mencing not earlier than 10 p.m. nor
later than 12 midnight.’’.
(b) ADJUSTMENT TO PAYMENTS.—
(1) MEDICARE.—Section 1888(e)(4)(G) of such
Act (42 U.S.C. 1395yy(e)(4)(G)) is amended by
adding at the end the following new clause:
‘‘(iv) 
ADJUSTMENT
TO
REFLECT
COSTS OF MINIMUM STAFFING.—The Sec-
retary shall provide for an appropriate ad-
justment to account for the costs attrib-
utable to meeting the minimum staffing re-
quirements of subsections (b)(4)(D) and
(f)(8) of section 1819.’’.
(2) MEDICAID.—Section 1902(a)(13)(A) of
such Act (42 U.S.C. 1396a(a)(13)(A)) is amended—
(A) in clause (iii), by striking the final
‘‘and’’;
(B) in clause (iv), by striking the semi-
colon and inserting ‘‘, and’’; and
(C) by inserting after clause (iv) the fol-
lowing new clause:
‘‘(v) in the case of nursing facilities,
such rates take into account the costs at-
tributable to the requirements of section
1919(b)(4)(D).’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services provided on or after
the date that is two years after the date of enactment of
this Act.
(d) REPORT TO CONGRESS ON ADEQUACY OF PER-
SONNEL TO MEET STAFFING REQUIREMENTS.—Not later
than one year after the date of enactment of this Act, the
Secretary of Health and Human Services shall submit to
the Congress a report regarding the adequacy of personnel
in nursing facilities covered under titles XVIII and XIX
of the Social Security Act to meet the direct care staffing
requirements required under sections 1819(b)(4)(D) and
1919(b)(4)(D) of the Social Security Act (as added by
subsection (a)) and, if inadequate, recommendations on
steps that should be taken to ensure that adequate num-
bers of trained staff are available to meet such require-
ments, including ways to attract and retain such direct
caregiving personnel.
SEC. 3. DISCLOSURE OF STAFFING LEVELS.
(a) 
IN
GENERAL.—Section 
1819(b)(8) 
and
1919(b)(8) of the Social Security Act (42 U.S.C. 1395i–
3(b)(8); 1396r(b)(8)), as added by section 941 of the
Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A–585), as
enacted into law by section 1(a)(6) of Public Law 106–
554, are each amended to read as follows:
‘‘(8) DISCLOSURE OF STAFFING LEVELS.—
‘‘(A) IN GENERAL.—A facility shall con-
spicuously post the notices described in sub-
paragraph (B), in the manner described in sub-
paragraph (C), in each area or unit of the facil-
ity where residents reside.
‘‘(B) NOTICES
DESCRIBED.—Notices re-
ferred to in subparagraph (A) are the following:
‘‘(i) MINIMUM
STAFFING
REQUIRE-
MENTS.—A notice describing the minimum
staffing requirements set forth in sub-
section (b)(4)(D).
‘‘(ii) 
CURRENT
STAFF
INFORMA-
TION.—A notice showing, separately for
each shift in the area or unit of the facility
in which it is posted—
‘‘(I) the name of the direct care
clinical supervisor for that area or
unit;
‘‘(II) the current number of di-
rect caregivers (including licensed
nurses) present on the premises who
perform resident care and the name
and credential or professional title of
each such caregiver;
‘‘(III) the current ratio of resi-
dents to licensed nurses present on
the premises;
‘‘(IV) the current ratio of resi-
dents to direct caregivers (including
licensed nurses) present on the prem-
ises assigned to that area or unit; and
‘‘(V) the current number of resi-
dents of such area or unit.
‘‘(C) MANNER
OF
POSTING; FORMAT
OF
NOTICE.—
‘‘(i) MANNER
OF
POSTING.—Notices
posted under subparagraph (A) shall be
posted adjacent to each other in each area
or unit to which such notices apply in the
facility, and posted in a manner visible and
accessible to residents, their families, care-
givers, and prospective residents of such
facility.
‘‘(ii) FORMAT OF NOTICE.—The Sec-
retary shall develop a uniform format for
the notices referred to in subparagraph (B)
for facilities to carry out the requirements
of this paragraph.
‘‘(D) RECORDKEEPING.—The facility shall
retain records of such notices for not fewer
than two years, and shall make the information
contained in those notices available upon re-
quest.’’.
(b) 
CONFORMING
AMENDMENTS.—Sections
1819(b)(4) and 1919(b)(4) of such Act (42 U.S.C. 1395i–
3(b)(4); 1396r(b)(4)) are each amended in subparagraph
(D)(v), as added by section 2(a) of this Act, by inserting
‘‘and paragraph (8)’’ after ‘‘this subparagraph’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services provided on or after
the date that is two years after the date of enactment of
this Act.
SEC. 4. ADMINISTRATIVE STAFFING REQUIREMENTS.
(a) 
IN
GENERAL.—Sections 
1819(d)(1) 
and
1919(d)(1) of the Social Security Act (42 U.S.C. 1395i–
3(d)(1); 1396r(d)(1)) are each amended by adding at the
end the following new subparagraph:
‘‘(D) ADMINISTRATIVE STAFFING.—A fa-
cility must maintain at least the administrative
staff described in the following clauses: