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106th CONGRESS
2d Session
H. R. 4614
To amend title XVIII of the Social Security Act to require skilled
nursing facilities furnishing services to Medicare beneficiaries to
submit data to the Secretary of Health and Human Services with respect
to nursing staff levels of the facility, to require posting of staffing
information by facilities and the Secretary, to assess the adequacy of
training requirements for certified nurse aides, and provide for grants
to improve the quality of care furnished in nursing facilities.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 8, 2000
Mr. Stark (for himself, Ms. Eshoo, Mr. George Miller of California, Ms.
Woolsey, Ms. Pelosi, Ms. Lee, and Mr. Lantos) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on 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 title XVIII of the Social Security Act to require skilled
nursing facilities furnishing services to Medicare beneficiaries to
submit data to the Secretary of Health and Human Services with respect
to nursing staff levels of the facility, to require posting of staffing
information by facilities and the Secretary, to assess the adequacy of
training requirements for certified nurse aides, and provide for grants
to improve the quality of care furnished in nursing facilities.
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 ``Nursing Staff
Accountability and Training Improvement Act of 2000''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title.
TITLE I--INFORMATION ON NURSING STAFF IN NURSING FACILITIES
Sec. 101. Submission of nursing staff level data to the secretary.
Sec. 102. Information on nursing facility staffing.
Sec. 103. Direct spending for administrative expenses of State agencies
determining compliance by providers of
services with conditions of participation.
Sec. 104. Comprehensive report on certified nurse aide training.
Sec. 105. Effective date.
TITLE II--GRANTS TO IMPROVE QUALITY OF NURSING HOME AND LONG-TERM CARE
Sec. 201. Improvement of training of long-term care professionals and
workers.
Sec. 202. Upward mobility of long-term care workers.
Sec. 203. Retention of long-term care professionals and workers in
medically underserved areas.
Sec. 204. Improvement in worker safety.
Sec. 205. Demonstration program to implement quality improvement models
in nursing facility settings.
TITLE I--INFORMATION ON NURSING STAFF IN NURSING FACILITIES
SEC. 101. SUBMISSION OF NURSING STAFF LEVEL DATA TO THE SECRETARY.
(a) Medicare.--
(1) In general.--Section 1819(b) of the Social Security Act
(42 U.S.C. 1395i-3(b)) is amended by adding at the end the
following new paragraph:
``(8) Submission of data on staffing levels.--
``(A) In general.--A skilled nursing facility shall
submit to the Secretary, in a form and manner
determined by the Secretary, such data for a covered
period (as defined in subparagraph (C)) with respect to
nursing staff as is necessary for the Secretary to
determine whether a resident of the skilled nursing
facility receives the level of care commensurate with
the assessment of the resident under this subsection.
Such data shall include the total number of nursing
staff hours furnished during each covered period by the
facility to residents for which payment is made under
section 1888(e) broken down by total certified nurse
aide hours, total licensed practical or vocational
nurse hours, and total registered nurse hours.
``(B) Adjustment in payment amount for inadequate
staffing.--If the nursing staff data discloses that the
aggregate nursing staff hours furnished during the
covered period by the facility for residents for which
payment is made under section 1888(e) during the period
is less than the aggregate amount corresponding to the
nursing staff hours which is the basis of the case mix
reimbursement (under section 1888(e)(4)(G)(i)) for such
residents for the facility for that period, the
Secretary shall make proportionate adjustments in the
payment amounts determined under section 1888(e) to the
facility.
``(C) Covered period defined.--
``(i) In general.--For purposes of this
paragraph, the term `covered period' means the
lesser of 32 days or the facility billing
period described in clause (ii).
``(ii) Facility billing period described.--
A facility billing period referred to in clause
(i) the aggregate number of days between
periods that the Secretary makes payment for
claims for services furnished by the facility
under this title.''.
(2) Inclusion of nursing staffing levels in annual
survey.--Section 1819(g)(2)(A)(ii) of such Act (42 U.S.C.
1395i-3(g)(2)(A)(ii)) is amended--
(A) by striking ``and'' at the end of subclause
(II);
(B) by striking the period at the end of subclause
(III) and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(IV) a review of the sufficiency
and distribution of staffing in the
skilled nursing facility to meet the
needs of residents 24 hours a day, 7
days a week.''.
(3) Development of standard cost reporting form for all
skilled nursing facilities.--Section 1888(e) of the Social
Security Act (42 U.S.C. 1395yy(e)) is amended by adding at the
end the following new paragraph:
``(13) Required uniform cost reporting forms.--For cost
reporting periods beginning on or after October 1, 2001, a
skilled nursing facility shall submit to the Secretary a cost
report for the cost reporting period involved using the
standard, uniform cost reporting form developed by the
Secretary for such purpose. Such standard, uniform form shall
be developed in a manner to enable the Secretary to assess
amounts of direct patient care furnished by nursing staff of
the facility and to determine whether payments made for such care are
appropriate.''.
(b) Medicaid.--
(1) Analysis of spending for patient care in audits of
nursing facility cost reports.--
(A) In general.--A State shall carry out periodic
audits of cost reports submitted by a nursing facility
(as defined in section 1919(a) of the Social Security
Act (42 U.S.C. 1396r(a))) operating in the State. Such
audits shall (i) determine the aggregate expenditures
made by the nursing facility during the cost reporting
period on direct patient care furnished by licensed
health professionals (as defined in subparagraph (G) of
section 1919(b)(5) of such Act (42 U.S.C. 1396r(b)(5)))
and by nurse aides (as defined in subparagraph (F) of
such section) and (ii) compare such aggregate
expenditures to payments made by the State for such
direct patient care.
(B) Study.--The Secretary of Health and Human
Services shall conduct a study to determine the
feasibility of developing and administering a
standardized, uniform cost reporting form for all
nursing facilities furnishing services for which
payment is made under title XIX of the Social Security
Act. Any such form should enable the Secretary to
assess the amount of direct patient care referred to in
subparagraph (A) furnished by each nursing facility and
to determine whether payments made for such direct
patient care are appropriate.
(2) Inclusion of nursing staffing levels in annual
survey.--Section 1919(g)(2)(A)(ii) of the Social Security Act
(42 U.S.C. 1396r(g)(2)(A)(ii)) is amended--
(A) by striking ``and'' at the end of subclause
(II);
(B) by striking the period at the end of subclause
(III) and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(IV) a review of the sufficiency
and distribution of staffing in the
skilled nursing facility to meet the
needs of residents 24 hours a day, 7
days a week.''.
SEC. 102. INFORMATION ON NURSING FACILITY STAFFING.
(a) Medicare Amendments.--
(1) In general.--Section 1819(b) of the Social Security Act
(42 U.S.C. 1395i-3(b)), as amended by section 2(a), is further
amended by adding at the end the following new paragraph:
``(9) Information on nurse staffing.--
``(A) In general.--A skilled nursing facility shall
post daily for each nursing unit of the facility and
for each shift the current number of licensed and
unlicensed nursing staff directly responsible for
resident care and the current ratios of residents to
staff, stated separately for the ratio of the number of
residents to such licensed nursing staff and the ratio
of the number of residents to such unlicensed nursing
staff. The information shall be displayed in a uniform
manner and in a clearly visible place. The facility
shall also post in a clearly visible place annual
average daily staffing ratios per shift for the last
cost reporting period.
``(B) Publication of data.--
``(i) In general.--A skilled nursing
facility shall, upon request, make available to
the public nursing staff data to the same
extent and in the same manner as cost reporting information.
``(ii) Internet.--Not later than 60 days
after the date of completion of an annual
survey under subsection (g)(2), the Secretary
shall provide for the publication on the
Internet Site of the Department of Health and
Human Services known as Nursing Home Compare
the facility-specific nursing staff information
collected under such survey. The Secretary
shall update such information periodically.''.
(2) Penalty for failure to post required information.--
Section 1819(h)(2) of such Act (42 U.S.C. 1395i-3(h)(2)), is
amended by adding at the end the following new subparagraph:
``(F) Mandatory civil money penalty for failure to
post required information.--Notwithstanding any other
provision of law, the Secretary shall impose a civil
monetary penalty upon a skilled nursing facility that
fails to meet the posting requirement of subsection
(b)(9). The penalty shall be in the amount of $1,000
for each day upon which the facility fails to meet
fully such requirement. The provisions of section 1128A
of the Social Security Act (other than subsections (a)
and (b)) shall apply to civil money penalties under
this subparagraph in the same manner as they apply to a
penalty or proceeding under section 1128A(a) of such
Act.''.
(b) Medicaid Amendments.--
(1) In general.--Section 1919(b) of the Social Security Act
(42 U.S.C. 1396r(b)) is amended by adding at the end the
following new paragraph:
``(8) Information on nurse staffing.--
``(A) In general.--A skilled nursing facility shall
post daily for each nursing unit of the facility and
for each shift the current number of licensed and
unlicensed nursing staff directly responsible for
resident care and the current ratios of residents to
staff, stated separately for the ratio of the number of
residents to such licensed nursing staff and the ratio
of the number of residents to such unlicensed nursing
staff. The information shall be displayed in a uniform
manner and in a clearly visible place. The facility
shall also post in a clearly visible place annual
average daily staffing ratios per shift for the last
cost reporting period.
``(B) Publication of data.--
``(i) In general.--A skilled nursing
facility shall, upon request, make available to
the public nursing staff data to the same
extent and in the same manner as cost reporting
information.
``(ii) Internet.--Not later than 60 days
after the date of completion of an annual
survey under subsection (g)(2), the Secretary
shall provide for the publication on the
Internet Site of the Department of Health and
Human Services known as Nursing Home Compare
the facility-specific nursing staff information
collected under such survey. The Secretary
shall update such information periodically.''.
(2) Section 1919(h)(3) of such Act (42 U.S.C. 1396r(h)(3)),
is amended by adding at the end the following new subparagraph:
``(E) Mandatory civil money penalty for failure to
post required information.--Notwithstanding any other
provision of law, the Secretary shall impose a civil
monetary penalty upon a nursing facility that fails to
meet the posting requirement of subsection (b)(9). The
penalty shall be in the amount of $1,000 for each day
upon which the facility fails to meet fully such
requirement. The provisions of section 1128A of the
Social Security Act (other than subsections (a) and
(b)) shall apply to civil money penalties under this
subparagraph in the same manner as they apply to a
penalty or proceeding under section 1128A(a) of such
Act. This subparagraph shall not apply to a failure for
which a civil money penalty is imposed under section
1819(h)(2)(F).''.
SEC. 103. DIRECT SPENDING FOR ADMINISTRATIVE EXPENSES OF STATE AGENCIES
DETERMINING COMPLIANCE BY PROVIDERS OF SERVICES WITH
CONDITIONS OF PARTICIPATION.
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