[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 2694 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 2694
To improve care furnished and to support the workforce in skilled
nursing facilities under the Medicare program and in nursing facilities
under the Medicaid program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 10, 2021
Mr. Wyden (for himself, Mr. Casey, Mr. Blumenthal, Mr. Bennet, Mr.
Whitehouse, and Mr. Brown) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve care furnished and to support the workforce in skilled
nursing facilities under the Medicare program and in nursing facilities
under the Medicaid program, and for other purposes.
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 Home
Improvement and Accountability Act of 2021''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--TRANSPARENCY AND ACCOUNTABILITY
Sec. 101. Improving the accuracy and reliability of certain skilled
nursing facility data.
Sec. 102. Ensuring accurate information on cost reports.
Sec. 103. Requiring a surety bond for skilled nursing facilities and
nursing facilities.
Sec. 104. Survey improvements.
Sec. 105. Prohibiting pre-dispute arbitration agreements.
Sec. 106. Improvements to the special focus facility program.
TITLE II--STAFFING IMPROVEMENTS
Sec. 201. Nurse staffing requirements.
Sec. 202. Improving Nursing Home Compare staffing data.
Sec. 203. Ensuring the submission of accurate staffing data.
Sec. 204. Requiring 24-hour use of registered professional nurses.
Sec. 205. Provision of infection control services.
Sec. 206. Enhanced funding to support staffing and quality care in
nursing facilities.
TITLE III--BUILDING MODIFICATION AND STAFF INVESTMENT DEMONSTRATION
PROGRAM
Sec. 301. Establishing a skilled nursing facility building modification
and staff investment demonstration program.
TITLE I--TRANSPARENCY AND ACCOUNTABILITY
SEC. 101. IMPROVING THE ACCURACY AND RELIABILITY OF CERTAIN SKILLED
NURSING FACILITY DATA.
(a) Reduction in Payments for Inaccurate Reporting.--Section
1888(e)(6)(A) of the Social Security Act (42 U.S.C. 1395yy(e)(6)(A)) is
amended--
(1) in the header, by striking ``for failure to report'';
and
(2) in clause (i)--
(A) by striking ``For fiscal years'' and inserting
the following:
``(I) Failure to report.--For
fiscal years''; and
(B) by adding at the end the following new
subclause:
``(II) Reporting of inaccurate
information.--For fiscal years
beginning with fiscal year 2025, in the
case of a skilled nursing facility that
submits data under this paragraph,
measures under subsection (h), or
resident assessment data described in
section 1819(b)(3) with respect to such
fiscal year that is inaccurate (as
determined by the Secretary through the
validation process described in section
1888(h)(12) or otherwise), after
determining the percentage described in
paragraph (5)(B)(i), and after
application of clauses (ii) and (iii)
of paragraph (5)(B) and of subclause
(I) if this clause (if applicable), the
Secretary shall reduce such percentage
for payment rates during such fiscal
year by 2 percentage points.''.
(b) Data and Measures Validation.--Section 1888(h)(12) of the
Social Security Act (42 U.S.C. 1395yy(h)(12)) is amended--
(1) in subparagraph (A), by striking ``and the data
submitted under subsection (e)(6)'' and inserting ``, the data
submitted under subsection (e)(6), and, beginning with fiscal
year 2024, the resident assessment data described in section
1819(b)(3)''; and
(2) in subparagraph (B), by striking ``of $5,000,000'' and
all that follows through the period at the end and inserting
the following: ``of--
``(i) $5,000,000 for each of fiscal years
2023 through 2025; and
``(ii) $50,000,000 for the period of fiscal
years 2026 through 2035,
to the Centers for Medicare & Medicaid Services Program
Management Account, to remain available until
expended.''.
(c) Providing Authority To Collect Data on Additional Measures.--
Section 1888(e)(6)(B)(i)(II) of the Social Security Act (42 U.S.C.
1395yy(e)(6)(B)(i)(II)) is amended by inserting ``, and data on any
other validated measure specified by the Secretary'' after ``under such
subsection (d)(1)''.
SEC. 102. ENSURING ACCURATE INFORMATION ON COST REPORTS.
Section 1888(f) of the Social Security Act (42 U.S.C. 1395yy(f)) is
amended by adding at the end the following new paragraphs:
``(5) Audit of cost reports.--
``(A) In general.--Beginning in 2022, and annually
thereafter, the Secretary shall conduct an audit of
cost reports submitted under this title for a
representative sample of skilled nursing facilities.
``(B) Funding.--The Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 to the Centers for Medicare &
Medicaid Services Program Management Account, of
$250,000,000 for fiscal year 2023 for purposes of
carrying out this paragraph. Amounts transferred
pursuant to the previous sentence shall remain
available until expended.
``(6) Review of relationship between cost report data and
quality.--
``(A) In general.--Not later than 2 years after the
Secretary completes the first audit described in
paragraph (5), and not less frequently than once every
2 years thereafter, the Inspector General of the
Department of Health and Human Services shall conduct
an analysis of, and submit to Congress a report on, the
relationship between skilled nursing facility
expenditures for functional accounts described in
paragraph (3) and skilled nursing facility quality (as
specified by the Inspector General).
``(B) Funding.--The Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 to the Inspector General of the
Department of Health and Human Services $25,000,000 for
fiscal year 2023 for purposes of carrying out this
paragraph. Amounts transferred pursuant to the previous
sentence shall remain available until expended''.
SEC. 103. REQUIRING A SURETY BOND FOR SKILLED NURSING FACILITIES AND
NURSING FACILITIES.
(a) Medicare.--Section 1819(a) of the Social Security Act (42
U.S.C. 1395i-3(a)) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by adding at the end the following new paragraph:
``(4) provides the Secretary with a surety bond in a form
specified by the Secretary and in an amount that is not less
than the minimum of $500,000, unless the Secretary waives the
provision of such surety bond due to such facility providing a
comparable surety bond under State law.''.
(b) Medicaid.--Section 1919(a) of the Social Security Act (42
U.S.C. 1396r(a)) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (3) the following new
paragraph:
``(4) provides the Secretary with a surety bond in a form
specified by the Secretary and in an amount that is not less
than the minimum of $500,000, unless the Secretary waives the
provision of such surety bond due to such facility providing a
comparable surety bond under State law.''.
SEC. 104. SURVEY IMPROVEMENTS.
(a) In General.--Section 1128I of the Social Security Act (42
U.S.C. 1320a-7j) is amended--
(1) in the section heading, by striking ``accountability
requirements for'' and inserting ``additional requirements with
respect to''; and
(2) by adding at the end the following new subsection:
``(i) Survey Improvements.--
``(1) Review.--The Secretary shall review (and, as
appropriate, identify plans to improve) the following:
``(A) The extent to which surveys conducted under
subsection (g) of sections 1819 and 1919 and the
enforcement process under subsection (h) of sections
1819 and 1919 result in increased compliance with
requirements under sections 1819 and 1919 and subpart B
of part 483 of title 42, Code of Federal Regulations,
with respect to facilities.
``(B) The timeliness and thoroughness of State
agency verification of deficiency corrections at
facilities.
``(C) The appropriateness of the scoping and
substantiation of cited deficiencies at facilities.
``(D) The accuracy of the identification and
appropriateness of the scoping of life safety,
infection control, and emergency preparedness
deficiencies at facilities.
``(E) The timeliness of State agency investigations
of--
``(i) complaints at facilities; and
``(ii) reported allegations of abuse,
neglect, and exploitation at facilities.
``(F) The consistency of facility reporting of
substantiated complaints to law enforcement.
``(G) The ability of the State agency to
sufficiently hire, train, and retain individuals who
conduct surveys.
``(H) Any other area related to surveys of
facilities, or the individuals conducting such surveys,
determined appropriate by the Secretary.
``(2) Report.--Not later than 3 years after the date of
enactment of this subsection, the Secretary shall submit to
Congress a report on the review conducted under paragraph (1),
together with recommendations for such legislation and
administrative action as the Secretary determines to be
appropriate.
``(3) Support.--If determined appropriate by the Secretary,
based on the review under paragraph (1), the Secretary shall
provide training, tools, technical assistance, and financial
support to State agencies that perform surveys of facilities
for the purpose of improving the surveys conducted under
subsection (g) and the enforcement process under subsection (h)
with respect to the areas reviewed under paragraph (1).
``(4) Funding.--There is appropriated to the Secretary, out
of any monies in the Treasury not otherwise appropriated,
$570,000,000, to remain available until expended, for purposes
of carrying out this subsection.''.
SEC. 105. PROHIBITING PRE-DISPUTE ARBITRATION AGREEMENTS.
(a) Medicare.--Section 1819(c) of the Social Security Act (42
U.S.C. 1395i-3(c)) is amended by adding at the end the following new
paragraph:
``(7) Prohibition on use of pre-dispute arbitration
agreements.--
``(A) In general.--A skilled nursing facility may
not enter into a pre-dispute arbitration agreement with
an individual applying to reside or residing in the
facility (or a legal representative of such resident),
and may not enter into an agreement for services with
an entity or individual that enters into a pre-dispute
arbitration agreement with an individual applying to
reside or residing in the facility (or a legal
representative of such resident).
``(B) No validity or enforcement.--A skilled
nursing facility shall not enforce a pre-dispute
arbitration agreement against a resident or former
resident of a skilled nursing facility (or a legal
representative of such resident), without regard to
whether the agreement was made prior to or after the
effective date of this paragraph.
``(C) Definition of pre-dispute arbitration
agreement.--In this paragraph, the term `pre-dispute
arbitration agreement' means any agreement to arbitrate
a potential dispute that, as of the date on which such
agreement is entered into, has not yet arisen.
``(D) Judicial review.--A determination as to
whether and how this paragraph applies to a pre-dispute
arbitration agreement shall be determined under Federal
law by a court of competent jurisdiction, rather than
an arbitrator, without regard to whether the party
opposing arbitration challenges such agreement
specifically or in conjunction with any other term of
the contract containing such agreement.''.
(b) Medicaid.--
(1) Home and community-based services and home health care
services.--Section 1915 of the Social Security Act (42 U.S.C.
1396n) is amended by adding at the end the following new
subsection:
``(l) Prohibiting Pre-Dispute Arbitration Agreements.--
``(1) In general.--For home and community-based services or
home health care services provided under a waiver under this
section, section 1902(a)(10)(D), or any other provision
authorizing the provision of home and community-based services
or home health care services under this title, the provider of
such services (and any employee, agent, related entity, or
affiliate of such provider) may not enter into a pre-dispute
arbitration agreement with an individual receiving such
services (or a legal representative of such individual). A
provider of such services (and any employee, agent, related
entity, or affiliate of such provider) shall not enforce a pre-
dispute arbitration agreement against an individual receiving
such services, or who formerly received such services (or a
legal representative of such individual), without regard to
whether such agreement was made prior to the effective date of
this subsection.
``(2) Definition of pre-dispute arbitration agreement.--In
this subsection, the term `pre-dispute arbitration agreement'
means any agreement to arbitrate a potential dispute that, as
of the date on which such agreement is entered into, has not
yet arisen.
``(3) Judicial review.--A determination as to whether and
how this subsection applies to a pre-dispute arbitration
agreement shall be determined under Federal law by a court of
competent jurisdiction, rather than an arbitrator, without
regard to whether the party opposing arbitration challenges
such agreement specifically or in conjunction with any other
term of the contract containing such agreement.''.
(2) Nursing facilities.--Section 1919(c) of the Social
Security Act (42 U.S.C. 1396r(c)) is amended by adding at the
end the following new paragraph:
``(9) Prohibition on use of pre-dispute arbitration
agreements.--
``(A) In general.--A nursing facility may not enter
into a pre-dispute arbitration agreement with an
individual applying to reside or residing in the
facility (or a legal representative of such resident),
and may not enter into an agreement for services with
an entity or individual that enters into a pre-dispute
arbitration agreement with an individual applying to
reside or residing in the facility (or a legal
representative of such resident).
``(B) No validity or enforcement.--A nursing
facility shall not enforce a pre-dispute arbitration
agreement against a resident or former resident of a
nursing facility (or a legal representative of such
resident), without regard to whether the agreement was
made prior to or after the effective date of this
paragraph.
``(C) Definition of pre-dispute arbitration
agreement.--In this paragraph, the term `pre-dispute
arbitration agreement' means any agreement to arbitrate
a potential dispute that, as of the date on which such
agreement is entered into, has not yet arisen.
``(D) Judicial review.--A determination as to
whether and how this paragraph applies to a pre-dispute
arbitration agreement shall be determined under Federal
law by a court of competent jurisdiction, rather than
an arbitrator, without regard to whether the party
opposing arbitration challenges such agreement
specifically or in conjunction with any other term of
the contract containing such agreement.''.
SEC. 106. IMPROVEMENTS TO THE SPECIAL FOCUS FACILITY PROGRAM.
(a) Appropriate Participation.--
(1) Medicare.--Section 1819(f)(8) of the Social Security
Act (42 U.S.C. 1395i-3(f)(8)) is amended--
(A) in subparagraph (A), by striking ``The
Secretary'' and inserting ``Subject to the succeeding
provisions of this subsection, the Secretary''; and
(B) by adding at the end the following new
subparagraph:
``(C) Appropriate participation.--Not later than
October 1, 2022, the Secretary shall ensure that the
number of facilities participating in the special focus
facility program is not less than 5 percent of all
skilled nursing facilities.''.
(2) Medicaid.--Section 1919(f)(10) of the Social Security
Act (42 U.S.C. 1395r(f)(10)) is amended--
(A) in subparagraph (A), by striking ``The
Secretary'' and inserting ``Subject to the succeeding
provisions of this subsection, the Secretary''; and
(B) by adding at the end the following new
subparagraph:
``(C) Appropriate participation.--Not later than
October 1, 2022, the Secretary shall ensure that the
number of facilities participating in the special focus
facility program is not less than 5 percent of all
nursing facilities.''.
(b) Compliance Assistance Programs.--
(1) Medicare.--Section 1819(f)(8) of the Social Security
Act (42 U.S.C. 1395i-3(f)(8)), as amended by subsection (a)(1),
is amended by adding at the end the following new subparagraph:
``(D) 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
special focus 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 special focus 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.''.
(2) Medicaid.--Section 1919(f)(10) of the Social Security
Act (42 U.S.C. 1395r(f)(10)), as amended by subsection (a)(2),
is amended by adding at the end the following new subsection:
``(D) 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 special
focus 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
special focus 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.''.
(c) Funding for the Special Focus Facility Program, Including
Compliance Assistance Programs.--Section 1819(f)(8) of the Social
Security Act (42 U.S.C. 1395i-3(f)(8)), as amended by subsections
(a)(1) and (b)(1), is amended by adding at the end the following new
subparagraph:
``(E) For purposes of carrying out this paragraph
and section 1919(f)(10), there is appropriated to the
Secretary, out of any monies in the Treasury not
otherwise appropriated, $14,800,000 for fiscal year
2022 and each subsequent fiscal year, to remain
available until expended.''.
TITLE II--STAFFING IMPROVEMENTS
SEC. 201. NURSE STAFFING REQUIREMENTS.
(a) In General.--Title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by inserting after section 1128K the following
new section:
``SEC. 1128L. NURSE STAFFING REQUIREMENTS FOR FACILITIES.
``(a) Study.--Not later than 3 years after the date of the
enactment of this section, and not less frequently than once every 5
years thereafter, the Secretary shall conduct a study and submit to
Congress a report on the appropriateness of establishing minimum staff
to resident ratios for nursing staff for skilled nursing facilities (as
defined in section 1819(a)) and nursing facilities (as defined in
section 1919(a)). Each such report shall include--
``(1) with respect to the first such report,
recommendations regarding appropriate minimum ratios of
registered nurses (and, if practicable, licensed practical
nurses (or licensed vocational nurses) and certified nursing
assistants) to residents at such skilled nursing facilities and
such nursing facilities; and
``(2) with respect to each subsequent such report,
recommendations regarding appropriate minimum ratios of
registered nurses, licensed practical nurses (or licensed
vocational nurses), and certified nursing assistants to
residents at such skilled nursing facilities and such nursing
facilities.
``(b) Promulgation of Regulations.--
``(1) In general.--Not later than 2 years after the
Secretary first submits a report under subsection (a), the
Secretary shall--
``(A) specify through regulations, consistent with
such report, appropriate minimum ratios (if any) of
registered nurses (and, if practicable, licensed
practical nurses (or licensed vocational nurses) and
certified nursing assistants) to residents at skilled
nursing facilities and nursing facilities; and
``(B) subject to any waiver in effect under section
1819(b)(9)(B) or 1919(b)(9)(B), require such skilled
nursing facilities and such nursing facilities to
comply with such ratios.
``(2) Update.--Not later than 2 years after the submission
of each subsequent report under subsection (a), the Secretary
shall, consistent with such report, update the regulations
described in paragraph (1)(A) to reflect appropriate minimum
ratios (if any) of registered nurses, licensed practical nurses
(or licensed vocational nurses), and certified nursing
assistants to residents at skilled nursing facilities and
nursing facilities.
``(c) Funding.--The Secretary shall provide for the transfer, from
the Federal Hospital Insurance Trust Fund under section 1817 to the
Centers for Medicare & Medicaid Services Program Management Account, of
$50,000,000 for fiscal year 2022 for purposes of carrying out this
section. Amounts transferred pursuant to the previous sentence shall
remain available until expended.''.
(b) Imposition of Requirements.--
(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:
``(9) Nurse staffing requirement.--
``(A) In general.--Subject to subparagraph (B), a
skilled nursing facility shall comply with any minimum
staffing ratios for registered nurses, licensed
practical nurses (or licensed vocational nurses), or
certified nurse assistants specified by the Secretary
for such a facility in regulations promulgated under
section 1128L(b) or, if greater, as specified by the
State involved for such a facility.
``(B) Waiver.--
``(i) In general.--The Secretary may waive
the application of subparagraph (A) with
respect to a skilled nursing facility if the
Secretary finds that--
``(I) the facility is located in a
rural area and the supply of skilled
nursing facility services in such area
is not sufficient to meet the needs of
individuals residing therein;
``(II) the Secretary provides
notice of the waiver to the State long-
term care ombudsman (established under
section 307(a)(12) of the Older
Americans Act of 1965) and the
protection and advocacy system in the
State for the mentally ill and the
mentally retarded; and
``(III) the facility that is
granted such a waiver notifies
residents of the facility (or, where
appropriate, the guardians or legal
representatives of such residents) and
members of their immediate families of
the waiver.
``(ii) Renewal.--Any waiver in effect under
this subparagraph shall be subject to annual
renewal.''.
(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) Nurse staffing requirement.--
``(A) In general.--Subject to subparagraph (B), a
nursing facility shall comply with any minimum staffing
ratios for registered nurses, licensed practical nurses
(or licensed vocational nurses), or certified nurse
assistants specified by the Secretary for such a
facility in regulations promulgated under section
1128L(b) or, if greater, as specified by the State
involved for such a facility.
``(B) Waiver.--
``(i) In general.--The Secretary may waive
the application of subparagraph (A) with
respect to a nursing facility if the Secretary
finds that--
``(I) the facility is located in a
rural area and the supply of nursing
facility services in such area is not
sufficient to meet the needs of
individuals residing therein;
``(II) the Secretary provides
notice of the waiver to the State long-
term care ombudsman (established under
section 307(a)(12) of the Older
Americans Act of 1965) and the
protection and advocacy system in the
State for the mentally ill and the
mentally retarded; and
``(III) the facility that is
granted such a waiver notifies
residents of the facility (or, where
appropriate, the guardians or legal
representatives of such residents) and
members of their immediate families of
the waiver.
``(ii) Renewal.--Any waiver in effect under
this subparagraph shall be subject to annual
renewal.''.
SEC. 202. IMPROVING NURSING HOME COMPARE STAFFING DATA.
(a) Medicare.--Section 1819(i)(1)(A)(i) of the Social Security Act
(42 U.S.C. 1395i-3(i)(1)(A)(i)) is amended by inserting ``(excluding,
with respect to such data provided on or after October 1, 2022, any
hours spent on administrative duties by licensed nurse staff) and,
beginning October 1, 2022, data on the hours of care provided per
resident per weekend day'' after ``per resident per day''.
(b) Medicaid.--Section 1919(i)(1)(A)(i) of the Social Security Act
(42 U.S.C. 1396r(i)(1)(A)(i)) is amended by inserting ``(excluding,
with respect to such data provided on or after October 1, 2022, any
hours spent on administrative duties by licensed nurse staff) and,
beginning October 1, 2022, data on the hours of care provided per
resident per weekend day'' after ``per resident per day''.
SEC. 203. ENSURING THE SUBMISSION OF ACCURATE STAFFING DATA.
Section 1128I(g) of the Social Security Act (42 U.S.C. 1320a-7j(g))
is amended--
(1) by redesignating paragraphs (1) through (4) as
subparagraphs (A) through (D), respectively, and adjusting the
margins accordingly;
(2) in subparagraph (D), as so redesignated, by striking
``paragraph (1)'' and inserting ``subparagraph (A)'';
(3) by moving the flush matter following subparagraph (D),
as so redesignated, 2 ems to the right;
(4) by striking ``Beginning not later than'' and inserting
the following:
``(1) In general.--Beginning not later than''; and
(5) by adding at the end the following new paragraph:
``(2) Penalty for submission of inaccurate information.--
Any facility that submits inaccurate information to the
Secretary under paragraph (1) may be subject to a civil
monetary penalty not to exceed $10,000 for each such
submission. The provisions of section 1128A (other than
subsections (a) and (b) of such section) shall apply to a civil
money penalty under the preceding sentence in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a).''.
SEC. 204. REQUIRING 24-HOUR USE OF REGISTERED PROFESSIONAL NURSES.
(a) Medicare.--Section 1819(b)(4)(C)(i) of the Social Security Act
(42 U.S.C. 1395i-3(b)(4)(C)(i)) is amended by striking ``registered
professional nurse'' and all that follows through the period at the end
and inserting the following: ``registered professional nurse, with
respect to such services furnished--
``(I) before October 1, 2023, at
least 8 consecutive hours a day, 7 days
a week; and
``(II) on or after such date, 24
hours a day, 7 days a week.''.
(b) Medicaid.--Section 1919(b)(4)(C)(i)(II) of the Social Security
Act (42 U.S.C. 1396r(b)(4)(C)(i)(II)) is amended by striking
``registered professional nurse'' and all that follows through the
period at the end and inserting the following: ``registered
professional nurse, with respect to such services furnished--
``(aa) before October 1,
2023, at least 8 consecutive
hours a day, 7 days a week; and
``(bb) on or after such
date, 24 hours a day, 7 days a
week.''.
SEC. 205. PROVISION OF INFECTION CONTROL SERVICES.
(a) Medicare.--Section 1819(d)(3) of the Social Security Act (42
U.S.C. 1395i-3(d)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) respectively, and moving such clauses 2 ems to the
right;
(2) by striking ``environment.--A skilled'' and inserting
``environment.--
``(A) In general.--A skilled'';
(3) in subparagraph (A), as amended by paragraphs (1) and
(2)--
(A) in clause (i), by striking ``, and'' at the end
and inserting a semicolon;
(B) in clause (ii), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) provide, directly or under
arrangements with others, for infection control
services overseen by an infection preventionist
for a minimum number of hours per week as
determined appropriate by the Secretary (but,
subject to subparagraph (B), not less than 40
hours per week).''; and
(4) by adding at the end the following new subparagraph:
``(B) Reduction in required number of hours for
infection control services overseen by an infection
preventionist.--
``(i) In general.--The Secretary may grant
a waiver to a skilled nursing facility under
which the number of hours per week that
infection control services overseen by an
infection preventionist at the facility are
required under subparagraph (A)(iii) are
reduced if the Secretary finds that--
``(I) the facility--
``(aa) is located in a
rural area and the supply of
skilled nursing facility
services in such area is not
sufficient to meet the needs of
individuals residing therein;
or
``(bb) is of a size that
necessitates a lower
requirement;
``(II) the Secretary provides
notice of the waiver to the State Long-
Term Care Ombudsman (supported under
title III or chapter 2 of subtitle A of
title VII of the Older Americans Act of
1965) and the protection and advocacy
system (as defined in section 102 of
the Developmental Disabilities
Assistance and Bill of Rights Act of
2000) in the State; and
``(III) the facility that is
granted the waiver notifies residents
of the facility (or, where appropriate,
the guardians or legal representatives
of such residents) and members of their
immediate families of the waiver.
``(ii) Annual review.--A waiver under this
subparagraph shall be subject to annual review
by the Secretary.''.
(b) Medicaid.--Section 1919(d)(3) of the Social Security Act (42
U.S.C. 1396r(d)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) respectively, and moving such clauses 2 ems to the
right;
(2) by striking ``environment.--A nursing facility'' and
inserting ``environment.--
``(A) In general.--A nursing facility'';
(3) in subparagraph (A), as amended by paragraphs (1) and
(2)--
(A) in clause (i), by striking ``, and'' at the end
and inserting a semicolon;
(B) in clause (ii), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) provide, directly or under
arrangements with others, for infection control
services overseen by an infection preventionist
for a minimum number of hours per week as
determined appropriate by the Secretary (but,
subject to subparagraph (B), not less than 40
hours per week).''; and
(4) by adding at the end the following new subparagraph:
``(B) Reduction in required number of hours for
infection control services overseen by an infection
preventionist.--
``(i) In general.--A State may grant a
waiver to a nursing facility under which the
number of hours per week that infection control
services overseen by an infection preventionist
at the facility are required under subparagraph
(A)(iii) are reduced if--
``(I) the facility demonstrates to
the satisfaction of the State that the
facility has been unable, despite
diligent efforts (including offering
wages at the community prevailing rate
for nursing facilities), to recruit
appropriate personnel;
``(II) the State determines that
the waiver will not endanger the health
or safety of individuals staying in the
facility;
``(III) the State agency granting
the waiver provides notice of the
waiver to the State Long-Term Care
Ombudsman (supported under title III or
chapter 2 of subtitle A of title VII of
the Older Americans Act of 1965) and
the protection and advocacy system (as
defined in section 102 of the
Developmental Disabilities Assistance
and Bill of Rights Act of 2000); and
``(IV) the nursing facility that is
granted the waiver by a State notifies
residents of the facility (or, where
appropriate, the guardians or legal
representatives of such residents) and
members of their immediate families of
the waiver.
``(ii) Annual review.--A waiver under this
subparagraph shall be subject to annual review
by the State agency and to the review of the
Secretary and subject to clause (iii) shall be
accepted by the Secretary for purposes of this
title to the same extent as is the State's
certification of the facility. In granting or
renewing a waiver, a State may require the
facility to use other qualified, licensed
personnel to meet the staffing requirements
under subparagraph (A)(iii).
``(iii) Assumption of waiver authority by
secretary.--If the Secretary determines that a
State has shown a clear pattern and practice of
allowing waivers in the absence of diligent
efforts by facilities to meet the staffing
requirements under subparagraph (A)(iii), the
Secretary shall assume and exercise the
authority of the State to grant waivers.''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2022.
SEC. 206. ENHANCED FUNDING TO SUPPORT STAFFING AND QUALITY CARE IN
NURSING FACILITIES.
(a) FMAP Increase.--
(1) In general.--Notwithstanding subsection (b) or (ff) of
section 1905 of the Social Security Act (42 U.S.C. 1396d), in
the case of a State that meets the requirements described in
subsection (c), the Federal medical assistance percentage
determined for the State under subsection (b) of section 1905
of such Act (or subsection (ff) of such section, if applicable)
and, if applicable, as increased under subsection (y), (z),
(aa), or (ii) of such section or section 6008 of the Families
First Coronavirus Response Act (Public Law 116-127), or any
other provision of law, shall be increased by the applicable
number of percentage points specified in paragraph (2) (but not
to exceed 95 percent) with respect to amounts expended by the
State Medicaid program for medical assistance for nursing
facility services provided for each calendar quarter that
occurs during the applicable period and for which the Secretary
determines that the State meets such requirements. Any payment
made to Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, or American Samoa for expenditures on medical
assistance that are subject to the Federal medical assistance
percentage increase specified under the first sentence of this
paragraph shall not be taken into account for purposes of
applying payment limits under subsections (f) and (g) of
section 1108 of the Social Security Act (42 U.S.C. 1308).
(2) Applicable number of percentage points.--For purposes
of paragraph (1), the applicable number of percentage points
specified in this paragraph is--
(A) in the case of a calendar quarter that occurs
within the 16-quarter period that begins on the 1st day
of the applicable period, 3 percentage points;
(B) in the case of a calendar quarter that occurs
within the 4-quarter period immediately succeeding such
16-quarter period, 2 percentage points; and
(C) in the case of a calendar quarter that occurs
within the 4-quarter period immediately succeeding the
4-quarter period described in subparagraph (B), 1
percentage point.
(b) Definitions.--In this section:
(1) Applicable period.--The term ``applicable period''
means the period that--
(A) begins on the 1st day of the 1st calendar
quarter that begins on or after the date that is 1 year
after the date of enactment of this section; and
(B) ends on the last day of the succeeding 24th
calendar quarter.
(2) Nursing facility staff.--The term ``nursing facility
staff'' includes a registered nurse, licensed practical nurse,
licensed nursing assistant, certified nursing assistant,
nursing assistant, and any other relevant staff, as determined
by the Secretary, who provide care to Medicaid beneficiaries
who are residents in a nursing facility.
(3) Medicaid beneficiary.--The term ``Medicaid
beneficiary'' means an individual who is eligible for, and
enrolled in, a State Medicaid program.
(4) Medicaid program.--The term ``Medicaid program'' means,
with respect to a State, the State program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) (including any
waiver or demonstration under such title or under section 1115
of such Act (42 U.S.C. 1315) relating to such title).
(5) Nursing facility.--The term ``nursing facility''--
(A) has the meaning given such term in section
1919(a) of the Social Security Act (42 U.S.C.
1396r(a)); and
(B) includes a skilled nursing facility, as defined
in section 1819(a) of the Social Security Act (42
U.S.C. 1395i-3(a)), that is a participating provider in
the Medicaid program of the State in which the facility
is located or otherwise furnishes items or services for
which medical assistance is available under the
Medicaid program of the State in which the facility is
located.
(6) Nursing facility services.--
(A) In general.--Subject to subparagraphs (B) and
(C), the term ``nursing facility services'' has the
meaning given such term under section 1905(f) of the
Social Security Act (42 U.S.C. 1396d(f)).
(B) State medicaid program.--With respect to a
State, such term includes those services (including any
limitations on the provision of, or payment for, such
services) that are specified as nursing facility
services for purposes of the Medicaid program of the
State in which the nursing facility furnishing such
services is located.
(C) Individual plan of care.--Notwithstanding
subparagraph (A) or (B), such term includes items or
services that are specified in the individual plan of
care for a resident of a nursing facility and are
furnished to the resident in accordance with the
requirements of such plan.
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(c) Requirements.--As a condition for receipt of the increase under
subsection (a) to the Federal medical assistance percentage determined
for a State under subsection (b) of section 1905 of the Social Security
Act (42 U.S.C. 1396d) for a calendar quarter, the State shall
demonstrate to the satisfaction of the Secretary the following:
(1) Use of additional federal funds.--The State agrees to--
(A) use the Federal funds attributable to the
increase under subsection (a) only for the purposes
specified in subsection (d); and
(B) not use such Federal funds to satisfy any State
contribution required under the State Medicaid program.
(2) Plan for staffing and service improvements and
reporting.--The State has a reasonable plan for achieving the
purposes specified in subsection (d), including with respect
to--
(A) carrying out the staffing and service
improvements specified in subsection (e) to strengthen
nursing facility staff workforce and improve the
quality and safety of care for Medicaid beneficiaries;
and
(B) collecting and reporting the information
required under subsection (f).
(3) Supplement, not supplant.--The State agrees to use the
Federal funds attributable to the increase under subsection (a)
to supplement, and not supplant, the level of State funds
expended as of October 1, 2021, for nursing facility services,
including with respect to efforts to strengthen the nursing
facility staff workforce and improve the quality and safety of
care for Medicaid beneficiaries, under the State Medicaid
program.
(4) Reporting and oversight.--The State agrees to--
(A) annually report the information specified in
subsection (f) to the Secretary in such form and manner
as the Secretary shall require; and
(B) provide such data and information as is
necessary for the evaluation required under subsection
(g).
(d) Use of Funds.--A State may use the Federal funds attributable
to the increase under subsection (a) only for expenditures eligible for
payment under the State Medicaid program that are attributable to State
efforts to achieve both of the following purposes:
(1) To expand and improve nursing facility staffing,
including by increasing payments for nursing facility services
to improve staff wages and benefits, support retention and
recruitment, and reduce staff turnover, consistent with the
improvements specified in paragraphs (1) and (2) of subsection
(e).
(2) To support and improve the quality and safety of care
provided to Medicaid beneficiaries in nursing facilities,
including through efforts to expand the use of person-centered
models of care, and incentives or payments related to the
provision of care for Medicaid beneficiaries in private rooms.
(e) Staffing and Service Improvements.--The staffing and service
improvements specified in this subsection are the following:
(1) The State makes such changes to processes for
determining payment rates for nursing facility services as are
necessary to ensure that--
(A) such payment rates are reviewed and updated
every 2 years during the applicable period to support
the recruitment and retention of nursing facility
staff, and reduce turnover in such staff through a
transparent process that involves meaningful input from
stakeholders; and
(B) increases to such payment rates are, at a
minimum, used to proportionally increase wages and
benefits for nursing facility staff.
(2) The State updates, develops, and adopts training
opportunities and resources for nursing facility staff,
including training for providing person-centered care.
(3) The State improves and streamlines education and
options counseling services for Medicaid beneficiaries,
potential Medicaid beneficiaries, and family members of such
beneficiaries and potential beneficiaries, with respect to
eligibility and options for institutional and non-institutional
long term care.
(f) Annually Reported Information.--The information required to be
annually reported to the Secretary by a State with respect to such
reporting periods as the Secretary shall specify is the following:
(1) The number of Medicaid beneficiaries who received
during the reporting period or, as of the date of the report,
are receiving, nursing facility services in the State,
disaggregated by race, ethnicity, gender, geography, age, and
income.
(2) A description of how the State spent the Federal funds
attributable to the increase under subsection (a) during the
reporting period.
(3) Changes to payment rates for nursing facility services
under the State Medicaid program during the reporting period.
(4) The staffing information and employee turnover and
tenure information in nursing facilities in the State during
the reporting period, based on submissions to the Payroll-Based
Journal system of the Centers for Medicare & Medicaid Services
under section 1128I(g) of the Social Security Act (42 U.S.C.
1320a-7j(g)).
(5) The wages and benefits provided to nursing facility
staff in nursing facilities in the State during the reporting
period.
(6) A description of the health status of, and quality of
care provided to, Medicaid beneficiaries who are residents of
nursing facilities in the State during the reporting period, in
the manner determined by the Secretary.
(g) Evaluation.--The Secretary shall engage an external contractor
to conduct an independent evaluation of the impact of this section on--
(1) the quality and safety of care provided in nursing
facilities to Medicaid beneficiaries who are residents of
nursing facilities;
(2) the capacity of the nursing facility staff workforce to
provide quality, safe care for Medicaid beneficiaries who are
residents of nursing facilities; and
(3) the wages, benefits, and turnover of nursing facility
staff.
(h) Interim and Final Reports to Congress.--
(1) In general.--The Secretary shall submit an interim
report to Congress on the implementation of this section 4
years after the date of enactment of this section, and a final
report on the implementation of this section 8 years after such
date.
(2) Required information.--
(A) Interim and final reports.--The interim and
final reports submitted under this subsection shall
include the following information:
(i) The number of States that received an
increase to the Federal medical assistance
percentage of the State under subsection (a)
during the applicable period.
(ii) The State activities funded by the
Federal funds attributable to the increase
under subsection (a).
(B) Final report.--The final report submitted under
this section shall include, in addition to the
information required under subparagraph (A), the
results of the independent evaluation conducted
pursuant to subsection (g).
TITLE III--BUILDING MODIFICATION AND STAFF INVESTMENT DEMONSTRATION
PROGRAM
SEC. 301. ESTABLISHING A SKILLED NURSING FACILITY BUILDING MODIFICATION
AND STAFF INVESTMENT DEMONSTRATION PROGRAM.
Part A of title XVIII of the Social Security Act (42 U.S.C. 1395c
et seq.) is amended by inserting after section 1819 the following new
section:
``SEC. 1819A. COMMUNITY-BASED LIVING MODIFICATIONS AND STAFF INVESTMENT
DEMONSTRATION PROGRAM.
``(a) Establishment.--Not later than January 1, 2023, the Secretary
shall establish a demonstration program to test the impact of providing
skilled nursing facilities (as defined in section 1819(a)) selected by
the Secretary under subsection (b) funding to modify the built
environments of such facilities (or portions of such facilities) and
invest in individuals providing resident care in such facilities (or in
portions of such facilities) in order to, with respect to residents of
such facilities, improve health outcomes relative to residents of
facilities not so selected.
``(b) Application and Selection of Facilities.--
``(1) Application.--
``(A) In general.--A skilled nursing facility shall
only be eligible to receive funding under the
demonstration program established under subsection (a)
if such facility submits an application at such time
and in such manner as specified by the Secretary that
contains--
``(i) a description of modifications and
investments described in subsection (a) that
will be made by the facility using such funds,
including the estimated costs of such
modifications and investments;
``(ii) an agreement that such facility (or,
in the case such modifications and investments
are to be made only with respect to a portion
of such facility, such portion of such
facility)--
``(I) will meet the requirements
described in subparagraph (B) not later
than the date that is 2 years after
such facility first receives funds for
such modifications and investments
under such program; and
``(II) will continue to meet such
requirements for the 5-year period
beginning on the date that is 2 years
after such facilities first receives
such funds;
``(iii) an agreement that, in the case such
facility (or such portion of such facility, as
applicable) fails to meet such requirements in
accordance with clause (ii), such facility
will--
``(I) repay such funds to the
Secretary in an amount determined
appropriate by the Secretary under
subsection (d); and
``(II) notify each resident of such
facility (or each resident of such
portion of such facility, as
applicable) of the failure of such
facility or such portion, as
applicable, to meet such requirements;
``(iv) an agreement that, if such facility
is selected by the Secretary under paragraph
(2), the facility will notify each resident of
such facility (or each resident of such portion
of such facility, as applicable), of such
selection and include in such notification a
description of the program established under
subsection (a), including any modifications and
investments to be made with respect to such
facility (or with respect to such portion of
such facility, as applicable); and
``(v) in the case such modifications and
investments are to be made only with respect to
a portion of such facility, an agreement that
such facility will not discriminate in the
selection of residents who may reside in such
portion based on whether payment is being made
to such facility with respect to such resident
under this title, a State plan (or waiver of
such plan) under title XIX, or otherwise.
``(B) Requirements.--For purposes of subparagraph
(A), the requirements described in this subparagraph
with respect to a skilled nursing facility (or a
portion of such facility) are the following:
``(i) The facility (or portion) maintains
beds for no less than 5 and no more than 14
residents.
``(ii) The facility (or portion)
incorporates universal design (defined in
section 3(19) of the Assistive Technology Act
of 1998)) to ensure such facility (or portion)
is accessible to all residents, regardless of
age or disability, including by providing for
the following:
``(I) Private rooms and bathrooms
(unless such facility determines that
the provision of private rooms and
bathrooms at such facility would
adversely affect the availability of
skilled nursing facility services in
the area in which such facility is
located and the Secretary concurs with
such determination).
``(II) Shared space, including a
central living area, as defined by the
Secretary, with a communal dining table
and accessible kitchen.
``(III) Accessible outdoor space,
including a protected garden space for
use by residents and their visitors.
``(iii) The facility (or portion) provides
a clinical team that consists of a full-time
registered professional nurse or licensed
practical nurse (or licensed vocational nurse)
who works in partnership with certified nursing
assistants in a team-based, collaborative
model.
``(iv) The facility (or portion) has a
licensed practical nurse (or licensed
vocational nurse) on site at all times.
``(v) The facility (or portion) facilitates
a standing resident council run by residents,
and a standing family council run by family
members of residents, that meets such
requirements as may be specified by the
Secretary.
``(vi) The facility (or portion) solicits
resident input on facility policies (or
policies relating to such portion of such
facility), including with respect to programs
and scheduling, and, in the case of an
incapacitated resident, solicits such input
from an individual recognized by State law to
act on behalf of such resident.
``(vii) In addition to the resident
assessment under section 1819(b)(3), the
facility (or portion) conducts an assessment of
residents' care preferences (or, in the case of
an incapacitated resident, such preferences as
expressed by an individual recognized by State
law to act on behalf of such resident) not
later than 14 days after the resident is
admitted to such facility or portion of such
facility (or, in the case of a resident
residing at such facility at the time such
facility receives funding under the program
established under paragraph (1), not later than
14 days after the date of such receipt) to
ensure care is person-directed.
``(viii) The facility (or portion) offers
daily activities, such as art, music,
educational activities, or other activities
based on resident preferences.
``(C) Timeframe.--The Secretary shall develop the
application described in subparagraph (A) and begin
accepting such applications not later than July 1,
2023. The Secretary shall accept such applications
during the 2-year period beginning on the date such
applications are first accepted.
``(2) Selection.--
``(A) In general.--Not later than 2 years after the
date the Secretary first accepts applications under
paragraph (1), the Secretary shall select a number of
skilled nursing facilities determined appropriate by
the Secretary to receive funding under the program
established under subsection (a).
``(B) Preference.--In selecting skilled nursing
facilities under this paragraph, the Secretary shall--
``(i) give preference to facilities that--
``(I) are located in medically
underserved areas (as defined in
section 330(b)(3)(A) of the Public
Health Service Act); and
``(II) house a majority of
residents who are receiving medical
assistance consisting of nursing
facility services under a State plan
(or waiver of such plan) under title
XIX;
``(ii) give preference to facilities that
demonstrate the greatest likelihood of meeting
the requirements described in paragraph (1)(B)
within 2 years of receiving funding under the
program established under subsection (a);
``(iii) give preference to facilities that
offer staff training beyond such training
required under section 1819 (as determined
through payroll based journal data); and
``(iv) so select such facilities in a
manner that ensures geographic diversity, to
the extent practicable.
``(c) Funds.--
``(1) In general.--Subject to paragraph (3) and subsection
(h), the Secretary shall provide funds to each skilled nursing
facility selected under subsection (b)(2) in an amount equal to
not more than the costs specified by such facility pursuant to
subsection (b)(1)(A)(i).
``(2) Use of funds.--
``(A) In general.--Subject to subparagraph (B),
funds provided under paragraph (1) may only be used by
a skilled nursing facility for modifications and
investments specified by such facility pursuant to
subsection (b)(1)(A)(i).
``(B) Exception.--A skilled nursing facility may
use funds provided under paragraph (1) for
modifications and investments described in subsection
(a) but not specified by such facility pursuant to
subsection (b)(1)(A)(i) if--
``(i) such facility submits a request to
the Secretary containing a description of such
modifications and investments; and
``(ii) the Secretary determines that such
modifications and investments will assist such
facility (or a portion of such facility, as
applicable) in complying with the requirements
specified in subsection (b)(1)(B).
``(3) Form of provision of funds.--The Secretary may
provide funding under paragraph (1) in the form of a single
upfront payment or in up to 3 installment payments, spaced out
across the first 3 fiscal years beginning with the fiscal year
in which the first such payment is made.
``(4) Limitation of provision of funding.--No skilled
nursing facility may receive more than 3 percent of the total
monies appropriated under paragraph (5).
``(5) Appropriation.--In addition to any amounts otherwise
available, there is appropriated to the Secretary, out of any
monies in the Treasury not otherwise appropriated,
$1,300,000,000, to remain available until expended, for
purposes of providing funds to skilled nursing facilities under
paragraph (1).
``(d) Failure To Meet Requirements.--
``(1) In general.--Subject to paragraph (2), in the case of
a facility (or a portion of such facility, as applicable) that
fails to meet the requirements described in subsection
(b)(1)(B) in accordance with the agreement described in
subsection (b)(1)(A)(ii), the Secretary may recoup any funds
provided to such facility under subsection (c)(1) in an amount
determined appropriate by the Secretary. In determining such
amount, the Secretary shall take into account the extent of the
compliance of such facility (or portion of such facility, as
applicable) with such requirements.
``(2) Exception.--The Secretary may suspend any recoupment
described in paragraph (1) with respect to a facility (or a
portion of such facility, as applicable) described in such
paragraph for a period of time determined appropriate by the
Secretary if the Secretary finds that such facility (or such
portion) will likely be in compliance with the requirements
described in such paragraph within a reasonable time specified
by the Secretary.
``(e) Evaluation of Program.--
``(1) In general.--The Secretary shall evaluate each
skilled nursing facility receiving funds under the program
established under subsection (a) to assess whether, relative to
similarly situated skilled nursing facilities not receiving
funds under such program and residents of such facilities,
modifications and investments described in subsection (a) made
at skilled nursing facilities using such funds resulted in,
with respect to residents of such facilities (or, in the case
such modifications and investments are made only with respect
to a portion of such facility, residents of such portion of
such facility)--
``(A) a reduction in preventable hospitalizations;
``(B) a reduction in hospital readmissions;
``(C) a reduction in emergency room visits;
``(D) greater improvement in functional status;
``(E) an improvement in infection control;
``(F) a reduction in nursing staff turnover rates;
``(G) an increase in resident and family caregiver
satisfaction;
``(H) other improvements in resident quality of
life as may be specified by the Secretary;
``(I) a reduction in expenditures under this part
(excluding funds provided under subsection (c)(1)); or
``(J) any other outcomes specified by the
Secretary.
``(2) Reports to congress.--Based on evaluations described
in paragraph (1), the Secretary shall, not later than July 1,
2031, and again not later than July 1, 2035, submit to Congress
a report on such program. Each such report shall include an
analysis of the demonstration program's effect on the outcomes
described in paragraph (1).
``(f) Implementation.--Chapter 35 of title 44, United States Code,
shall not apply to this section.
``(g) Authority To Expand to Certain Nursing Facilities.--The
Secretary may, subject to subsection (h), enter into agreements with
States to include nursing facilities (as defined in section 1919(a))
that are not skilled nursing facilities (as defined in section 1819(a))
in the demonstration program established under subsection (a) and may
modify the requirements of the previous provisions of this section as
appropriate to be applicable to such facilities.
``(h) Funding.--The Secretary shall provide for the transfer, from
the Federal Hospital Insurance Trust Fund under 1817 to the Centers for
Medicare & Medicaid Services Program Management Account, of $30,000,000
for fiscal year 2023 for purposes of carrying out this section (other
than for purposes of making payments under subsection (c)(1)). Amounts
transferred pursuant to the previous sentence shall remain available
until expended.''.
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