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106th CONGRESS
2d Session
H. R. 5646
To amend titles XVIII and XIX of the Social Security Act to provide for
increased accountability of nursing facilities and adequate nurse
staffing for patient needs in the facilities.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 7, 2000
Mr. Stark 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 titles XVIII and XIX of the Social Security Act to provide for
increased accountability of nursing facilities and adequate nurse
staffing for patient needs in the facilities.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Nursing Facility Staffing
Improvement Act of 2000''.
SEC. 2. INTERIM SURVEYS FOR NURSING HOMES FOR DEFICIENCIES ATTRIBUTABLE
TO INADEQUATE NURSE STAFFING.
(a) Interim Surveys for Quality Deficiencies Attributable to
Inadequate Nurse Staffing.--
(1) Establishment of requirement for interim surveys.--
Sections 1819(g)(2) and 1919(g)(2) of the Social Security Act
(42 U.S.C. 1395i-3(g)(2) and 1396r(g)(2)) are each amended--
(A) in subparagraph (A)(ii)--
(i) in subclause (II), by striking ``and''
at the end;
(ii) in subclause (III), by striking the
period and inserting ``, and''; and
(iii) by adding at the end the following
new subclause:
``(IV) for each quality deficiency
identified in the survey that resulted
in actual harm to a resident of the
facility or that posed a risk of
immediate jeopardy to the health or
safety of the resident, an assessment
of whether inadequate nurse staffing is
a contributing factor to that
deficiency.''; and
(B) by adding at the end the following new
subparagraph:
``(F) Interim surveys for inadequate staffing.--
``(i) In general.--With respect to each
quality deficiency of a facility identified in
a survey to which inadequate nurse staffing is
determined to be a contributing factor under
subparagraph (A)(ii)(IV), the facility shall be
subject to interim surveys under this
subparagraph.
``(ii) Initial 2 mandatory surveys.--
``(I) Period for conduct of interim
surveys.--Two interim surveys shall be
conducted during the period beginning
on the date of the implementation by
the facility of a plan of correction
for such quality deficiencies and
ending before the date of the
succeeding standard survey conducted
under subparagraph (A).
``(II) Required assessment of
interim surveys.--Such surveys shall
assess the adequacy of nurse staffing
at the facility and the continued
compliance of the facility with such
plan of correction.
``(III) Conduct of interim surveys
without notice to facility.--Such
surveys shall be conducted without any
prior notice to the facility. Any
individual who notifies (or causes to
be notified) a facility of the time or
date on which such a survey is
scheduled to be conducted is subject to
a civil money penalty in the same
manner as provided for under the second
and third sentences of subparagraph
(A)(i).
``(iii) Finding of inadequate nurse
staffing in an interim survey.--In the case of
a finding in a facility of a quality deficiency
that is identified in an interim survey under
clause (ii) to which inadequate nurse staffing
is determined to be a contributing factor,
during the two-year period beginning on the
date of such finding, the facility shall be
subject to such additional interim surveys as
the State determines appropriate to verify the
maintenance of adequate nurse staffing in the
facility and continued compliance by the
facility with the plan of correction.
``(iv) Nurse staffing defined.--In this
paragraph and subsection (b)(1)(B), the term
`nurse staffing' means nursing staff consisting
of registered professional nurses, licensed
practical nurses, or certified nurse aides.''.
(2) Conforming amendment.--Section 1864(d) of the Social
Security Act (42 U.S.C. 1395aa(d)) is amended by inserting
``(including interim surveys under section 1819(g)(2)(F))''
after ``section 1819(g)''.
(b) Prompt Implementation of Plans of Correction for Deficiencies
Attributable to Inadequate Nurse Staffing.--Sections 1819(b)(1)(B) and
1919(b)(1)(B) of the Social Security Act (42 U.S.C. 1395i-3(b)(1)(B)
and 1396r(b)(1)(B)) are each amended by adding at the end the
following: ``In the case of a plan of correction to correct quality
deficiencies of a facility identified in a survey to which inadequate
nurse staffing is determined to be a contributing factor under
subsection (g)(2)(A)(ii)(IV), such plan shall specify the number
and type of additional nurse staff necessary to provide the requisite
care required under paragraph (2) for each resident of the facility and
shall be implemented not later than 30 days after receipt of notice of
the deficiency.''.
(c) Collection of Data on Nurse Staffing Levels.--
(1) Medicare.--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) Collection of data.--
``(A) Submission to secretary.--
``(i) On staffing levels.--A skilled
nursing facility shall submit to the Secretary,
in such form and manner and at such intervals
as the Secretary may require, data with respect
to nursing staff of the facility. Such data
shall include the total number of nursing staff
hours furnished during the period specified by
the Secretary (including totals for each shift
worked during such 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, and shall also include the average
wage rate for each class of nursing staff
employed by the facility.
``(ii) Information concerning residents.--
The skilled nursing facility shall provide the
Secretary, in such form and manner and at such
intervals as the Secretary may require, a
classification of all residents of the skilled
nursing facility that accords with the patient
classification system described in section
1888(e)(3)(B)(ii), or such successor system as
the Secretary may identify.
``(B) Publication.--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 pursuant to subparagraph (A). The
Secretary shall update such information periodically.
``(C) Review of data.--The Secretary shall
determine for each year from data collected under
subparagraph (A) whether a facility maintains adequate
nurse staffing for resident care in the facility.''.
(2) Medicaid.--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:
``(9) Submission of data.--
``(A) Submission to secretary.--
``(i) On staffing levels.--A nursing
facility shall submit to the Secretary, in such
form and manner and at such intervals as the
Secretary may require, data with respect to
nursing staff of the facility. Such data shall
include the total number of nursing staff hours
furnished during the period specified by the
Secretary (including totals for each shift
worked during such 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, and shall also include the average
wage rate for each class of nursing staff
employed by the facility.
``(ii) Information concerning residents.--
The nursing facility shall provide the
Secretary, in such form and manner and at such
intervals as the Secretary may require, a
classification of all residents of the skilled
nursing facility that accords with the patient
classification system described in section
1888(e)(3)(B)(ii), or such successor system as
the Secretary may identify.
``(B) Publication.--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 pursuant to subparagraph (A). The
Secretary shall update such information periodically.
``(C) Review of data.--The Secretary shall
determine for each year from data collected under
subparagraph (A) whether a facility maintains adequate
nurse staffing for resident care in the facility.''.
(d) Effective Date.--The amendments made by this section apply with
respect to surveys conducted on or after the date that is 6 months
after the date of the enactment of this Act.
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