Title: Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020
Policy area: Health

Summary:
Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020
This bill establishes a series of requirements relating to the quality of care provided in nursing and long-term care facilities, specifically with respect to COVID-19 (i.e., coronavirus disease 2019) and elder abuse, and also modifies and extends several elder justice programs and initiatives.
Among other things, the bill (1) requires a portion of any funds received through COVID-19 appropriations to be used for personal protective equipment and testing in Medicare skilled nursing facilities (SNFs), Medicaid nursing facilities (NFs), and long-term care facilities, including assisted living facilities, and for specialized strike teams to address outbreaks in SNFs and NFs; (2) requires SNFs, NFs, and long-term care facilities to report COVID-19 cases and deaths, as well as unrelated deaths, from January 1, 2020, onwards and on a continual daily basis; and (3) requires a specified portion of COVID-19 appropriations to be directed to state and tribal agencies responsible for adult protective services.
Additionally, the bill reauthorizes through FY2023 (1) grants to support state long-term care ombudsman programs, (2) elder abuse forensic centers, and (3) grants to support state adult protective services.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4182 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4182

To provide nursing homes with resources for responding to the COVID-19 
 public health emergency to protect the health and safety of residents 
   and workers, to reauthorize funding for programs under the Elder 
              Justice Act of 2009, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              July 2, 2020

Mr. Grassley (for himself, Mr. Daines, and Ms. McSally) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
To provide nursing homes with resources for responding to the COVID-19 
 public health emergency to protect the health and safety of residents 
   and workers, to reauthorize funding for programs under the Elder 
              Justice Act of 2009, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Emergency Support 
for Nursing Homes and Elder Justice Reform Act of 2020''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Providing resources for personal protective equipment and 
                            testing.
Sec. 4. Promoting transparency about COVID-19-related cases and 
                            fatalities and staffing levels in long-term 
                            care facilities.
Sec. 5. Establishing strike teams.
Sec. 6. Promoting identification and reporting of potential abuse or 
                            neglect in long-term care facilities.
Sec. 7. Promoting quality of life of long-term care facility residents 
                            through televisitation.
Sec. 8. Upgrading nursing home compare and the Five-Star rating system.
Sec. 9. Enhancing Federal oversight of nursing homes participating in 
                            Medicare or Medicaid.
Sec. 10. Continuing funding for programs to prevent and prosecute elder 
                            abuse and neglect.
Sec. 11. Increasing resources to investigate abuse or neglect and 
                            extend services to victims.
Sec. 12. Protecting Americans with dementia.
Sec. 13. Reducing racial and ethnic disparities in long-term care 
                            facilities.
Sec. 14. Establishing reciprocity with Drug Enforcement Administration 
                            to address improper prescribing of 
                            controlled substances.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) COVID-19 public health emergency period.--The term 
        ``COVID-19 public health emergency period'' means the period 
        beginning on the first day of the emergency period defined in 
        paragraph (1)(B) of section 1135(g) of the Social Security Act 
        (42 U.S.C. 1320b-5(g)) and ending on the last day of the 
        calendar quarter in which the last day of such emergency period 
        occurs.
            (2) Indian tribe.--The term ``Indian tribe'' has the 
        meaning given that term in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
            (3) Long-term care facility.--The term ``long-term care 
        facility'' has the meaning given that term in section 2011(15) 
        of the Social Security Act (42 U.S.C. 1397j(15)).
            (4) Nursing facility.--The term ``nursing facility'' has 
        the meaning given that term in section 1919(a) of the Social 
        Security Act (42 U.S.C. 1396r(a)).
            (5) Participating provider.--The term ``participating 
        provider'' means a skilled nursing facility or a nursing 
        facility that has been assigned a national provider identifier 
        number by the Secretary and has executed an agreement to 
        participate in the Medicare program established under title 
        XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or 
        the Medicaid program established under title XIX of such Act 
        (42 U.S.C. 1396 et seq.).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) Skilled nursing facility.--The term ``skilled nursing 
        facility'' has the meaning given that term in section 1819(a) 
        of the Social Security Act (42 U.S.C. 1395i-3(a)).
            (8) State.--Except as otherwise provided, the term 
        ``State'' has the meaning given such term for purposes of title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
            (9) Tribal organization.--The term ``tribal organization'' 
        has the meaning given that term in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        5304).
            (10) Other terms.--Each other term has the meaning given 
        the term for purposes of subtitle B of title XX of the Social 
        Security Act (42 U.S.C. 1397j et seq.).

SEC. 3. PROVIDING RESOURCES FOR PERSONAL PROTECTIVE EQUIPMENT AND 
              TESTING.

    (a) In General.--A portion of any payments received or funds made 
available on or after July 1, 2020, for responding to the public health 
or fiscal impacts related to the Coronavirus Disease (COVID-19) under 
Federal legislation enacted on or after that date which primarily makes 
appropriations for the coronavirus response and related activities, 
shall be used for the purposes described in subsection (b), 
notwithstanding the original purpose for which the amounts were 
appropriated to make such payments or funds available, or any other 
provision of law restricting the use of such payments or funds.
    (b) Purposes Described.--The purposes described in this subsection 
are the following:
            (1) To establish and maintain a supply of personal 
        protective equipment at a level that is sufficient, as 
        determined by the Centers for Disease Control and Prevention, 
        in collaboration with the Secretary and the Administrator of 
        the Federal Emergency Management Agency, to provide for the 
        safety of--
                    (A) personnel employed by participating providers 
                and long-term care facilities, including licensed 
                assisted living or residential care facilities, during 
                the COVID-19 public health emergency period; and
                    (B) State survey agency personnel who conduct 
                audits or investigations of participating providers and 
                long-term care facilities, including licensed assisted 
                living or residential care facilities, during the 
                COVID-19 public health emergency period.
            (2) To provide regular COVID-19 testing for personnel and 
        residents of participating providers and long-term care 
        facilities, including licensed assisted living or residential 
        care facilities (at no cost to such personnel and residents), 
        at a level that is sufficient, based on the needs of the 
        locality and its circumstances, as determined by the Director 
        of the Centers for Disease Control and Prevention, in 
        collaboration with the Secretary and the Administrator of the 
        Federal Emergency Management Agency, to provide for the safety 
        of such personnel and residents. A State shall provide such 
        testing during the 90-day period that begins on the date on 
        which the Secretary, after consultation with the Director of 
        the Centers for Disease Control and Prevention, determines the 
        State is able to conduct such testing at such level and 
        notifies the State of the date on which the testing period is 
        to start.
    (c) Standards and Guidance.--Not later than 30 days after the date 
of enactment of this Act, the Director of the Centers for Disease 
Control and Prevention, in collaboration with the Secretary and the 
Administrator of the Federal Emergency Management Agency, shall issue 
detailed guidance to States on compliance with the requirements of this 
section as it relates to participating providers and long-term care 
facilities, including licensed assisted living or residential care 
facilities.

SEC. 4. PROMOTING TRANSPARENCY ABOUT COVID-19-RELATED CASES AND 
              FATALITIES AND STAFFING LEVELS IN LONG-TERM CARE 
              FACILITIES.

    (a) Collection and Reporting of Staffing Data by Participating 
Providers.--The Secretary shall develop a plan for ensuring that 
participating providers shall resume compliance with the requirement, 
under section 1128I(g) of the Social Security Act (42 U.S.C. 1320a-
7j(g)), to electronically submit direct care staffing information based 
on payroll and other auditable data (including measures to ensure that 
the submitted data includes direct care staffing information for the 
entire duration of the emergency period).
    (b) Collection and Reporting of Data Related to COVID-19 by 
Participating Providers and Long-Term Care Facilities.--
            (1) In general.--
                    (A) Reporting of covid-19 cases and fatalities by 
                participating providers and long-term care 
                facilities.--The Secretary shall ensure that 
                participating providers and long-term care facilities 
                report all suspected and confirmed cases of COVID-19 
                among personnel and residents of the provider or 
                facility, all COVID-19-related fatalities among 
                personnel and residents of the provider or facility, 
                and all fatalities among personnel and residents of the 
                provider or facility, whether related to COVID-19 or 
                unrelated to COVID-19, for the period beginning on 
                January 1, 2020, to the Secretary.
                    (B) Timing and manner of reporting.--Such data 
                shall be reported to the Secretary by participating 
                providers and long-term care facilities in a format and 
                manner that is consistent with any data that the 
                Secretary has directed participating providers to 
                furnish to the Centers for Disease Control and 
                Prevention on or after May 8, 2020, and, beginning on 
                the date that is 15 days after the date of enactment of 
                this Act, shall be collected and reported to the 
                Secretary by participating providers and long-term care 
                facilities on a daily basis.
                    (C) Publication of data.--Not later than 15 days 
                after the date of enactment of this Act, the Secretary 
                shall make the data collected under this paragraph 
                publicly available and shall update such data on a 
                daily basis.
            (2) Collection and reporting of demographic data.--The 
        Secretary shall post the following information with respect to 
        participating providers and long-term care facilities on the 
        official internet website of the Federal Government for 
        Medicare beneficiaries (commonly referred to as the ``Nursing 
        Home Compare'' Medicare website) (or a successor website) 
        aggregated by State:
                    (A) The age, gender, race, ethnicity, disability, 
                and preferred language of the residents of 
                participating providers with suspected or confirmed 
                COVID-19 infections.
                    (B) With respect to residents of participating 
                providers and long-term care facilities who died on or 
                after January 1, 2020, the age, gender, race, 
                ethnicity, disability, and preferred language of--
                            (i) all of such residents; and
                            (ii) all of such residents whose deaths are 
                        related to COVID-19.
            (3) Confidentiality.--Any information reported under this 
        subsection that is made available to the public shall be made 
        so available in a manner that protects the identity of 
        residents of participating providers and long-term care 
        facilities.

SEC. 5. ESTABLISHING STRIKE TEAMS.

    (a) In General.--A portion of any payments received or funds made 
available on or after July 1, 2020, for responding to the public health 
or fiscal impacts related to the Coronavirus Disease (COVID-19) under 
Federal legislation enacted on or after that date which primarily makes 
appropriations for the coronavirus response and related activities, 
shall be used to establish and support the operation of statewide or 
regional strike teams that meet the requirements of subsection (b) to 
respond to COVID-19-related crises in participating providers, 
notwithstanding the original purpose for which the amounts were 
appropriated to make such payments or funds available, or any other 
provision of law restricting the use of such payments or funds.
    (b) Strike Team Requirements.--The requirements of this section 
with respect to a strike team of a State are the following:
            (1) Strike teams may include assessment, testing, and 
        clinical teams, and the State shall establish a mission for 
        each such team by written directive, which may include 
        performing medical examinations, conducting COVID-19 testing, 
        and assisting participating providers with the implementation 
        of quarantine, isolation, or disinfection procedures.
            (2) Each strike team shall be comprised of individuals who 
        have relevant skills, qualifications, and experience to serve 
        as members of 1 or more of the assessment, testing, and 
        clinical teams described in paragraph (1), such as employees of 
        the State or any of its political subdivisions, members of the 
        militia on State activity duty, members of COVID-19 response 
        teams sent to the State by the Secretary, or other individuals 
        designated by the State agency with primary responsibility for 
        promoting resident and employee safety in participating 
        providers.
            (3) Strike teams and members of such teams shall be subject 
        to the State's oversight and direction and team members shall 
        receive a State-issued letter of authorization describing--
                    (A) the individual's designation to serve on 1 or 
                more teams under an emergency proclamation;
                    (B) the mission of the team;
                    (C) the authority of the individual to perform the 
                team mission on the State's behalf;
                    (D) the individual's authority to access places, 
                persons, and materials necessary for the team member's 
                performance of the team's mission; and
                    (E) the requirement that team members maintain the 
                confidentiality of patient information shared with such 
                individuals by the facility.
            (4) The State may, at any time, disband any strike team and 
        rescind the letter of authorization for any team member.
            (5) A team and team member may not use the letter of 
        authorization described in paragraph (3) for any purpose except 
        in connection with the team's mission of acting in good faith 
        to promote resident and employee safety in participating 
        providers in which COVID-19 is confirmed to be present.
            (6) The State shall establish protocols and procedures for 
        requesting the assistance of a strike team established under 
        this section and any other procedures deemed necessary for the 
        team's operation.
            (7) If a strike team finds consistent quality of care 
        deficiencies with respect to a participating provider and such 
        deficiencies immediately jeopardize the health or safety of 
        residents of the participating provider, the team shall, within 
        18 hours of making such finding, alert the State survey agency 
        (which may take immediate enforcement action to remove the 
        jeopardy and correct the deficiencies through the remedies 
        specified in section 1819(h)(2)(B)(iii) or 1919(h)(2)(A)(iii) 
        of the Social Security Act (42 U.S.C. 1395i-3(h)(2)(B)(iii), 
        1396r(h)(2)(A)(iii)), the long-term care ombudsman of the 
        State, and the Medicaid fraud control unit of such State).

SEC. 6. PROMOTING IDENTIFICATION AND REPORTING OF POTENTIAL ABUSE OR 
              NEGLECT IN LONG-TERM CARE FACILITIES.

    (a) Use of Claims Data To Identify Instances of Potential Abuse or 
Neglect in Facilities.--Section 1128I of the Social Security Act (42 
U.S.C. 1320a-7j) is amended by adding at the end the following new 
subsection:
    ``(i) Use of Claims Data To Identify Instances of Potential Abuse 
or Neglect.--
            ``(1) Compilation of codes.--Not later than 1 year after 
        the date of the enactment of this subsection, the Secretary, in 
        collaboration with the Inspector General of the Department of 
        Health and Human Services, shall--
                    ``(A) compile a comprehensive list of diagnosis 
                codes that may indicate potential physical or sexual 
                abuse or neglect of the elderly; and
                    ``(B) develop a plan for reliance on data from 
                claims under titles XVIII and XIX that contain 1 or 
                more of those codes, for the purpose of identifying 
                instances of potential physical or sexual abuse or 
                neglect in facilities receiving reimbursement under 
                such titles.
            ``(2) Availability to states.--Not later than 2 years after 
        the date of the enactment of this subsection, the Secretary 
        shall make such claims data available to State survey agencies 
        to help verify compliance with Federal and State mandatory 
        reporting laws.''.
    (b) Required Training on Signs and Symptoms of Potential Abuse or 
Neglect.--Section 1128I of the Social Security Act (42 U.S.C. 1320a-
7j), as amended by subsection (a), is amended by adding at the end the 
following new subsection:
    ``(j) Required Training on Signs and Symptom of Potential Abuse or 
Neglect.--Beginning not later than 1 year after the date of the 
enactment of this subsection, a facility shall ensure that any staff of 
the facility who provide direct care (as defined in section 2011) to 
residents of the facility receive training on the signs and symptoms of 
potential abuse or neglect of the elderly.''.
    (c) Evaluation and Report on Protocols To Encourage Prompt 
Reporting of Suspected Incidents of Potential Abuse or Neglect.--
            (1) Evaluation and implementation of protocols.--The 
        Secretary, in collaboration with the Attorney General, shall 
        evaluate the effectiveness of current protocols and, if 
        warranted, recommend and implement improvements in those 
        protocols, to encourage prompt reporting of suspected incidents 
        of potential abuse or neglect to the appropriate law 
        enforcement officials or adult protective services office, by 
        State and Federal surveyors of Medicare and Medicaid covered 
        entities.
            (2) Report.--Not later than 180 days after the completion 
        of the evaluation under paragraph (1), the Secretary shall 
        submit to Congress a report containing the results of such 
        evaluation, together with recommendations for improvements, 
        including such legislation and administrative action as the 
        Secretary determines appropriate.
    (d) Issuance of Guidance To Deter Social Media Abuse in 
Facilities.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall--
                    (A) update guidance, and, as necessary, issue new 
                guidance to clarify for State survey and certification 
                agencies the requirements applicable to facilities (as 
                defined in section 483.5 of title 42, Code of Federal 
                Regulations (or any successor regulations)) under part 
                483 of title 42, Code of Federal Regulations (or any 
                successor regulations), to protect resident privacy and 
                prohibit mental abuse or exploitation, specifically as 
                it relates to exploitative photographs, audio and video 
                recordings, and posting or sharing of such photographs 
                or recordings on social media networks or through 
                multimedia messages; and
                    (B) establish procedures to ensure that violations 
                of the safety and privacy requirements applicable to 
                facilities (as so defined) under part 483 of title 42, 
                Code of Federal Regulations (or any successor 
                regulations), which prohibit misuse of photographs, 
                audio and video recordings, and the inappropriate 
                posting or sharing of such photographs or recordings on 
                social media networks or through multimedia messages, 
                are reported by State survey agencies to law 
                enforcement agencies, adult protective service 
                agencies, and other relevant agencies and that such 
                violations are recorded and tracked in the Automated 
                Survey Processing Environment (``ASPEN'') and the ASPEN 
                Complaints/Incident Tracking System (``ACTS'').
            (2) Clarification.--The guidance issued under paragraph (1) 
        shall clarify that enforcement penalties do not apply to the 
        posting or sharing of such photographs or recordings that 
        occurred solely for the purpose of documenting and promptly 
        reporting, to the appropriate authorities, a case of abuse in a 
        facility.

SEC. 7. PROMOTING QUALITY OF LIFE OF LONG-TERM CARE FACILITY RESIDENTS 
              THROUGH TELEVISITATION.

    (a) Promoting Televisitation for Residents.--
            (1) In general.--Sections 1819(c)(3) and 1919(c)(3) of the 
        Social Security Act (42 U.S.C. 1395i-3(c)(3), 1396r(c)(3)) are 
        each amended--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) provide for access to telecommunications 
                devices and use of the internet, including assistance 
                from facility staff in the use of such technology, if 
                necessary or requested by the resident or a family 
                member, to support telecommunication, including but not 
                limited to audio, visual, text communication, 
                videoconference, and two-way audio/video options, by 
                residents of such facility with family members and 
                other individuals.''.
            (2) Access during covid-19 public health emergency 
        period.--
                    (A) In general.--Not later than 30 days after the 
                date of enactment of this Act, the Secretary shall take 
                steps necessary to ensure that the residents of each 
                participating provider and licensed assisted living or 
                residential care facility have access to 
                telecommunications devices and use of the internet (to 
                the extent practicable), including assistance from 
                facility staff in the use of such technology, if 
                necessary or requested by the resident or a family 
                member, to support telecommunication, including but not 
                limited to audio, visual, text communication, 
                videoconference and two-way audio/video options, by 
                residents of such provider or facility with family 
                members and other individuals.
                    (B) Requirements.--In taking such steps, the 
                Secretary shall address--
                            (i) notification to residents, family 
                        members, and other individuals of access to 
                        televisitation described in subparagraph (A);
                            (ii) how such a provider or facility will 
                        ensure or enable installation and access to a 
                        device purchased by, or for the use or benefit 
                        of, individual residents; and
                            (iii) operational issues and steps to avoid 
                        unnecessary barriers to the timely deployment 
                        of such televisitation.
    (b) Funding.--A participating provider may use a portion of any 
emergency funding that the provider receives (prior to and after the 
date of enactment of this Act) from the Secretary related to the COVID-
19 public health emergency period to purchase any technology, including 
telecommunications devices and internet service, or any other items or 
services as necessary to implement the televisitation described in the 
provisions of, and amendments made by, subsection (a), notwithstanding 
any other provision of law restricting the use of such funding.

SEC. 8. UPGRADING NURSING HOME COMPARE AND THE FIVE-STAR RATING SYSTEM.

    (a) Comprehensive Review of Five-Star Quality Rating System.--
Sections 1819 and 1919 of the Social Security Act (42 U.S.C. 1395i-3, 
1396r) are each amended--
            (1) by redesignating subsection (j) as subsection (k); and
            (2) by inserting after subsection (i) the following new 
        subsection:
    ``(j) Comprehensive Review and Modification of Five-Star Quality 
Rating System.--
            ``(1) In general.--The Secretary shall conduct a 
        comprehensive review of the system maintained by the Secretary 
        to measure and publicly report the quality of skilled nursing 
        facilities and nursing facilities (commonly referred to as the 
        `Five-Star Quality Rating System').
            ``(2) Timing.--The Secretary shall conduct such review not 
        later than 1 year after the end of the COVID-19 public health 
        emergency period and shall implement modifications to the Five-
        Star Quality Rating System (or its successor system) not later 
        than 180 days after the release of the report that is required 
        under paragraph (4).
            ``(3) Requirements.--The review of the system under this 
        subsection shall include an evaluation of the relative weight 
        accorded to each of the following:
                    ``(A) The adequacy of the facility's procedures for 
                preventing and reporting infection.
                    ``(B) The adequacy of the facility's procedures for 
                preventing and reporting incidents of abuse, neglect, 
                mistreatment, or exploitation of residents of the 
                facility.
                    ``(C) Deficiencies identified in the facility's 
                most recent standard survey and the extent to which the 
                facility corrected such deficiencies since the date of 
                the most recent survey.
                    ``(D) The number, type, severity, and outcome of 
                substantiated complaints.
                    ``(E) The number of adjudicated instances of 
                criminal violations by a facility or the employees of a 
                facility.
                    ``(F) The number of civil monetary penalties levied 
                against the facility, employees, contractors, and other 
                agents of the facility.
                    ``(G) Selected quality measures (such as the 
                percentages of long-stay residents who experience 
                pressure ulcers, are physically restrained, experience 
                falls with major injury, or received antipsychotic 
                medication).
                    ``(H) Whether a facility is connected to an 
                assisted living facility and whether such facilities 
                should be rated separately from facilities that are 
                standalone skilled nursing facilities or nursing 
                facilities.
                    ``(I) Other items determined appropriate by the 
                Secretary.
            ``(4) Report.--Not later than 180 days after the completion 
        of the review under paragraph (1), the Secretary shall submit 
        to the Committee on Finance of the Senate and the Committee on 
        Ways and Means of the House of Representatives a final report 
        that includes such findings and recommendations as the 
        Secretary considers appropriate based on the review, including 
        recommended actions to be taken to implement the specific 
        recommendations in such report.
            ``(5) Consultation.--In conducting such review and 
        implementing modifications of the system, the Secretary shall 
        consult with each of the following:
                    ``(A) State long-term care ombudsman programs.
                    ``(B) Adult protective services agencies.
                    ``(C) Consumer advocacy and other nonprofit 
                organizations whose mission is to promote the health, 
                safety, and well being of older Americans.
                    ``(D) Provider stakeholder groups.
                    ``(E) Statewide provider agencies and advocacy 
                groups with relevant expertise.
                    ``(F) Any other representatives of programs or 
                groups the Secretary determines appropriate.
            ``(6) COVID-19 public health emergency period.--In this 
        subsection, the term `COVID-19 public health emergency period' 
        means the period beginning on the first day of the emergency 
        period defined in paragraph (1)(B) of section 1135(g) and 
        ending on the last day of the calendar quarter in which the 
        last day of such emergency period occurs.''.
    (b) Transparency.--The Secretary shall publicly report data, at 
least quarterly, regarding each State's enforcement actions with 
respect to deficiencies or statutory violations that have been reported 
to the Centers for Medicare & Medicaid Services, corrective actions, if 
any, that were recommended to resolve such deficiencies or statutory 
violations, and the status of implementation of each such recommended 
corrective action by the participating provider involved.
    (c) Funding.--The Secretary shall transfer to the Centers for 
Medicare & Medicaid Services Program Management Account, from the 
Federal Hospital Insurance Trust Fund established under section 1817 of 
the Social Security Act (42 U.S.C. 1395i) a one-time allocation of 
$20,000,000, to be used to carry out sections 1819(j) and 1919(j) of 
the Social Security Act (42 U.S.C. 1395i-3, 1396r) (as added by 
subsection (a) and subsection (b)). The amount shall be available on 
the date of the enactment of this Act and shall remain available until 
expended.

SEC. 9. ENHANCING FEDERAL OVERSIGHT OF NURSING HOMES PARTICIPATING IN 
              MEDICARE OR MEDICAID.

    (a) Identification of Facilities Included in, or Candidates for, 
the Special Focus Facility Program.--Not later than 60 days after the 
date of enactment of this Act, the Secretary shall publish the 
following lists on the official internet website of the Federal 
Government for Medicare beneficiaries (commonly referred to as the 
``Nursing Home Compare'' Medicare website) (or a successor website):
            (1) A list of all participating providers that are included 
        in the special focus facility program conducted under sections 
        1819(f)(8) and 1919(f)(10) of the Social Security Act (42 
        U.S.C. 1395i-3(f)(8), 1396r(f)(10)).
            (2) A list of all participating providers that have been 
        identified as candidates for such program, based on the most 
        recent survey of the facility.
    (b) Regularly Published Updates.--The Secretary shall publish 
periodic updates of the lists published under subsection (a) no less 
often than once every 30 days.
    (c) Data Collection.--To the extent that the Secretary maintains a 
system to collect certification deficiencies and licensure violations 
relating to participating providers (such as the Automated Survey 
Processing Environment ``ASPEN'' or a successor system), the Secretary 
shall develop methods to separately track reports of confirmed 
incidents of abuse or neglect in such providers on survey forms through 
such system.
    (d) Guidance on the Meaning of Terms.--Not later than 18 months 
after the date of enactment of this Act, the Secretary, after 
consultation with staff of participating providers and other long-term 
care facilities that receive provider payments under the Medicare or 
Medicaid programs, shall issue guidance for such participating 
providers and other long-term care facilities to clarify the meaning of 
certain terms, such as ``suspicious'', ``injuries of unknown source'', 
and ``mistreatment'', when used in the statutory and regulatory 
requirements for such providers relating to reporting and tracking 
incidents of abuse, sexual abuse, neglect, mistreatment, or 
exploitation of residents of such providers by facility staff, 
including on social media.

SEC. 10. CONTINUING FUNDING FOR PROGRAMS TO PREVENT AND PROSECUTE ELDER 
              ABUSE AND NEGLECT.

    (a) Long-Term Care Ombudsman Program Grants and Training.--Section 
2043 of the Social Security Act (42 U.S.C. 1397m-2) is amended--
            (1) in subsection (a)(2)--
                    (A) in subparagraph (B), by striking ``and'' after 
                the semicolon;
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(D) for each of fiscal years 2020 through 2023, 
                $12,000,000.''; and
            (2) in subsection (b)(2), by inserting before the period 
        the following: ``, and for each of fiscal years 2020 through 
        2023, $12,000,000''.
    (b) Elder Abuse, Neglect, and Exploitation Forensic Centers.--
Section 2031(f) of the Social Security Act (42 U.S.C. 1397l(f)) is 
amended--
            (1) in paragraph (2), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(4) for each of fiscal years 2020 through 2023, 
        $10,000,000.''.
    (c) Elder Justice Coordinating Council.--
            (1) Membership.--Section 2021(b)(1) of the Social Security 
        Act (42 U.S.C. 1397k(b)(1)) is amended--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (B) by inserting after subparagraph (B), the 
                following:
                    ``(C) The Administrator of the Federal Emergency 
                Management Agency.''.
            (2) Duties.--Section 2021(f)(1) of such Act (42 U.S.C. 
        1397k(f)(1)) is amended by inserting ``the Federal Emergency 
        Management Agency,'' after ``Justice,''.
    (d) Adult Protective Services Functions and Grant Programs.--
Section 2042 of the Social Security Act (42 U.S.C. 1397m-1) is 
amended--
            (1) in subsection (a)(2), by striking ``$3,000,000'' and 
        all that follows through the period and inserting ``$5,000,000 
        for each of fiscal years 2020 through 2023.'';
            (2) in subsection (b)(5), by striking ``$100,000,000'' and 
        all that follows through the period and inserting 
        ``$120,000,000 for each of fiscal years 2020 through 2023.''; 
        and
            (3) in subsection (c)(6), by striking ``$25,000,000'' and 
        all that follows through the period and inserting ``$30,000,000 
        for each of fiscal years 2020 through 2023.''.
    (e) Technical Amendment.--Section 2011(12)(A) of the Social 
Security Act (42 U.S.C. 1397j(12)(A)) is amended by striking ``450b'' 
and inserting ``5304''.

SEC. 11. INCREASING RESOURCES TO INVESTIGATE ABUSE OR NEGLECT AND 
              EXTEND SERVICES TO VICTIMS.

    (a) Funding for Adult Protective Services During the COVID-19 
Public Health Emergency.--
            (1) In general.--A total of $60,000,000 of the amounts 
        appropriated to make payments or funds available on or after 
        July 1, 2020, for responding to the public health or fiscal 
        impacts related to the Coronavirus Disease (COVID-19) under 
        Federal legislation enacted on or after that date which 
        primarily makes appropriations for the coronavirus response and 
        related activities, shall be transferred and made available to 
        the Secretary to make direct payments under this subsection to 
        the agency of each State with primary responsibility for adult 
        protective services and to tribally operated adult protective 
        services agencies, notwithstanding the original purpose for 
        which the amounts were appropriated to make such payments or 
        funds available, or any other provision of law restricting the 
        use of such payments or funds.
            (2) Payments.--
                    (A) In general.--From the funds transferred and 
                made available under paragraph (1), the Secretary 
                shall--
                            (i) reserve 3 percent of such funds for 
                        making payments to tribally operated adult 
                        protective services agencies in such manner, 
                        and based on such information, as the Secretary 
                        shall specify; and
                            (ii) make allotments to States from the 
                        remainder of such funds (after the application 
                        of clause (i)), in the same manner as amounts 
                        are allotted to States for fiscal year 2020 
                        under section 2003(b) of the Social Security 
                        Act (42 U.S.C. 1397b(b)).
                    (B) Direct payments.--The Secretary shall make 
                direct payment from the amounts reserved under 
                subparagraph (A) to tribally operated adult protective 
                services agencies and from the amounts allotted under 
                that subparagraph to the agency of each State with 
                primary responsibility for adult protective services.
            (3) Other requirements.--
                    (A) No match.--No cash or in-kind matching 
                requirement shall apply to the payments made under this 
                subsection.
                    (B) Deadline.--The Secretary shall make the 
                payments required under this subsection not later than 
                60 days after the date on which funds are transferred 
                and made available under paragraph (1).
                    (C) Use of funds.--Each agency that receives funds 
                from a payment made under this subsection shall use the 
                funds to provide adult protective services during the 
                COVID-19 public health emergency period.
                    (D) Prohibition.--No funds from a payment made 
                under this subsection shall be used to satisfy any 
                requirement of a federally funded program relating to 
                State or local matching funds or in-kind contributions.
            (4) Definitions.--In this subsection:
                    (A) Adult protective services.--The term ``adult 
                protective services'' has the meaning given that term 
                in section 2011(2) of the Social Security Act (42 
                U.S.C. 1397j(2)).
                    (B) Indian country.--The term ``Indian country'' 
                has the meaning given that term in section 1151 of 
                title 18, United States Code.
                    (C) State.--The term ``State'' has the meaning 
                given that term in section 1101(a)(1) of the Social 
                Security Act (42 U.S.C. 1301(a)(1)) for purposes of 
                title XX of such Act.
                    (D) Tribally operated adult protective services 
                agency.--The term ``tribally operated adult protective 
                services agency'' means an agency of the recognized 
                governing body of any Indian or Alaska Native Tribe, 
                band, Nation, pueblo, village, community, component 
                band, or component reservation, individually identified 
                (including parenthetically) in the list published most 
                recently as of the date of enactment of this Act 
                pursuant to section 104 of the Federally Recognized 
                Indian Tribe List Act of 1994 (25 U.S.C. 5131) whose 
                primary purpose is to protect any vulnerable adult who 
                is the victim of an alleged or substantiated incident 
                of abuse, neglect, or exploitation in Indian Country.
    (b) Authority for Transfers From the Crime Victims Fund.--Section 
1402(d)(3) of the Victims of Crime Act of 1984 (34 U.S.C. 20101(d)(3)) 
is amended by adding at the end the following:
                    ``(C)(i) Notwithstanding subparagraph (B), the 
                Director may use not more than 3 percent of the amount 
                to be distributed from the Fund under this paragraph in 
                a particular fiscal year to provide and improve 
                services for victims of elder abuse, neglect, or 
                exploitation by a department or agency of the Federal 
                Government other than the Department of Justice.''.

SEC. 12. PROTECTING AMERICANS WITH DEMENTIA.

    (a) Alzheimer's Disease Best Practices and Reporting.--
            (1) Addressing alzheimer's disease in best practices.--
                    (A) In general.--Section 101(b) of the Elder Abuse 
                Prevention and Prosecution Act (34 U.S.C. 21711(b)) is 
                amended--
                            (i) by redesignating subparagraphs (A), 
                        (B), and (C) of paragraph (2) as clauses (i), 
                        (ii), and (iii), respectively, and adjusting 
                        the margin accordingly;
                            (ii) by redesignating paragraphs (1), (2), 
                        and (3) as subparagraphs (A), (B), and (C), 
                        respectively, and adjusting the margin 
                        accordingly;
                            (iii) by striking ``Not later than'' and 
                        inserting the following:
            ``(1) In general.--Not later than'';
                            (iv) in paragraph (1)(B), as so 
                        redesignated--
                                    (I) in clause (ii), by inserting 
                                ``, including witnesses who have 
                                Alzheimer's disease and related 
                                dementias'' after ``other legal 
                                issues''; and
                                    (II) in clause (iii), by striking 
                                ``elder abuse cases,'' and inserting 
                                ``elder abuse cases (including victims 
                                and witnesses who have Alzheimer's 
                                disease and related dementias),''; and
                            (v) by adding at the end the following:
            ``(2) Training materials.--
                    ``(A) In general.--In creating or compiling 
                replication guides and training materials under 
                paragraph (1)(B), the Elder Justice Coordinator shall 
                consult with the Secretary of Health and Human 
                Services, State, local, and Tribal adult protective 
                services, aging, social, and human services agencies, 
                Federal, State, local, and Tribal law enforcement 
                agencies, and nationally recognized nonprofit 
                associations with relevant expertise, as appropriate.
                    ``(B) Updating.--The Elder Justice Coordinator 
                shall--
                            ``(i) review the best practices identified 
                        and replication guides and training materials 
                        created or compiled under paragraph (1)(B) to 
                        determine if the replication guides or training 
                        materials require updating; and
                            ``(ii) perform any necessary updating of 
                        the replication guides or training 
                        materials.''.
                    (B) Applicability.--The amendments made by 
                subparagraph (A) shall--
                            (i) take effect on the date of enactment of 
                        this Act; and
                            (ii) apply on and after the date that is 1 
                        year after the date of enactment of this Act.
            (2) Report on outreach.--
                    (A) In general.--Section 101(c)(2) of the Elder 
                Abuse Prevention and Prosecution Act (34 U.S.C. 
                21711(c)(2)) is amended--
                            (i) by redesignating subparagraphs (A) 
                        through (D) as clauses (i) through (iv), 
                        respectively, and adjusting the margin 
                        accordingly;
                            (ii) by striking ``a report detailing'' and 
                        inserting the following: ``a report--
                    ``(A) detailing''; and
                            (iii) by adding at the end the following:
                    ``(B) with respect to the report by the Attorney 
                General, including a link to the publicly available 
                best practices identified under subsection (b)(1)(B) 
                and the replication guides and training materials 
                created or compiled under such subsection.''.
                    (B) Applicability.--The amendments made by 
                subparagraph (A) shall apply with respect to the report 
                under section 101(c)(2) of the Elder Abuse Prevention 
                and Prosecution Act (34 U.S.C. 21711(c)(2)) submitted 
                during the second year beginning after the date of 
                enactment of this Act, and each year thereafter.
    (b) Promoting Accountability of Court-Appointed Guardians.--Section 
2042(c) of the Social Security Act (42 U.S.C. 1397m-1(c)) is amended--
            (1) in paragraph (1), by striking ``paragraph (2)(E)'' and 
        inserting ``subparagraphs (E), (F), (G), and (H) of paragraph 
        (2)'';
            (2) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by striking ``Funds'' and inserting 
                        ``Subject to paragraph (7), funds''; and
                            (ii) by striking ``subparagraph (E)'' and 
                        inserting ``subparagraphs (E), (F), (G), and 
                        (H)'';
                    (B) in subparagraph (E), by striking ``or'' at the 
                end;
                    (C) by redesignating subparagraph (F) as 
                subparagraph (I); and
                    (D) by inserting after subparagraph (E) the 
                following new paragraphs:
                    ``(F) methods to assess State guardianship 
                statistics such as the creation of State databases to 
                collect information about the number and 
                characteristics of guardianship arrangements, 
                guardians, and individuals subject to guardianship;
                    ``(G) the use of trained court visitors to improve 
                court administration of guardianship arrangements, 
                including the appointment and oversight of guardians;
                    ``(H) methods for collecting, storing, and making 
                available to the appropriate individuals, 
                organizations, and entities information on prospective, 
                current, and previously appointed guardians, which may 
                include--
                            ``(i) contact and identifying information;
                            ``(ii) information relating to background 
                        check investigations;
                            ``(iii) court decisions regarding petitions 
                        for appointment as a guardian, including the 
                        rationale for such decisions; and
                            ``(iv) information relating to the cause 
                        for removal of the guardian or termination of 
                        the guardianship arrangement; or'';
            (3) in paragraph (4), by striking ``paragraph (2)(E)'' and 
        inserting ``subparagraphs (E), (F), (G), and (H) of paragraph 
        (2)'';
            (4) in paragraph (5), by striking ``paragraph (2)(E)'' each 
        place it appears and inserting ``subparagraphs (E), (F), (G), 
        and (H) of paragraph (2)''; and
            (5) by adding at the end the following new paragraph:
            ``(7) Ensuring demonstration program funding for the 
        highest courts of states.--The Secretary shall ensure that up 
        to 5 percent of the total of any funds made available to carry 
        out this subsection in a fiscal year (beginning with fiscal 
        year 2020) is awarded under grants to the highest courts of 
        States for purposes of conducting demonstration programs 
        described in subparagraphs (E), (F), (G), and (H) of paragraph 
        (2).''.

SEC. 13. REDUCING RACIAL AND ETHNIC DISPARITIES IN LONG-TERM CARE 
              FACILITIES.

    (a) Task Force.--The Secretary shall establish a task force, to be 
known as the ``Ethnic and Racial Disparities in Long-Term Care 
Facilities Task Force'' (referred to in this section as the ``task 
force''), to gather data on racial and ethnic disparities in long-term 
care facilities and provide recommendations to Federal, State, local, 
and Tribal policymakers on ways to reduce such disparities.
    (b) Membership.--The task force shall be composed of the Secretary, 
the Surgeon General, other Federal, State, and local government 
officials, and individuals appointed by the Secretary with firsthand 
knowledge of, or expertise relating to, disparities in access to 
quality care for residents of long-term care facilities who are members 
of racial or ethnic minority groups. In appointing such individuals, 
the Secretary shall ensure the individuals appointed provide ample 
representation with respect to the demographics of residents and 
caregivers of such facilities, particularly with respect to residents 
and caregivers of such facilities who are members of racial or ethnic 
minority groups.
    (c) Administration.--
            (1) Chairperson.--The Secretary shall serve as the 
        chairperson of the task force. The Surgeon General shall serve 
        as the vice chairperson.
            (2) Staff.--The task force shall have 2 full-time staff 
        members.
            (3) Meetings.--The task force shall convene at least 
        monthly, with the first meeting to occur within 60 days after 
        the enactment of this Act.
    (d) Reporting and Recommendations.--
            (1) Monthly reports.--Not later than 45 days after the 1st 
        meeting of the task force, and monthly thereafter, the task 
        force shall submit to Congress and the Federal Emergency 
        Management Agency a report that includes--
                    (A) recommended methodologies for improving Federal 
                data collection on resident outcomes in long-term care 
                facilities with disproportionately high rates of 
                admission of individuals who are members of racial or 
                ethnic minority groups;
                    (B) the identification of long-term care facilities 
                evidencing racial or ethnic disparities in psychotropic 
                drug usage, infection prevention and control 
                deficiencies, hospitalization rates, infectious disease 
                rates, injury rates, abuse rates, neglect rates, 
                fatality rates, and any additional areas, as determined 
                by the task force based on available public health data 
                (or, if no such data are available, on the basis of 
                such other publicly available data or information as 
                the task force may determine);
                    (C) the identification of factors, including 
                Federal and State policies, that have contributed to 
                racial or ethnic health disparities in resident 
                outcomes in long-term care facilities, and actions 
                Congress (and if appropriate, other entities) can take 
                to address these factors; and
                    (D) recommendations for best practices to promote 
                improvements in long-term care facilities evidencing 
                racial or ethnic disparities in psychotropic drug 
                usage, infection prevention and control deficiencies, 
                hospitalization rates, infectious disease rates, injury 
                rates, abuse and neglect rates, fatality rates, or any 
                additional areas determined by the task force.
            (2) Consultation with indian tribes.--In submitting reports 
        and recommendations under this subsection, the task force shall 
        consult with Indian Tribes and Tribal organizations.
            (3) Sunset.--The task force shall terminate on December 31, 
        2021.

SEC. 14. ESTABLISHING RECIPROCITY WITH DRUG ENFORCEMENT ADMINISTRATION 
              TO ADDRESS IMPROPER PRESCRIBING OF CONTROLLED SUBSTANCES.

    (a) Notification of the Attorney General by the Secretary of Health 
and Human Services in Cases of Improper Prescribing of Controlled 
Substances.--
            (1) In general.--Section 1866(j) of the Social Security Act 
        (42 U.S.C. 1395cc(j)) is amended by adding at the end the 
        following new paragraph:
            ``(10) Notification of attorney general.--
                    ``(A) In general.--If the Secretary makes a 
                determination described in subparagraph (B) with 
                respect to improper prescribing of a controlled 
                substance (as defined in section 102(6) of the 
                Controlled Substances Act), the Secretary shall notify 
                the Attorney General in accordance with subparagraph 
                (C).
                    ``(B) Determination by secretary.--A determination 
                described in this subparagraph is a determination by 
                the Secretary under which--
                            ``(i) the enrollment of a provider of 
                        services or supplier under this title is 
                        revoked, based in whole or in part on a finding 
                        by the Secretary under section 424.535(a)(14) 
                        of title 42, Code of Federal Regulations (or 
                        any successor regulation), as applied to 
                        improper prescribing of controlled substances; 
                        or
                            ``(ii) a provider of services or supplier 
                        is placed on the preclusion list as defined 
                        under sections 422.2 and 423.100 of such title 
                        42 (or any successor regulation), based in 
                        whole or in part on a finding by the Secretary 
                        that such provider or supplier has engaged in 
                        conduct, in connection with prescribing of 
                        controlled substances, that would be considered 
                        improper prescribing under such section 
                        424.535(a)(14), if the provider of services or 
                        supplier were enrolled under this title.
                    ``(C) Notification.--If the Secretary revokes an 
                enrollment or makes a preclusion list placement as 
                described in subparagraph (B), the Secretary shall 
                notify the Attorney General of such revocation or 
                placement, no later than 30 days after--
                            ``(i) the affirmation of such Secretarial 
                        action, in response to a request for 
                        reconsideration by the provider of services or 
                        supplier involved under section 424.545(a) or 
                        part 498 of such title 42, as applicable (or 
                        any successor regulations); or
                            ``(ii) absent such a request for 
                        reconsideration, expiration of the time period 
                        during which such a request may be filed.
                    ``(D) Subsequent notification.--In the case that a 
                revocation of enrollment or a preclusion list placement 
                as described in subparagraph (B) is reversed under 
                proceedings subsequent to the appropriate notification 
                under subparagraph (C), the Secretary shall inform the 
                Attorney General of such reversal (and as applicable, 
                reinstatement of such enrollment or removal from the 
                preclusion list).''.
            (2) Technical correction to citation for appeals 
        provision.--Section 1866(j)(5)(B) of the Social Security Act 
        (42 U.S.C. 1395cc(j)(5)(B)) is amended by striking ``paragraph 
        (7)'' and inserting ``paragraph (9)''.
    (b) Revocation of Registration Under the Controlled Substances 
Act.--Section 304 of the Controlled Substances Act (21 U.S.C. 824) is 
amended by adding at the end the following:
    ``(h)(1) Upon receipt of a notification from the Secretary under 
section 1866(j)(10)(C) of the Social Security Act (42 U.S.C. 
1395cc(j)(10)(C)) of a determination of the Secretary to revoke an 
enrollment or make a preclusion list placement, the Attorney General 
shall revoke the registration granted under section 303 of this Act of 
the registrant that is the subject of such revocation or placement.
    ``(2) After revocation of a registration under paragraph (1), if 
the Attorney General receives information from the Secretary under 
section 1866(j)(10)(D) of the Social Security Act (42 U.S.C. 
1395cc(j)(10)(D)) that the determination of the Secretary described in 
paragraph (1) has been reversed, the Attorney General may reverse the 
revocation of the registration if the Attorney General determines such 
reversal is appropriate.''.
                                 <all>