[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1985 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 1985
To amend titles XVIII and XIX of the Social Security Act to modernize
Federal nursing home protections and to enhance care quality and
transparency for nursing home residents and their families.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 17, 2021
Mr. Pascrell (for himself, Mr. Kelly of Pennsylvania, Ms. Eshoo, and
Mr. McKinley) 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 modernize
Federal nursing home protections and to enhance care quality and
transparency for nursing home residents and their families.
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 Home Reform Modernization
Act of 2021''.
SEC. 2. IMPROVEMENTS TO NURSING FACILITIES UNDER THE MEDICARE AND
MEDICAID PROGRAMS.
(a) Advisory Council on Skilled Nursing Facility Rankings under
Medicare and Nursing Facility Rankings under Medicaid.--
(1) Establishment.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish the Advisory Council on Skilled
Nursing Facility Rankings under Medicare and Nursing Facility
Rankings under Medicaid (in this subsection referred to as the
``Advisory Council'').
(2) Membership.--The Secretary shall ensure that the
membership of the Advisory Council includes equal
representation from the following:
(A) Consumers with nursing home experience,
including adults age 65 and older, individuals with
disabilities, family caregivers, and their advocates.
(B) Skilled nursing facilities and nursing
facilities, including non-profit facilities.
(C) Academics with expertise in nursing home
oversight.
(D) Health professionals with nursing home
experience, such as physicians, nurses, pharmacists,
certified nursing assistants, and direct care
professionals.
(E) Professionals with expertise in quality
measurement.
(F) Professionals with expertise in emergency
management.
(G) State surveying agencies.
(H) State long-term care ombudsman programs.
(I) The Medicare Payment Advisory Commission.
(J) The Medicaid and CHIP Payment and Access
Commission.
(K) The Centers for Medicare & Medicaid Services.
(L) Other representatives as the Secretary
determines appropriate.
(3) Duties.--
(A) Study.--The Advisory Council shall conduct a
study of processes for ranking skilled nursing
facilities and nursing facilities under paragraph (9)
of section 1819(f) of the Social Security Act, as added
by subsection (b)(1) and under paragraph (11) of
section 1919(f) of such Act, as added by subsection
(c)(1). Such study shall include an analysis of--
(i) which available, verifiable data
sources and measures are best for appropriately
designating facilities in--
(I) the high-rated facility program
under paragraph (10) of such section
1819(f) and under paragraph (12) of
such section 1919(f); and
(II) the low-rated facility program
under paragraph (8) of such section
1819(f) and under paragraph (10) of
such section 1919(f);
(ii) the appropriate frequency with which
to update the rankings for the high-rated and
low-rated facility programs described in clause
(i);
(iii) how best to ensure that skilled
nursing facilities and nursing facilities
appropriately report adverse events;
(iv) how surveyors can clearly provide the
rationale for giving deficiencies to such
skilled nursing facilities and nursing
facilities and how this can be done in a timely
manner;
(v) how to manage suspensions from the
high-rated facility program described in clause
(i)(I) and the need for additional consumer
protections to administer such high-rated
facility program;
(vi) the availability or potential
development of, or modifications to, measures
or verifiable data sources on topics, including
avoidable hospital readmissions, emergency room
visits, risk-adjusted mortality, discharges to
the community, involuntary discharges,
situations involving the inappropriate
administration of medications by a facility,
and emergency management; and
(vii) the development of, or modifications
to, data collection, verifiable data sources,
and potential measures to assess the financial
stability of a facility.
(B) Findings and recommendations.--
(i) In general.--Not later than 2 years
after the date of enactment of this Act, the
Advisory Council shall submit to the Secretary
the findings of the Advisory Council under the
study conducted under subparagraph (A),
together with recommendations for such
legislation and administrative action as the
Advisory Council determines appropriate.
(ii) Public availability.--Upon receiving
the findings and recommendations under clause
(i), the Secretary shall make the findings and
recommendations available to the public on the
Internet website of the Centers for Medicare &
Medicaid Services.
(4) Sunset.--The Advisory Council shall terminate upon the
submission of the report to the Secretary under paragraph
(3)(B)(i).
(b) Medicare Program Revisions.--
(1) Establishment of rankings and high-rated facility
program.--
(A) In general.--Section 1819(f) of the Social
Security Act (42 U.S.C. 1395i-3(f)) is amended by
adding at the end the following new paragraphs:
``(9) Ranking process.--
``(A) Process.--
``(i) Establishment.--The Secretary shall
establish a process to rank skilled nursing
facilities based on compliance with the
applicable requirements of this Act.
``(ii) Data.--The process established under
clause (i) shall include the use of at least
the preceding 3 years of health inspection
data, if appropriate, and other data as
determined appropriate by the Secretary.
``(iii) Findings and recommendations of the
advisory council on skilled nursing facility
rankings under medicare and nursing facility
rankings under medicaid.--In establishing the
process under clause (i), the Secretary shall
take into account the findings and
recommendations of the Advisory Council that
are submitted to the Secretary under section
2(a)(3)(B)(i) of the Nursing Home Reform
Modernization Act of 2021.
``(B) Ranking.--
``(i) In general.--Under the process
established under subparagraph (A), the
Secretary shall use the rankings of skilled
nursing facilities to categorize facilities
into highest and lowest groups for the purposes
specified in clause (ii).
``(ii) Timing and use of rankings.--Not
later than 2 years after the date the Secretary
receives the findings and recommendations
described in subparagraph (A)(iii), the
Secretary shall use the rankings under clause
(i) for purposes of carrying out--
``(I) the high-rated facility
program under paragraph (10); and
``(II) the low-rated facility
program under paragraph (8).
``(10) High-rated facility program.--
``(A) Establishment.--
``(i) In general.--Not later than 2 years
after the date the Secretary receives the
findings and recommendations described in
paragraph (9)(A)(iii), the Secretary shall
establish and implement a high-rated facility
program to encourage and reward compliance with
the requirements of this Act.
``(ii) Report.--In establishing the high-
rated facility program, the Secretary shall
take into account the findings and
recommendations described in paragraph
(9)(A)(iii).
``(iii) Regulations.--The Secretary shall
establish the high-rated facility program under
clause (i) through notice and comment
rulemaking.
``(B) Designation.--Under the high-rated facility
program, subject to subparagraph (D), the Secretary
shall designate the highest rated skilled nursing
facilities under the rankings under paragraph (9)(B) as
high-rated skilled nursing facilities.
``(C) Distinction on nursing home compare
website.--A skilled nursing facility that is designated
as a high-rated skilled nursing facility under
subparagraph (B) shall receive a high-rated distinction
on the official Internet website of the Federal
Government for comparing nursing homes pursuant to
subsection (i)(1)(C).
``(D) Suspension of high-rated status.--
``(i) In general.--The Secretary shall
suspend a skilled nursing facility's
designation under subparagraph (B) if the
Secretary determines that there are
circumstances warranting such suspension.
``(ii) Circumstances.--In establishing the
circumstances under clause (i), the Secretary
shall take into account--
``(I) findings from Federal surveys
and investigations;
``(II) findings from State surveys
conducted under subsection (g)(2)(A);
``(III) findings from State
investigations and surveys conducted
under subsection (g)(4), including a
high number of substantiated
complaints, the frequency and severity
of substantiated complaints, and how
the complaints are handled by the
facility;
``(IV) situations involving changes
of ownership, administration, or
management of a skilled nursing
facility, or the director of nursing;
``(V) situations involving the
inappropriate administration of
medications by a facility;
``(VI) situations involving
involuntary discharges of residents;
and
``(VII) other factors determined
appropriate by the Secretary.
``(iii) No reinstatement prior to next
standard survey.--If a skilled nursing
facility's designation is suspended under
clause (i), such designation shall not be
reinstated prior to a subsequent survey as
specified under subsection (g)(2)(A)(iii).''.
(B) Assessment of high-rated designation in special
surveys.--Section 1819(g)(2)(A)(iii)(II) of the Social
Security Act (42 U.S.C. 1395i-3(g)(2)(A)(iii)(II)) is
amended--
(i) by inserting ``(or, in the case of a
facility that is designated as a high-rated
skilled nursing facility under subsection
(f)(10), shall be conducted)'' after ``may be
conducted''; and
(ii) by adding at the end the following new
sentence: ``On and after the date the Secretary
implements the high-rated facility program
under subsection (f)(10), any survey conducted,
pursuant to the preceding sentence, of a
facility that is designated as a high-rated
skilled nursing facility under such subsection
shall include an assessment of whether such
designation should continue or be suspended
under subparagraph (D) of such subsection.''.
(2) Improvements to the special focus facility program.--
(A) Appropriate participation.--Section 1819(f)(8)
of the Social Security Act (42 U.S.C. 1395i-3(f)(8)) is
amended--
(i) in subparagraph (A), by striking ``The
Secretary'' and inserting ``Subject to the
succeeding provisions of this subsection, the
Secretary''; and
(ii) by adding at the end the following new
subparagraph:
``(C) Appropriate participation.--Not later than 1
year after the date of enactment of the Nursing Home
Reform Modernization Act of 2021, the Secretary shall
ensure that the number of facilities participating in
the special focus facility program is not less than 3.5
percent of all skilled nursing facilities.''.
(B) Conversion of the special focus facility
program to the low-rated facility program and
additional requirements.--Section 1819(f)(8) of the
Social Security Act (42 U.S.C. 1395i-3(f)(8)), as
amended by subparagraph (A), is amended--
(i) in subparagraph (B), by inserting the
following before the period at the end: ``(or,
on and after the date the Secretary makes the
conversion described in subparagraph (D), at a
frequency determined appropriate by the
Secretary (but in no case less than once every
6 months))''; and
(ii) by adding at the end the following new
subparagraphs:
``(D) Conversion to the low-rated facility
program.--
``(i) In general.--On the same date that
the Secretary implements the high-rated
facility program under paragraph (10), the
Secretary shall convert the special focus
facility program under this subsection to the
low-rated facility program.
``(ii) Regulations.--The Secretary shall
carry out the conversion under clause (i)
through notice and comment rulemaking.
``(iii) Additional requirements for the
low-rated facility program.--In addition to the
provisions that apply to the low-rated facility
program through the conversion from the special
focus facility program, the succeeding
provisions of this subsection shall also apply
to the low-rated facility program.
``(E) Participation.--Subject to the minimum
participation requirement under subparagraph (C), the
Secretary shall designate the lowest rated skilled
nursing facilities under the rankings under paragraph
(9)(B) for participation in the low-rated facility
program.
``(F) Progressive enforcement actions.--The
Secretary, in consultation with States, shall utilize
progressive enforcement actions, of increasing
severity, to ensure facilities participating in the
low-rated facility program meet the applicable
requirements under this Act.
``(G) Enforcement for patterns of deficiency.--The
Secretary may utilize enforcement actions specified in
subsection (h)(2) to remedy patterns of deficiencies
cited across multiple surveys.
``(H) Compliance assistance programs.--
``(i) On-site consultation and educational
programming.--
``(I) In general.--The Secretary
shall establish on-site consultation
and educational programming for skilled
nursing facilities participating in the
low-rated facility program with respect
to compliance with the applicable
requirements under this Act.
``(II) Entity.--The on-site
consultation and educational
programming described in subclause (I)
shall be carried out by quality
improvement organizations under part B
of title XI or other independent
organizations of a similar type that do
not have conflicts of interest and are
deemed appropriate by the Secretary.
``(III) Required participation.--A
skilled nursing facility participating
in the low-rated facility program shall
participate in any consultations and
educational programming described in
subclause (I) conducted at the
facility.
``(ii) Consultation independent of
enforcement.--
``(I) In general.--Subject to
subclause (II), on-site consultations
and educational programming described
in clause (i) shall be conducted
independently of any enforcement
activity.
``(II) Exception.--Subclause (I)
shall not apply in the case where a
triggering event at the skilled nursing
facility is observed in the course of
providing on-site consultations and
educational programming described in
clause (i). In establishing such on-
site consultations and educational
programming, the Secretary shall
determine the triggering events for
which the use of necessary enforcement
actions is permitted notwithstanding
the limitation under subclause (I).
Such triggering events shall include
events that are required to be reported
under State and Federal law and a
pattern of deficiencies or problems
that the quality improvement
organization or other organization has
identified for correction but which are
consistently not corrected.
``(I) Public availability.--
``(i) In general.--The Secretary shall
ensure that a skilled nursing facility's
participation in the low-rated facility program
is publicly announced, including to--
``(I) resident family councils;
``(II) resident attending
physicians;
``(III) the State board responsible
for the licensing of the skilled
nursing facility administrator at the
facility;
``(IV) State Long-Term Care
Ombudsman programs (as described in
section 712(a)(1) of the Older
Americans Act of 1965); and
``(V) the community at large.
``(ii) Written notification.--The Secretary
shall ensure that, in the case of a skilled
nursing facility that is participating in the
low-rated facility program, residents of such
facility and family or legal representatives
are furnished with individualized written
notice of such participation. Such notice shall
be provided to current residents and to new
residents prior to admission.
``(J) Requirement for removal.--The Secretary shall
require that a skilled nursing facility show
improvement prior to removal from the low-rated
facility program.''.
(C) Use of civil money penalties.--Section
1819(h)(2)(B)(ii)(IV)(ff) of the Social Security Act
(42 U.S.C. 1395i-3(h)(2)(B)(ii)(IV)(ff)) is amended--
(i) by striking ``and facility improvement
initiatives'' and inserting ``facility
improvement initiatives''; and
(ii) by inserting the following before the
period at the end: ``, and, on and after the
date the Secretary makes the conversion
described in subsection (f)(8)(D),
consultation, education, and other activities
to foster improvement and remedy root causes
contributing to deficiencies cited across
multiple surveys among facilities in the low-
rated facility program under subsection
(f)(8)''.
(3) Information on high-rated and low-rated facilities on
nursing home compare medicare website.--Section 1819(i)(1) of
the Social Security Act (42 U.S.C. 1395i-3(i)(1)) is amended--
(A) in subparagraph (A), by adding at the end the
following new clause:
``(vi) On and after the date the Secretary
implements the high-rated facility program
under subsection (f)(10) and makes the
conversion under subsection (f)(8)(D),
consistent with subparagraph (C)--
``(I) for each skilled nursing
facility that is designated as a high-
rated skilled nursing facility under
subsection (f)(10), the date the
facility was so designated; and
``(II) for each skilled nursing
facility participating in the low-rated
facility program under subsection
(f)(8), the date the facility was
identified for inclusion in such
program.''; and
(B) by adding at the end the following new
subparagraphs:
``(C) Distinctions for high-rated and low-rated
facilities.--On and after the date the Secretary
implements the high-rated facility program under
subsection (f)(10) and makes the conversion under
subsection (f)(8)(D), the Secretary shall ensure that
graphics, including an appropriate explanation of such
graphics, are prominently displayed on the website
described in subparagraph (A) in order to distinguish
each of the following:
``(i) Skilled nursing facilities that are
designated as high-rated skilled nursing
facilities under subsection (f)(10).
``(ii) Skilled nursing facilities that are
participating in the low-rated facility program
under subsection (f)(8), with information on
facilities that have been placed in such
program more than one time over the course of
the last 10 years (including the number of
times such skilled nursing facilities have been
placed in the program).
``(D) Focus groups and consumer testing.--In order
to help limit confusion, particularly among older
adults, individuals with disabilities, and family
caregivers, the Secretary shall utilize focus groups
and other consumer testing methods prior to including
the additional information under subparagraph (A)(vi)
and implementing the distinctions under subparagraph
(C).''.
(c) Medicaid Program Revisions.--
(1) Establishment of rankings and high-rated facility
program.--
(A) In general.--Section 1919(f) of the Social
Security Act (42 U.S.C. 1396r(f)) is amended by adding
at the end the following new paragraphs:
``(11) Ranking process.--
``(A) Process.--
``(i) Establishment.--The Secretary shall
establish a process to rank nursing facilities
based on compliance with the applicable
requirements of this Act.
``(ii) Data.--The process established under
clause (i) shall include the use of at least
the preceding 3 years of health inspection
data, if appropriate, and other data as
determined appropriate by the Secretary.
``(iii) Findings and recommendations of the
advisory council on skilled nursing facility
rankings under medicare and nursing facility
rankings under medicaid.--In establishing the
process under clause (i), the Secretary shall
take into account the findings and
recommendations of the Advisory Council that
are submitted to the Secretary under section
2(a)(3)(B)(i) of the Nursing Home Reform
Modernization Act of 2021.
``(B) Ranking.--
``(i) In general.--Under the process
established under subparagraph (A), the
Secretary shall use the rankings of nursing
facilities to categorize facilities into
highest and lowest groups for the purposes
specified in clause (ii).
``(ii) Timing and use of rankings.--Not
later than 2 years after the date the Secretary
receives the findings and recommendations
described in subparagraph (A)(iii), the
Secretary shall use the rankings under clause
(i) for purposes of carrying out--
``(I) the high-rated facility
program under paragraph (12); and
``(II) the low-rated facility
program under paragraph (10).
``(12) High-rated facility program.--
``(A) Establishment.--
``(i) In general.--Not later than 2 years
after the date the Secretary receives the
findings and recommendations described in
paragraph (11)(A)(iii), the Secretary shall
establish and implement a high-rated facility
program to encourage and reward compliance with
the requirements of this Act.
``(ii) Report.--In establishing the high-
rated facility program, the Secretary shall
take into account the findings and
recommendations described in paragraph
(11)(A)(iii).
``(iii) Regulations.--The Secretary shall
establish the high-rated facility program under
clause (i) through notice and comment
rulemaking.
``(B) Designation.--Under the high-rated facility
program, subject to subparagraph (D), the Secretary
shall designate the highest rated nursing facilities
under the rankings under paragraph (11)(B) as high-
rated nursing facilities.
``(C) Distinction on nursing home compare
website.--A nursing facility that is designated as a
high-rated nursing facility under subparagraph (B)
shall receive a high-rated distinction on the official
Internet website of the Federal Government for
comparing nursing homes pursuant to subsection
(i)(1)(C).
``(D) Suspension of high-rated status.--
``(i) In general.--The Secretary shall
suspend a nursing facility's designation under
subparagraph (B) if the Secretary determines
that there are circumstances warranting such
suspension.
``(ii) Circumstances.--In establishing the
circumstances under clause (i), the Secretary
shall take into account--
``(I) findings from Federal surveys
and investigations;
``(II) findings from State surveys
conducted under subsection (g)(2)(A);
``(III) findings from State
investigations and surveys conducted
under subsection (g)(4), including a
high number of substantiated
complaints, the frequency and severity
of substantiated complaints, and how
the complaints are handled by the
facility;
``(IV) situations involving changes
of ownership, administration, or
management of a nursing facility, or
the director of nursing;
``(V) situations involving the
inappropriate administration of
medications by a facility;
``(VI) situations involving
involuntary discharges of residents;
and
``(VII) other factors determined
appropriate by the Secretary.
``(iii) No reinstatement prior to next
standard survey.--If a nursing facility's
designation is suspended under clause (i), such
designation shall not be reinstated prior to a
subsequent survey as specified under subsection
(g)(2)(A)(iii).''.
(B) Assessment of high-rated designation in special
surveys.--Section 1919(g)(2)(A)(iii)(II) of the Social
Security Act (42 U.S.C. 1396r(g)(2)(A)(iii)(II)) is
amended--
(i) by inserting ``(or, in the case of a
facility that is designated as a high-rated
nursing facility under subsection (f)(12),
shall be conducted)'' after ``may be
conducted''; and
(ii) by adding at the end the following new
sentence: ``On and after the date the Secretary
implements the high-rated facility program
under subsection (f)(12), any survey conducted,
pursuant to the preceding sentence, of a
facility that is designated as a high-rated
nursing facility under such subsection shall
include an assessment of whether such
designation should continue or be suspended
under subparagraph (D) of such subsection.''.
(2) Improvements to the special focus facility program.--
(A) Appropriate participation.--Section 1919(f)(10)
of the Social Security Act (42 U.S.C. 1395r(f)(10)) is
amended--
(i) in subparagraph (A), by striking ``The
Secretary'' and inserting ``Subject to the
succeeding provisions of this subsection, the
Secretary''; and
(ii) by adding at the end the following new
subparagraph:
``(C) Appropriate participation.--Not later than 1
year after the date of enactment of the Nursing Home
Reform Modernization Act of 2021, the Secretary shall
ensure that the number of facilities participating in
the special focus facility program is not less than 3.5
percent of all nursing facilities.''.
(B) Conversion of the special focus facility
program to the low-rated facility program and
additional requirements.--Section 1919(f)(10) of the
Social Security Act (42 U.S.C. 1395i-3(f)(10)), as
amended by subparagraph (A), is amended--
(i) in subparagraph (B), by inserting the
following before the period at the end: ``(or,
on and after the date the Secretary makes the
conversion described in subparagraph (D), at a
frequency determined appropriate by the
Secretary (but in no case less than once every
6 months))''; and
(ii) by adding at the end the following new
subparagraphs:
``(D) Conversion to the low-rated facility
program.--
``(i) In general.--On the same date that
the Secretary implements the high-rated
facility program under paragraph (12), the
Secretary shall convert the special focus
facility program under this subsection to the
low-rated facility program.
``(ii) Regulations.--The Secretary shall
carry out the conversion under clause (i)
through notice and comment rulemaking.
``(iii) Additional requirements for the
low-rated facility program.--In addition to the
provisions that apply to the low-rated facility
program through the conversion from the special
focus facility program, the succeeding
provisions of this subsection shall also apply
to the low-rated facility program.
``(E) Participation.--Subject to the minimum
participation requirement under subparagraph (C), the
Secretary shall designate the lowest rated nursing
facilities under the rankings under paragraph (11)(B)
for participation in the low-rated facility program.
``(F) Progressive enforcement actions.--The
Secretary, in consultation with States, shall utilize
progressive enforcement actions, of increasing
severity, to ensure facilities participating in the
low-rated facility program meet the applicable
requirements under this Act.
``(G) Enforcement for patterns of deficiency.--The
Secretary may utilize enforcement actions specified in
subsection (h)(2) to remedy patterns of deficiencies
cited across multiple surveys.
``(H) Compliance assistance programs.--
``(i) On-site consultation and educational
programming.--
``(I) In general.--The Secretary
shall establish on-site consultation
and educational programming for nursing
facilities participating in the low-
rated facility program with respect to
compliance with the applicable
requirements under this Act.
``(II) Entity.--The on-site
consultation and educational
programming described in subclause (I)
shall be carried out by quality
improvement organizations under part B
of title XI or other independent
organizations of a similar type that do
not have conflicts of interest and are
deemed appropriate by the Secretary.
``(III) Required participation.--A
nursing facility participating in the
low-rated facility program shall
participate in any consultations and
educational programming described in
subclause (I) conducted at the
facility.
``(ii) Consultation independent of
enforcement.--
``(I) In general.--Subject to
subclause (II), on-site consultations
and educational programming described
in clause (i) shall be conducted
independently of any enforcement
activity.
``(II) Exception.--Subclause (I)
shall not apply in the case where a
triggering event at the nursing
facility is observed in the course of
providing on-site consultations and
educational programming described in
clause (i). In establishing such on-
site consultations and educational
programming, the Secretary shall
determine the triggering events for
which the use of necessary enforcement
actions is permitted notwithstanding
the limitation under subclause (I).
Such triggering events shall include
events that are required to be reported
under State and Federal law and a
pattern of deficiencies or problems
that the quality improvement
organization or other organization has
identified for correction but which are
consistently not corrected.
``(I) Public availability.--
``(i) In general.--The Secretary shall
ensure that a nursing facility's participation
in the low-rated facility program is publicly
announced, including to--
``(I) resident family councils;
``(II) resident attending
physicians;
``(III) the State board responsible
for the licensing of the nursing
facility administrator at the facility;
``(IV) State Long-Term Care
Ombudsman programs (as described in
section 712(a)(1) of the Older
Americans Act of 1965); and
``(V) the community at large.
``(ii) Written notification.--The Secretary
shall ensure that, in the case of a nursing
facility that is participating in the low-rated
facility program, residents of such facility
and family or legal representatives are
furnished with individualized written notice of
such participation. Such notice shall be
provided to current residents and to new
residents prior to admission.
``(J) Requirement for removal.--The Secretary shall
require that a nursing facility show improvement prior
to removal from the low-rated facility program.''.
(C) Use of civil money penalties.--Section
1919(h)(3)(C)(ii)(IV)(ff) of the Social Security Act
(42 U.S.C. 1396r(h)(3)(C)(ii)(IV)(ff)) is amended--
(i) by striking ``and facility improvement
initiatives'' and inserting ``facility
improvement initiatives''; and
(ii) by inserting the following before the
period at the end: ``, and, on and after the
date the Secretary makes the conversion
described in subsection (f)(10)(D),
consultation, education, and other activities
to foster improvement and remedy root causes
contributing to deficiencies cited across
multiple surveys among facilities in the low-
rated facility program under subsection
(f)(10)''.
(3) Information on high-rated and low-rated facilities on
nursing home compare medicare website.--Section 1919(i)(1) of
the Social Security Act (42 U.S.C. 1396r(i)(1)) is amended--
(A) in subparagraph (A), by adding at the end the
following new clause:
``(vi) On and after the date the Secretary
implements the high-rated facility program
under subsection (f)(12) and makes the
conversion under subsection (f)(10)(D),
consistent with subparagraph (C)--
``(I) for each nursing facility
that is designated as a high-rated
nursing facility under subsection
(f)(12), the date the facility was so
designated; and
``(II) for each nursing facility
participating in the low-rated facility
program under subsection (f)(10), the
date the facility was identified for
inclusion in such program.''; and
(B) by adding at the end the following new
subparagraphs:
``(C) Distinctions for high-rated and low-rated
facilities.--On and after the date the Secretary
implements the high-rated facility program under
subsection (f)(12) and makes the conversion under
subsection (f)(10)(D), the Secretary shall ensure that
graphics, including an appropriate explanation of such
graphics, are prominently displayed on the website
described in subparagraph (A) in order to distinguish
each of the following:
``(i) Nursing facilities that are
designated as high-rated nursing facilities
under subsection (f)(12).
``(ii) Nursing facilities that are
participating in the low-rated facility program
under subsection (f)(10), with information on
facilities that have been placed in such
program more than one time over the course of
the last 10 years (including the number of
times such nursing facilities have been placed
in the program).
``(D) Focus groups and consumer testing.--In order
to help limit confusion, particularly among older
adults, individuals with disabilities, and family
caregivers, the Secretary shall utilize focus groups
and other consumer testing methods prior to including
the additional information under subparagraph (A)(vi)
and implementing the distinctions under subparagraph
(C).''.
(d) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
(in this section referred to as the ``Comptroller General'')
shall conduct a study on the quality of items and services
furnished by skilled nursing facilities under title XVIII of
the Social Security Act and nursing facilities under title XIX
of such Act, and such facilities' compliance with the
applicable requirements under such titles. Such study shall
include analysis of the following:
(A) The effectiveness of the low-rated facility
program established under paragraph (8) of section
1819(f) of the Social Security Act (42 U.S.C. 1395i-
3(f)), as amended by subsection (b)(2), and under
paragraph (10) of section 1919(f) of such Act (42
U.S.C. 1396r(f)), as amended by subsection (c)(2).
(B) Other areas determined appropriate by the
Comptroller General.
(2) Report.--Not later than 6 years after the date of
enactment of this Act, the Comptroller General shall submit to
the appropriate Committees of Congress a report containing the
results of the study conducted under paragraph (1), together
with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
(e) Rules of Construction.--
(1) Surveys.--Nothing in the provisions of, or the
amendments made by, this section shall be construed to allow
the Secretary to modify or deviate from--
(A) a survey schedule that requires unannounced and
unanticipated surveying of skilled nursing facilities
under subsection (g)(2)(A)(i) of section 1819 of the
Social Security Act (42 U.S.C. 1395i-3(g)) or under
subsection (g)(2)(A)(i) of section 1919 of the Social
Security Act (42 U.S.C. 1396r(g));
(B) the surveying frequency specified under
subsection (g)(2)(A)(iii) of such section 1819 or under
subsection (g)(2)(A)(iii) of such section 1919; or
(C) surveys and investigations as required under
subsection (g)(4) of such section 1819 or under
subsection (g)(4) of such section 1919.
(2) Accountability and state law.--Nothing in the
provisions of, or the amendments made by, this section shall be
construed to impact the ability of a resident, the family of a
resident, or a successor in interest to hold a skilled nursing
facility or nursing facility accountable or change protections
granted under State law.
SEC. 3. DEFINITIONS.
In this Act:
(1) Appropriate committees of congress.--The term
``appropriate Committee of Congress'' means--
(A) the Committee on Finance of the Senate;
(B) the Committee on Health, Education, Labor, and
Pensions of the Senate;
(C) the Special Committee on Aging of the Senate;
(D) the Committee on Ways and Means of the House of
Representatives; and
(E) the Committee on Energy and Commerce of the
House of Representatives.
(2) Nursing facility.--The term ``nursing facility'' has
the meaning given that term in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a)).
(3) Skilled nursing facility.--The term ``skilled nursing
facility'' has the meaning given that term in section 1819(a)
of the Social Security Act (42 U.S.C. 1395i-3(a)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
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