(2)(B)(ii) 
or 
subsection 
(h)(2)(A)(ii) of not less than $10,697 
for providing substandard quality of 
care; and 
‘‘(II) has not, in the determina-
tion of the Secretary, corrected the 
deficiencies in quality of care for 
which such civil monetary penalty was 
assessed. 
‘‘(ii) RESCISSION OF DISAPPROVAL.— 
The Secretary shall rescind a disapproval 
under clause (i) upon demonstration by a 
nursing facility that all deficiencies for 
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which the civil monetary penalty described 
in clause (i)(I) was assessed have been 
remedied. For purposes of rescinding dis-
approval under the previous sentence, the 
Secretary may require additional oversight 
of the nursing facility for a period not to 
exceed the period of disapproval imposed 
under clause (i) with respect to such facil-
ity.’’; and 
(2) in subsection (h)(3)(C)(ii)(I), by striking 
‘‘$10,000’’ and inserting ‘‘$21,393’’. 
(c) REGULATIONS.—Not later than 180 days after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall promulgate regulations as nec-
essary to implement the amendments made by this section. 
(d) APPLICABILITY.— 
(1) IN GENERAL.— 
(A) TIMING
OF
DETERMINATIONS.—The 
amendments made by subsections (a)(1)(D) and 
(b)(1)(D) of this section shall apply only to a 
civil monetary penalty if the relevant covered 
determination was made on or after the date of 
enactment of this Act. 
(B) 
COVERED
DETERMINATION
DE-
FINED.—The term ‘‘covered determination’’ 
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means, with respect to a skilled nursing facility 
or a nursing facility in a State, a determination 
by the State or the Secretary of Health and 
Human Services that the facility has provided 
a substandard quality of care for which a civil 
monetary 
penalty 
described 
in 
section 
1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 
Social Security Act (as such sections have been 
amended by this Act) may be assessed. 
(2) PREVIOUSLY PROHIBITED PROGRAMS.— 
(A) WAIVER.—With respect to a skilled 
nursing facility or a nursing facility subject, on 
the day before the date of enactment of this 
Act, to a prohibition under item (a) of either 
section 
1819(f)(2)(B)(iii)(I) 
or 
section 
1919(f)(2)(B)(iii)(I) of the Social Security Act 
(as in effect on the day before such date of en-
actment), such prohibition shall no longer apply 
to the facility on or after such date of enact-
ment. 
(B) SURVEY
OR
CIVIL
MONETARY
PEN-
ALTY.—With respect to a skilled nursing facil-
ity or a nursing facility subject, on the day be-
fore the date of enactment of this Act, to a pro-
hibition under item (b) or (c) of either section 
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1819(f)(2)(B)(iii)(I) 
or 
section 
1919(f)(2)(B)(iii)(I) of the Social Security Act 
(as in effect on the day before such date of en-
actment), such prohibition shall no longer apply 
to the facility on or after such date of enact-
ment upon a determination by the Secretary of 
Health and Human Services that the facility 
has corrected the issue that resulted in such 
prohibition. 
Æ 
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