Title: Nursing Home CARE Act
Policy area: Health

Summary:
Nursing Home Comfortable Air Ready for Emergencies Act or the Nursing Home CARE Act
This bill (1) provides statutory authority for certain emergency-preparedness requirements applicable to skilled-nursing facilities and nursing-facility providers and suppliers under the Medicare and Medicaid programs, (2) establishes a loan program to assist such facilities in complying with the requirements, and (3) otherwise revises provisions regarding the emergency preparedness of such facilities.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4704 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4704

To amend titles XVIII and XIX of the Social Security Act to codify the 
 emergency preparedness final rule for skilled nursing facilities and 
 nursing facilities as conditions of participation under the Medicare 
             and Medicaid programs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 20, 2017

  Ms. Wasserman Schultz (for herself and Mr. Walberg) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, 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 concerned

_______________________________________________________________________

                                 A BILL


 
To amend titles XVIII and XIX of the Social Security Act to codify the 
 emergency preparedness final rule for skilled nursing facilities and 
 nursing facilities as conditions of participation under the Medicare 
             and Medicaid programs, 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 ``Nursing Home Comfortable Air Ready 
for Emergencies Act'' or the ``Nursing Home CARE Act''.

SEC. 2. CODIFYING EMERGENCY PREPAREDNESS RULE FOR SKILLED NURSING 
              FACILITIES AND NURSING FACILITIES AS CONDITIONS OF 
              PARTICIPATION UNDER MEDICARE AND MEDICAID PROGRAMS.

    (a) Medicare.--Section 1819(a) of the Social Security Act (42 
U.S.C. 1395i-3(a)) is amended--
            (1) in paragraph (2), by striking at the end ``and'';
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and'';
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) beginning not later than the date of the enactment of 
        this paragraph--
                    ``(A) meets the emergency preparedness requirements 
                applicable to skilled nursing facilities under the 
                final rule `Medicare and Medicaid Programs; Emergency 
                Preparedness Requirements for Medicare and Medicaid 
                Participating Providers and Suppliers' as published by 
                the Centers for Medicare & Medicaid Services on 
                September 16, 2016 (81 Fed. Reg. 63859); and
                    ``(B) has in place alternative sources of energy 
                capable of powering heating, ventilation, and air 
                conditioning systems for at least 96 hours after a 
                catastrophic natural disaster.''; and
            (4) by adding at the end the following:
``Nothing in paragraph (4)(B) shall be construed to require a skilled 
nursing facility to continuously maintain a supply of fuel on its 
premise, as long as such facility is able to demonstrate to the 
Secretary the ability of the facility to obtain any fuel necessary to 
satisfy such paragraph.''.
    (b) Medicaid.--Section 1919(a) of the Social Security Act (42 
U.S.C. 1396r(a)) is amended--
            (1) in paragraph (2), by striking at the end ``and'';
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and'';
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) beginning not later than the date of the enactment of 
        this paragraph--
                    ``(A) meets the emergency preparedness requirements 
                applicable to nursing facilities under the final rule 
                `Medicare and Medicaid Programs; Emergency Preparedness 
                Requirements for Medicare and Medicaid Participating 
                Providers and Suppliers' as published by the Centers 
                for Medicare & Medicaid Services on September 16, 2016 
                (81 Fed. Reg. 63859); and
                    ``(B) has in place alternative sources of energy 
                capable of powering heating, ventilation, and air 
                conditioning systems for at least 96 hours after a 
                catastrophic natural disaster.''; and
            (4) by adding at the end the following new sentence:
``Nothing in paragraph (4)(B) shall be construed to require a nursing 
facility to continuously maintain a supply of fuel on its premise, as 
long as such facility is able to demonstrate to the Secretary the 
ability of the facility to obtain any fuel necessary to satisfy such 
paragraph.''.
    (c) Civil Money Penalties.--
            (1) Increased penalty.--In the case of a determination to 
        impose a civil money penalty under section 1819(h)(2)(B)(ii) of 
        the Social Security Act (42 U.S.C. 1395i-3(h)(2)(B)(ii)) or 
        section 1919(h)(2)(C)(ii) of such Act (42 U.S.C. 
        1396r(h)(2)(C)(ii)), with respect to a violation of paragraph 
        (4) of section 1819(a) of such Act (42 U.S.C. 1395i-3(a)) or of 
        paragraph (4) of section 1919(a) of such Act (42 U.S.C. 
        1396r(a)), as added by subsections (a) and (b), respectively, 
        such penalty shall be three times the amount that would 
        otherwise be imposed pursuant to the interim final rule, 
        relating to the adjustment of civil money penalties for 
        inflation, promulgated by the Department of Health and Human 
        Services on September 6, 2016 (81 Fed. Reg. 61538). Nothing in 
        this paragraph shall be construed as limiting the discretion of 
        the Secretary of Health and Human Services in determining the 
        amount of a civil monetary penalty that would otherwise be 
        imposed before application of this paragraph.
            (2) Additional penalty.--
                    (A) Medicare.--Section 1819(h)(2)(B)(ii) of the 
                Social Security Act (42 U.S.C. 1395i-3(h)(2)(B)(ii)) is 
                amended--
                            (i) in subclause (I), by inserting ``, 
                        subject to subclause (V),'' after ``exceed''; 
                        and
                            (ii) by adding at the end the following new 
                        subclause:
                                    ``(V) Increased penalty.--In the 
                                case of noncompliance described in 
                                subclause (I) of a skilled nursing 
                                facility that results in the death of a 
                                resident of the facility, the Secretary 
                                may impose an additional civil money 
                                penalty under such subclause in an 
                                amount not to exceed $100,000.''.
                    (B) Medicaid.--Section 1919(h)(3)(C)(ii) of the 
                Social Security Act (42 U.S.C. 1396r(h)(3)(C)(ii)) is 
                amended--
                            (i) in subclause (I), by inserting ``, 
                        subject to subclause (V),'' after ``exceed''; 
                        and
                            (ii) by adding at the end the following new 
                        subclause:
                                    ``(V) Increased penalty.--In the 
                                case of noncompliance described in 
                                subclause (I) of a nursing facility 
                                that results in the death of a resident 
                                of the facility, the Secretary may 
                                impose an additional civil monetary 
                                penalty under such subclause in an 
                                amount not to exceed $100,000.''.
            (3) State survey agencies compliance review.--The Secretary 
        of Health and Human Services shall direct State survey 
        agencies, in consultation with emergency preparedness experts, 
        to review findings related to the final rule ``Medicare and 
        Medicaid Programs; Emergency Preparedness Requirements for 
        Medicare and Medicaid Participating Providers and Suppliers'' 
        as published by the Centers for Medicare & Medicaid Services on 
        September 16, 2016 (81 Fed. Reg. 63859) and make a 
        determination of whether a skilled nursing facility or nursing 
        facility is substantially compliant or non-compliant (as 
        defined by the Secretary) with such rule, with special 
        attention given to Ftags E-0001, E-0004, E-0013, E-0020, E-
        0025, E-0036, 0037, and E-0041. If a State survey agency makes 
        a determination of substantial non-compliance for any such 
        facility in a State, the agency shall then inform those 
        facilities of that finding, and request that this be noted as 
        an indicator on Nursing Home Compare.

SEC. 3. LOAN FUND.

    (a) Establishment.--The Secretary of Health and Human Services 
shall, subject to subsection (e), establish a loan program that 
provides loans to qualifying nursing facilities and skilled nursing 
facilities for costs relating to coming into compliance with the 
requirement of paragraph (4) of section 1819(a) of the Social Security 
Act (42 U.S.C. 1395i-3(a)) and paragraph (4) of section 1919(a) of such 
Act (42 U.S.C. 1396r(a)), as added by section 2.
    (b) Application.--No loan may be provided under this section to a 
qualifying nursing facility or skilled nursing facility, except 
pursuant to an application that is submitted and approved in a time, 
manner, and form specified by the Secretary. A loan under this section 
shall be on such terms and conditions and meet such requirements as the 
Secretary determines appropriate.
    (c) Selection.--
            (1) In general.--The Secretary shall establish criteria for 
        selecting among qualifying nursing facilities and skilled 
        nursing facilities that apply for a loan under this section.
            (2) Qualifying facilities.--For purposes of this section, 
        qualifying nursing facilities and skilled nursing facilities 
        are nursing facilities under section 1919 of the Social 
        Security Act (42 U.S.C. 1396r) and skilled nursing facilities 
        under section 1819 of such Act (42 U.S.C. 1395i-3) that--
                    (A) have a monthly rate of less than $6,000 for 
                private rooms; or
                    (B) have fewer than 50 beds.
    (d) Fees.--The Secretary may charge such fees as determined 
appropriate with respect to a loan issued under this section, in an 
amount established annually by the Secretary, as necessary to reduce to 
zero the cost (as defined in section 502 of the Federal Credit Reform 
Act of 1990) to the Department of Health and Human Services of making 
loans under this section, which amounts shall be paid to and retained 
by the Secretary.
    (e) Limitation.--Commitments for loans authorized under this 
section shall not exceed--
            (1) $50,000,000 in fiscal year 2018;
            (2) $50,000,000 in fiscal year 2019; and
            (3) $100,000,000 for the duration of the loan program.

SEC. 4. PRIORITIZATION UNDER ALL-HAZARDS PUBLIC HEALTH EMERGENCY 
              PREPAREDNESS AND RESPONSE PLAN.

    (a) In General.--Section 319C-1(b)(2)(A) of the Public Health 
Service Act (42 U.S.C. 247d-3a(b)(2)(A)) is amended--
            (1) in clause (viii), by striking at the end ``and'';
            (2) in clause (ix), by adding at the end ``and''; and
            (3) by inserting after clause (ix) the following new 
        clause:
                            ``(x) a description of--
                                    ``(I) the measures the entity has 
                                in place prioritizing nursing 
                                facilities and skilled nursing 
                                facilities with respect to public 
                                health emergency preparedness in the 
                                same manner as such plan prioritizes 
                                hospitals, while ensuring that, in 
                                prioritizing nursing facilities, 
                                skilled nursing facilities, and 
                                hospitals, the entity retains the 
                                discretion to prioritize among such 
                                facilities; and
                                    ``(II) information on the plans of 
                                each electric utility company within 
                                the entity's jurisdiction to ensure 
                                that such facilities remain functioning 
                                or return to functioning as soon as 
                                practicable during power outages caused 
                                by natural hazards, including severe 
                                weather events;''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to cooperative agreements awarded on or after the 
date of the enactment of this Act.
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