Source: https://www.law.cornell.edu/uscode/text/42/1320a%E2%80%937j
Timestamp: 2019-07-17 17:33:50
Document Index: 1162885

Matched Legal Cases: ['§ 1320', '§ 1320', '§\u202f1320', '§\u202f1128', '§\u202f6102', '§\u202f6105', '§\u202f6106', '§\u202f6113', '§\u202f6105', '§\u202f6113', '§\u202f6112']

U.S. Code › Title 42 › Chapter 7 › Subchapter XI › Part A › § 1320a–7j
42 U.S. Code § 1320a–7j - Accountability requirements for facilities
§ 1320a–7j.
Accountability requirements for facilities
(a) Definition of facilityIn this section, the term “facility” means—
On or after the date that is 36 months after March 23, 2010, a facility shall, with respect to the entity that operates the facility (in this subparagraph [1] referred to as the “operating organization” or “organization”), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this chapter and in promoting quality of care consistent with regulations developed under paragraph (2).
(3) Requirements for compliance and ethics programsIn this subsection, the term “compliance and ethics program” means, with respect to a facility, a program of the operating organization that—
(4) Required components of programThe required components of a compliance and ethics program of an operating organization are the following:
Not later than December 31, 2011, the Secretary shall establish and implement a quality assurance and performance improvement program (in this subparagraph referred to as the “QAPI program”) for facilities, including multi unit chains of facilities. Under the QAPI program, the Secretary shall establish standards relating to quality assurance and performance improvement with respect to facilities and provide technical assistance to facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under paragraph (2), a facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under sections 1395i–3(b)(1)(B) and 1396r(b)(1)(B) of this title, as applicable.
(f) [2] Standardized complaint form
The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a facility.
(A) Complaint formsThe State must make the standardized complaint form developed under paragraph (1) available upon request to—
(B) Complaint resolution processThe State must establish a complaint resolution process in order to ensure that the legal representative of a resident of a facility or other responsible party is not denied access to such resident or otherwise retaliated against if they have complained about the quality of care provided by the facility or other issues relating to the facility. Such complaint resolution process shall include—
Nothing in this subsection shall be construed as preventing a resident of a facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under paragraph (1) (including submitting a complaint orally).
(g) Submission of staffing information based on payroll data in a uniform formatBeginning not later than 2 years after March 23, 2010, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
(1) In generalAny individual who is the administrator of a facility must—
(3) SanctionsAny individual who is the administrator of a facility that fails to comply with the requirements of paragraph (1)—
may be subject to exclusion from participation in any Federal health care program (as defined in section 1320a–7b(f) of this title); and
(Aug. 14, 1935, ch. 531, title XI, § 1128I, as added and amended Pub. L. 111–148, title VI, §§ 6102, 6105(a), 6106, 6113(a), Mar. 23, 2010, 124 Stat. 702, 711, 712, 718.)
[2]  So in original. No subsecs. (d) and (e) have been enacted.
2010—Subsec. (f). Pub. L. 111–148, § 6105(a), added subsec. (f).
Subsec. (g). Pub. L. 111–148, § 6106, added subsec. (g).
Subsec. (h). Pub. L. 111–148, § 6113(a), added subsec. (h).
Pub. L. 111–148, title VI, § 6105(b), Mar. 23, 2010, 124 Stat. 712, provided that:
“The amendment made by this section [amending this section] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”
Pub. L. 111–148, title VI, § 6113(c), Mar. 23, 2010, 124 Stat. 720, provided that:
“The amendments made by this section [amending this section and section 1395i–3 of this title] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”
Pub. L. 111–148, title VI, § 6112, Mar. 23, 2010, 124 Stat. 716, provided that:
The Secretary [of Health and Human Services], in consultation with the Inspector General of the Department of Health and Human Services, shall conduct a demonstration project to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.
The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the demonstration project under this section from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
The Secretary shall conduct the demonstration project under this section for a 2-year period.
The Secretary shall implement the demonstration project under this section not later than 1 year after the date of the enactment of this Act [Mar. 23, 2010].
The Secretary shall evaluate chains selected to participate in the demonstration project under this section based on criteria selected by the Secretary, including where evidence suggests that a number of the facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes a number of facilities participating in the ‘Special Focus Facility’ program (or a successor program) or multiple facilities with a record of repeated serious safety and quality of care deficiencies.
“(c)Responsibilities.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of the demonstration project under this section shall—
conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities;
conduct sustained oversight of the efforts of the chain, whether publicly or privately held, to achieve compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;
report findings and recommendations with respect to such reviews, analyses, and oversight to the chain and facilities of the chain, to the Secretary, and to relevant States; and
publish the results of such reviews, analyses, and oversight.
“(1)Receipt of finding by chain.—Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the demonstration project shall submit to the independent monitor a report—
outlining corrective actions the chain will take to implement the recommendations in such report; or
indicating that the chain will not implement such recommendations, and why it will not do so.
“(2)Receipt of report by independent monitor.—
Not later than 10 days after receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State or States, as appropriate, containing such final recommendations.
“(e)Cost of Appointment.—
A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the demonstration project under this section. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary).
The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the demonstration project under this section.
“(1)Additional disclosable party.—
The term ‘additional disclosable party’ has the meaning given such term in section 1124(c)(5)(A) of the Social Security Act [42 U.S.C. 1320a–3(c)(5)(A)], as added by section 4201(a) [probably should be “6101(a)”].
“(2)Facility.—
The term ‘facility’ means a skilled nursing facility or a nursing facility.
“(3)Nursing facility.—
The term ‘nursing facility’ has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
The term ‘Secretary’ means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
“(5)Skilled nursing facility.—
The term ‘skilled nursing facility’ has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a) [1395i–3(a)]).
The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall evaluate the demonstration project conducted under this section.
“(2)Report.—Not later than 180 days after the completion of the demonstration project under this section, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations—
as to whether the independent monitor program should be established on a permanent basis;
if the Secretary recommends that such program be so established, on appropriate procedures and mechanisms for such establishment; and
for such legislation and administrative action as the Secretary determines appropriate.”