PREPARE LTC Act
Bill: S.230 | Sponsor: Sen. Menendez, Robert (D-NJ)
Policy area: Health

Summary:
Promoting Restoration of Emergency Preparedness and Advancing Response to Epidemics in Long-Term Care Act or the PREPARE LTC Act
This bill provides statutory authority for certain infection control and emergency preparedness requirements for Medicare skilled nursing facilities and Medicaid nursing facilities, and expands certain requirements to apply to other infectious disease outbreaks beyond COVID-19 (i.e., coronavirus disease 2019).
Specifically, the bill provides statutory authority for regulations that require, and set standards for, infection control programs and emergency preparedness programs in such facilities. The bill requires facilities to report information concerning any infectious disease outbreak that results in a state or national emergency in accordance with the standards for COVID-19 reporting. It also prohibits the Centers for Medicare & Medicaid Services from reducing the frequency of compliance surveys or waiving direct care staffing reports during such outbreaks.
Additionally, the Government Accountability Office must report on deficiencies relating to COVID-19 infection control and direct care staffing requirements for skilled nursing facilities.

To amend titles XVIII and 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, and to prohibit the waiver of 
        certain reporting requirements, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

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 
              FACILITIES AS A REQUIREMENT FOR PARTICIPATION UNDER THE 
              MEDICARE AND MEDICAID PROGRAMS.

    (a) Infection Control Regulations.--
            (1) Medicare.--Section 1819(d)(3) of the Social 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 facility 
                must--''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(B) Application statement.--For purposes of 
                carrying out this paragraph, the Secretary shall apply 
                by reference the provisions of section 483.80 of title 
                42, Code of Federal Regulations (as in effect on the 
                date of the enactment of the Promoting Restoration of 
                Emergency 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 subparagraph (C); and
                            ``(ii) any reference to ventilator capacity 
                        shall be treated as a reference to medical 
                        equipment and supplies critical to the 
                        infectious disease outbreak, including 
                        ventilator capacity.
                    ``(C) Infectious disease outbreak defined.--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 
                        1135(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 declared 
                                by the President pursuant to the 
                                National Emergencies Act or the Robert 
                                T. Stafford Disaster Relief and 
                                Emergency Assistance Act and ending on 
                                the date that is 6 months after the 
                                date on which the declaration pursuant 
                                to the Stafford Act, a Major Disaster 
                                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 
                                outbreak declared by the Secretary 
                                pursuant 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 emergency or major disaster 
                                (as defined 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 Social Security 
        Act (42 U.S.C. 1396r(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 nursing facility 
                must--'' and inserting ``environment.--
                    ``(A) In general.--A nursing facility must--''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(B) Application statement.--For purposes of 
                carrying out this paragraph, the Secretary shall apply 
                by reference the provisions of section 483.80 of title 
                42, Code of Federal Regulations (as in effect on the 
                date of the enactment of the Promoting Restoration of 
                Emergency 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 subparagraph (C); and
                            ``(ii) any reference to ventilator capacity 
                        shall be treated as a reference to medical 
                        equipment and supplies critical to the 
                        infectious disease outbreak, including 
                        ventilator capacity.
                    ``(C) Infectious disease outbreak defined.--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) of such Act (42 U.S.C. 
        1395i-3(d)) is amended by adding at the end the following new 
        paragraph:
            ``(5) Emergency preparedness.--A skilled nursing facility 
        shall meet the requirements applicable to skilled 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 Promoting Restoration of Emergency 
        Preparedness and Advancing Response to Epidemics in Long-Term 
        Care Act).''.
            (2) Medicaid.--Section 1919(d) of such Act (42 U.S.C. 
        1396r(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 
        Promoting 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 section.
    (d) Public Availability of Data on Deficiencies in Infection 
Control and Direct Care Staffing in Skilled Nursing Facilities.--Not 
later than 2 weeks after the beginning of a period of an infectious 
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 described 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 of the enactment of 
this Act), the Administrator of the Centers for Medicare & Medicaid 
Services shall make publicly available on the internet website of the 
Centers for Medicare & Medicaid Services data on deficiencies 
identified during the survey process described under subsection (g) of 
such section 1819, with respect to infection control and direct care 
staffing in a skilled nursing facility (as defined in subsection (a) of 
such section 1819). Such data so posted, with respect to an infectious 
disease outbreak (as so defined), 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) of such Act (42 U.S.C. 
1395i-3(g)(2)(A)(iii)) is amended by adding at the end the following 
new subclause:
                                    ``(III) Prohibition on reducing 
                                frequency of surveys conducted during 
                                an infectious disease outbreak.--The 
                                Secretary shall not reduce the 
                                frequency of surveys conducted under 
                                this section during an infectious 
                                disease outbreak (as defined in 
                                subsection (d)(3)(C)).''.
    (b) Medicaid.--Section 1919(g)(2)(A)(iii) of such Act (42 U.S.C. 
1396r(g)(2)(A)(iii)) is amended 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 conducted under 
                                this section during an infectious 
                                disease outbreak (as defined in section 
                                1819(d)(3)(C)).''.

SEC. 4. PROHIBITION ON WAIVING SUBMISSIONS OF DIRECT 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 following 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 sentence: ``The 
        Secretary shall not waive the requirements 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-19 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 direct 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).

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.
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