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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Quality Nursing Care Act of 2005''.

SEC. 2. FINDINGS.

The Congress makes the following findings:
(1) There are hospitals throughout the United States that
have inadequate staffing of registered nurses to protect the
well-being and health of the patients.
(2) Studies show that the health of patients in hospitals
is directly proportionate to the number of registered nurses
working in the hospital.
(3) There is a critical shortage of registered nurses in
the United States.
(4) The effect of that shortage is revealed in unsafe
staffing levels in hospitals.
(5) Patient safety is adversely affected by these unsafe
staffing levels, creating a public health crisis.
(6) Registered nurses are being required to perform
professional services under conditions that do not support
quality health care or a healthful work environment for
registered nurses.
(7) As a payer for inpatient and outpatient hospital
services for individuals entitled to benefits under the program
established under title XVIII of the Social Security Act, the
Federal Government has a compelling interest in promoting the
safety of such individuals by requiring any hospital
participating in such program to establish minimum safe
staffing levels for registered nurses.

SEC. 3. ESTABLISHMENT OF MINIMUM STAFFING RATIOS BY MEDICARE
PARTICIPATING HOSPITALS.

(a) Requirement of Medicare Provider Agreement.--Section 1866(a)(1)
of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(1) by striking ''and'' at the end of subparagraph (U);
(2) by striking the period at the end of subparagraph (V)
and inserting '', and''; and
(3) by inserting after subparagraph (V) and before the end
matter the following:
''(W) in the case of a hospital--
''(i) to adopt and implement a staffing
system that meets the requirements of section
1898;
''(ii) to meet the requirements of such
section relating to--
''(I) records maintenance;
''(II) data collection; and
''(III) data submission; and
''(iii) to meet the requirements of such
section relating to non-discrimination and
retaliation.''.
(b) Requirements.--Title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) is amended by adding at the end the following:

''staffing requirements for medicare participating hospitals

''Sec. 1898. (a) Establishment of Staffing System.--Each
participating hospital shall adopt and implement a staffing system that
ensures a number of registered nurses on each shift and in each unit of
the hospital to ensure appropriate staffing levels for patient care. A
staffing system adopted and implemented under this section shall--
''(1) be developed on the basis of input from the direct
care-giving registered nurse staff or, where nurses are
represented, with the applicable recognized or certified
collective bargaining representatives of the registered nurses;
''(2) be based upon the number of patients and the level
and variability of intensity of care to be provided, with
appropriate consideration given to admissions, discharges and
transfers during each shift;
''(3) account for contextual issues affecting staffing and
the delivery of care, including architecture and geography of
the environment and available technology;
''(4) reflect the level of preparation and experience of
those providing care;
''(5) account for staffing level effectiveness or
deficiencies in related health care classifications, including
but not limited to, certified nurse assistants, licensed
vocational nurses, licensed psychiatric technicians, nursing
assistants, aides and orderlies;
''(6) reflect staffing levels recommended by specialty
nursing organizations;
''(7) subject to subsection (b), establish upwardly
adjustable registered nurse-to-patient ratios based upon
registered nurses' assessment of patient acuity and existing
conditions;
''(8) provide that a registered nurse shall not be assigned
to work in a particular unit without first having established
the ability to provide professional care in such unit; and
''(9) be based on methods that assure validity and
reliability.
''(b) Limitation.--A staffing system adopted and implemented
pursuant to subsection (a) may not--
''(1) set registered-nurse levels below those required by
any Federal or State law or regulation; or
''(2) utilize any minimum registered nurse-to-patient ratio
established pursuant to subsection (a)(7) as an upper limit on
the staffing of the hospital to which such ratio applies.
''(c) Reporting, and Release to Public, of Certain Staffing
Information.--
''(1) Requirements for hospitals.--Each participating
hospital shall--
''(A) post daily for each shift, in a clearly
visible place, a document that specifies in a uniform
manner (as prescribed by the Secretary) the current
number of licensed and unlicensed nursing staff
directly responsible for patient care in each unit of
the hospital, identifying specifically the number of
registered nurses;
''(B) upon request, make available to the public--
''(i) the nursing staff information
described in subparagraph (A); and
''(ii) a detailed written description of
the staffing system established by the hospital
pursuant to subsection (a); and
''(C) submit to the Secretary in a uniform manner
(as prescribed by the Secretary) the nursing staff
information described in subparagraph (A) through
electronic data submission not less frequently than
quarterly.
''(2) Secretarial responsibilities.--The Secretary shall--
''(A) make the information submitted pursuant to
paragraph (1)(C) publicly available, including by
publication of such information on the Internet site of
the Department of Health and Human Services; and
''(B) provide for the auditing of such information
for accuracy as a part of the process of determining
whether an institution is a hospital for purposes of
this title.
''(d) Record-Keeping; Data Collection; Evaluation.--
''(1) Record-keeping.--Each participating hospital shall
maintain for a period of at least 3 years (or, if longer, until
the conclusion of pending enforcement activities) such records
as the Secretary deems necessary to determine to whether the
hospital has adopted and implemented a staffing system pursuant
to subsection (a).
''(2) Data collection on certain outcomes.--The Secretary
shall require the collection, maintenance, and submission of
data by each participating hospital sufficient to establish the
link between the staffing system established pursuant to
subsection (a) and--
''(A) patient acuity from maintenance of acuity
data through entries on patients' charts;
''(B) patient outcomes that are nursing sensitive,
such as patient falls, adverse drug events, injuries to
patients, skin breakdown, pneumonia, infection rates,
upper gastrointestinal bleeding, shock, cardiac arrest,
length of stay, and patient re-admissions;
''(C) operational outcomes, such as work-related
injury or illness, vacancy and turnover rates, nursing
care hours per patient day, on-call use, overtime
rates, and needle-stick injuries; and
''(D) patient complaints related to staffing
levels.
''(3) Evaluation.--Each participating hospital shall
annually evaluate its staffing system and established minimum
registered nurse staffing ratios to assure on-going reliability
and validity of the system and ratios. The evaluation shall be
conducted by a joint management-staff committee comprised of at
least 50 percent of registered nurses who provide direct
patient care and where nurses are represented, with the
involvement of the applicable recognized or certified
collective bargaining representatives of the registered nurses.
''(e) Enforcement.--
''(1) Responsibility.--The Secretary shall enforce the
requirements and prohibitions of this section.
''(2) Procedures for receiving and investigating
complaints.--The Secretary shall establish procedures under
which--
''(A) any person may file a complaint that a
participating hospital has violated a requirement or a
prohibition of this section; and
''(B) such complaints are investigated by the
Secretary.
''(3) Remedies.--If the Secretary determines that a
participating hospital has violated a requirement of this
section, the Secretary--
''(A) shall require the facility to establish a
corrective action plan to prevent the recurrence of
such violation; and
''(B) may impose civil money penalties under
paragraph (4).
''(4) Civil money penalties.--
''(A) In general.--In addition to any other
penalties prescribed by law, the Secretary may impose a
civil money penalty of not more than $10,000 for each
knowing violation of a requirement of this section,
except that the Secretary shall impose a civil money
penalty of more than $10,000 for each such violation in
the case of a participating hospital that the Secretary
determines has a pattern or practice of such violations
(with the amount of such additional penalties being
determined in accordance with a schedule or methodology
specified in regulations).
''(B) Procedures.--The provisions of section 1128A
(other than subsections (a) and (b)) shall apply to a
civil money penalty under this paragraph in the same
manner as such provisions apply to a penalty or
proceeding under section 1128A.
''(C) Public notice of violations.--
''(i) Internet site.--The Secretary shall
publish on the Internet site of the Department
of Health and Human Services the names of
participating hospitals on which civil money
penalties have been imposed under this section,
the violation for which the penalty was
imposed, and such additional information as the
Secretary determines appropriate.
''(ii) Change of ownership.--With respect
to a participating hospital that had a change
in ownership, as determined by the Secretary,
penalties imposed on the hospital while under
previous ownership shall no longer be published
by the Secretary of such Internet site after
the 1-year period beginning on the date of
change in ownership.
''(f) Whistle-Blower Protections.--
''(1) Prohibition of discrimination and retaliation.--A
participating hospital shall not discriminate or retaliate in
any manner against any patient or employee of the hospital
because that patient or employee, or any other person, has
presented a grievance or complaint, or has initiated or
cooperated in any investigation or proceeding of any kind,
relating to the staffing system or other requirements and
prohibitions of this section.
''(2) Relief for prevailing employees.--An employee of a
participating hospital who has been discriminated or retaliated
against in employment in violation of this subsection may
initiate judicial action in a United States District Court and
shall be entitled to reinstatement, reimbursement for lost
wages and work benefits caused by the unlawful acts of the
employing hospital. Prevailing employees are entitled to
reasonable attorney's fees and costs associated with pursuing
the case.
''(3) Relief for prevailing patients.--A patient who has
been discriminated or retaliated against in violation of this
subsection may initiate judicial action in a United States
District Court. A prevailing patient shall be entitled to
liquidated damages of $5,000 for a violation of this statute in
addition to any other damages under other applicable statutes,
regulations or common law. Prevailing patients are entitled to
reasonable attorney's fees and costs associated with pursuing
the case.
''(4) Limitation on actions.--No action may be brought
under paragraph (2) or (3) more than 2 years after the
discrimination or retaliation with respect to which the action
is brought.
''(5) Treatment of adverse employment actions.--For
purposes of this subsection--
''(A) an adverse employment action shall be treated
as 'retaliation or discrimination'; and
''(B) an adverse employment action includes--
''(i) the failure to promote an individual
or provide any other employment-related benefit
for which the individual would otherwise be
eligible;
''(ii) an adverse evaluation or decision
made in relation to accreditation,
certification, credentialing, or licensing of
the individual; and
''(iii) a personnel action that is adverse
to the individual concerned.
''(g) Rules of Construction.--
''(1) Relationship to state laws.--Nothing in this section
shall be construed as exempting or relieving any person from
any liability, duty, penalty, or punishment provided by any
present or future law of any State or political subdivision of
a State, other than any such law which purports to require or
permit the doing of any act which would be an unlawful practice
under this title.
''(2) Relationship to conduct prohibited under the national
labor relations act.--Nothing in this section shall be
construed as permitting conduct prohibited under the National
Labor Relations Act or under any other federal, State, or local
collective bargaining law.
''(h) Regulations.--The Secretary shall promulgate such regulations
as are appropriate and necessary to implement this Act.
''(i) Definitions.--For purposes of this section--
''(1) the term 'participating hospital' means a hospital
that has entered into a provider agreement under section 1866;
''(2) the term 'registered nurse' means an individual who
has been granted a license to practice as a registered nurse in
at least one State;
''(3) the term 'unit' of a hospital is an organizational
department or separate geographic area of a hospital, such as a
burn unit, a labor and delivery room, a post-anesthesia service
area, an emergency department, an operating room, a pediatric
unit, a step-down or intermediate care unit, a specialty care
unit, a telemetry unit, a general medical care unit, a subacute
care unit, and a transitional inpatient care unit;
''(4) a 'shift' is a scheduled set of hours or duty period
to be worked at a participating hospital; and
''(5) a 'person' includes one or more individuals,
associations, corporations, unincorporated organizations or
labor unions.''.
(c) Effective Date.--The amendments made by this section shall
become effective on January 1, 2006.
A:
Quality Nursing Care Act of 2005 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require that each participating hospital adopt and implement a staffing system that ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care. Outlines whistle-blower protections.