I 113th CONGRESS 1st Session H. R. 2864 IN THE HOUSE OF REPRESENTATIVES July 30, 2013 Ms. Roybal-Allard introduced the following bill; which was referred to the Committee on Ways and Means , and in addition to the Committee on Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend titles XVIII and XIX of the Social Security Act to improve oversight of nursing facilities under the Medicare and Medicaid programs by preventing inappropriate influence over surveyors, and for other purposes.

1. Short title This Act may be cited as the Nursing Home Patient Protection and Standards Act of 2013 . 2. Improving the rigor of testing for surveyors (a) Medicare Section 1819(g)(2)(E)(iii) of the Social Security Act ( 42 U.S.C. 1395i–3(g)(2)(E)(iii) ) is amended by adding the following at the end: The testing program must be sufficiently rigorous (as determined by the Secretary) to ensure that surveyors are adequately prepared to survey and certify facilities in a consistent and accurate manner. . (b) Medicaid Section 1919(g)(2)(E)(iii) of the Social Security Act ( 42 U.S.C. 1396r(g)(2)(E)(iii) ) is amended by adding the following at the end: The testing program must be sufficiently rigorous (as determined by the Secretary) to ensure that surveyors are adequately prepared to survey and certify facilities in a consistent and accurate manner. . 3. Ensuring adequate staffing and training for State surveys of nursing homes (a) Medicare Section 1819(g)(2)(E) of the Social Security Act ( 42 U.S.C. 1395i–3(g)(2)(E) ) is amended by adding at the end the following: (iv) Adequate qualified staff for survey teams The Secretary, in consultation with the advisory committee under subparagraph (F), shall establish requirements for the qualifications and compensation of members of a survey team under this subsection and require that a State employs an adequate number of individuals as members of survey teams to ensure adequate oversight of skilled nursing facilities. (v) Continuing education In addition to the training and testing program required under clause (iii), the Secretary shall require that State and Federal surveyors regularly complete an adequate amount (as determined by the Secretary) of continuing education courses that meet requirements determined by the Secretary for content and the rigor of the material covered by such courses. An individual shall not serve as a member of a survey team unless the individual is in compliance with the requirements of this clause. . (b) Medicaid Section 1919(g)(2)(E) of the Social Security Act ( 42 U.S.C. 1396r(g)(2)(E) ) is amended by adding at the end the following: (iv) Adequate qualifed staff for survey teams The Secretary, in consultation with the advisory committee under subparagraph (F), shall establish requirements for the qualifications and compensation of members of a survey team under this subsection and require that a State employs an adequate number of individuals as members of survey teams to ensure adequate oversight of skilled nursing facilities. (v) Continuing education In addition to the training and testing program required under clause (iii), the Secretary shall require that State and Federal surveyors regularly complete an adequate amount (as determined by the Secretary) of continuing education courses that meet requirements determined by the Secretary for content and the rigor of the material covered by such courses. No individual shall serve as a member of a survey team unless the individual is in compliance with the requirements of this clause. . 4. Ensuring the independence and impartiality of surveyors (a) In general (1) Medicare Section 1819(g) of the Social Security Act ( 42 U.S.C. 1395i–3(g) ) is amended by adding the following at the end: (6) Reporting of inaccuracies (A) Covered individual defined For purposes of this paragraph, the term covered individual means an individual— (i) who is a member of a State survey team under this subsection; or (ii) who is an employee of the State department or agency that conducts surveys under this section. (B) Reporting requirement A covered individual shall report to the Secretary any instance in which the individual suspects that— (i) a survey under this subsection fails to report or under reports an issue in a facility that could impact the safety or quality of care of the residents in such facility; or (ii) a member of the survey team or an employee of the State survey agency was inappropriately influenced (through the offering of monetary awards or through undue pressure) to alter the results of the survey. (C) Response to report If the Secretary receives a report under subparagraph (B) , the Secretary shall take appropriate action, as determined by the Secretary, to ensure the accuracy of the survey. (D) Penalties for inappropriately influencing a surveyor Subject to subparagraph (H) , any individual (including an employee of a skilled nursing facility or any affiliated corporate entity, a representative of the skilled nursing facility industry, a member of a State survey team, an employee of the State department or agency that conducts surveys under this section, or an elected official) who attempts to inappropriately influence (as defined by the Secretary through regulations) the results of a survey under this subsection, or the actions of a member of a survey team or an employee of a survey agency, shall be subject to a civil money penalty not to exceed $10,000. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (E) Whistleblower protections With respect to a covered individual, any officer or employee of the State may not— (i) discharge, demote, suspend, threaten, harass, or deny a promotion or other employment-related benefit to such individual, or in any other manner discriminate against an individual in the terms and conditions of employment because the individual submitted a report under subparagraph (B) ; or (ii) file a complaint or a report against the individual with the appropriate State professional disciplinary agency because the individual submitted a report under subparagraph (B) . (F) Penalties for violating whistleblower protections Subject to subparagraph (H) , any officer or employee of a State who engages in an activity that is prohibited by subparagraph (E) shall be subject to a civil money penalty not to exceed $50,000. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (G) Requirement to post notice Each State shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of covered individuals under this section. Such sign shall include— (i) a statement that a covered individual may file a complaint with the Secretary describing any violations of the provisions of this paragraph by an employee or officer of a State; and (ii) information concerning the form and manner in which such a complaint should be filed. (H) Construction related to legislative oversight For purposes of this paragraph, to the extent that a member of a State legislature requests that a covered individual appear at a hearing of a committee of such legislature or asks questions of such individual during such a hearing, the actions of such member shall not be construed in a manner that would subject such member to a penalty under this paragraph. . (2) Medicaid Section 1919(g) of the Social Security Act ( 42 U.S.C. 1396r(g) ) is amended by adding the following at the end: (6) Reporting of inaccuracies (A) Covered individual defined For purposes of this paragraph, the term covered individual means an individual— (i) who is a member of a State survey team under this subsection; or (ii) who is an employee of the State department or agency that conducts surveys under this section. (B) Reporting requirement A covered individual shall report to the Secretary any instance in which the individual suspects that— (i) a survey under this subsection fails to report or under reports an issue in a facility that could impact the safety or quality of care of the residents in such facility; or (ii) a member of the survey team or an employee of the State survey agency was inappropriately influenced (through the offering of monetary awards or through undue pressure) to alter the results of the survey. (C) Response to report If the Secretary receives a report under subparagraph (B) , the Secretary shall take appropriate action, as determined by the Secretary, to ensure the accuracy of the survey. (D) Penalties for inappropriately influencing a surveyor Subject to subparagraph (H) , any individual (including an employee of a skilled nursing facility or any affiliated corporate entity, a representative of the skilled nursing facility industry, a member of a State survey team, an employee of the State department or agency that conducts surveys under this section, or an elected official) who attempts to inappropriately influence (as defined by the Secretary through regulations) the results of a survey under this subsection, or the actions of a member of a survey team or an employee of a survey agency, shall be subject to a civil money penalty not to exceed $10,000. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (E) Whistleblower protections With respect to a covered individual, any officer or employee of the State may not— (i) discharge, demote, suspend, threaten, harass, or deny a promotion or other employment-related benefit to such individual, or in any other manner discriminate against an individual in the terms and conditions of employment because the individual submitted a report under subparagraph (B) ; or (ii) file a complaint or a report against the individual with the appropriate State professional disciplinary agency because the individual submitted a report under subparagraph (B) . (F) Penalties for violating whistleblower protections Subject to subparagraph (H) , any officer or employee of a State who engages in an activity that is prohibited by subparagraph (E) shall be subject to a civil money penalty not to exceed $50,000. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (G) Requirement to post notice Each State shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of covered individuals under this section. Such sign shall include— (i) a statement that a covered individual may file a complaint with the Secretary describing any violations of the provisions of this paragraph by an employee or officer of a State; and (ii) information concerning the form and manner in which such a complaint should be filed. (H) Construction related to legislative oversight For purposes of this paragraph, to the extent that a member of a State legislature requests that a covered individual appear at a hearing of a committee of such legislature or asks questions of such individual during such a hearing, the actions of such member shall not be construed in a manner that would subject such member to a penalty under this paragraph. . (b) Conforming amendments (1) Section 1819(f)(2)(B)(iii)(I)(c) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(B)(iii)(I)(c)) is amended by inserting , a civil monetary penalty described in section 1919(g)(6)(D) of not less than $10,000 after of not less than $5,000 . (2) Section 1919(f)(2)(B)(iii)(I)(c) of the Social Security Act (42 U.S.C. 1396r(f)(2)(B)(iii)(I)(c)) is amended by inserting , a civil monetary penalty described in (g)(6)(D) of not less than $10,000 after of not less than $5,000 . 5. Advisory committee (a) Medicare Section 1819(g)(2) of the Social Security Act ( 42 U.S.C. 1395i–3(g)(2) ) is amended by adding at the end the following: (F) Advisory Committee (i) Establishment The Secretary shall establish an advisory committee on surveys under this paragraph. (ii) Membership The membership of the advisory committee under clause (i) shall include advocates for residents of skilled nursing facilities, members of survey teams under this subsection, and nursing home administrators. (iii) Recommended standards The advisory committee under clause (i) shall make recommendations to the Secretary on standards for— (I) the adequate staffing of survey teams under this subsection; (II) the training of members of such teams; and (III) disclosing any contact between such members and individuals associated with skilled nursing facilities, and limiting such contact to prevent inappropriate influence of such members by such individuals. (iv) Other recommendations The advisory committee under clause (i) may also make recommendations to the Secretary on any other issue that would improve the survey process under this paragraph. . (b) Medicaid Section 1919(g)(2) of the Social Security Act ( 42 U.S.C. 1396r(g)(2) ) is amended by adding at the end the following: (F) Advisory Committee (i) Establishment The Secretary shall establish an advisory committee on surveys under this paragraph. (ii) Membership The membership of the advisory committee under clause (i) shall include advocates for residents of nursing facilities, members of survey teams under this subsection, and nursing home administrators. (iii) Recommended standards The advisory committee under clause (i) shall make recommendations to the Secretary on standards for— (I) the adequate staffing of survey teams under this subsection; (II) the training of members of such teams; and (III) disclosing any contact between such members and individuals associated with nursing facilities, and limiting such contact to prevent inappropriate influence of such members by such individuals. (iv) Other recommendations The advisory committee under clause (i) may also make recommendations to the Secretary on any other issue that would improve the survey process under this paragraph. . 6. Review of surveys (a) Medicare Section 1819(g)(2)(D) of the Social Security Act ( 42 U.S.C. 1395i–3(g)(2)(D) ) is amended— (1) by striking Each State and inserting the following: (i) In general Each State ; and (2) by adding at the end the following new clause: (ii) Review of surveys The supervisor of the survey team shall review each survey conducted under this subsection to ensure that any issues that impact quality of care that are identified by such surveys are consistently and appropriately described and rated by the survey team. . (b) Medicaid Section 1919(g)(2)(D) of the Social Security Act ( 42 U.S.C. 1396r(g)(2)(D) ) is amended— (1) by striking Each State and inserting the following: (i) In general Each State ; and (2) by adding at the end the following new clause: (ii) Review of surveys The supervisor of the survey team shall review each survey conducted under this subsection to ensure that any issues that impact quality of care that are identified by such surveys are consistently and appropriately described and rated by the survey team. .