Nursing Home Staffing Act of 2003 - Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to direct the Secretary of Health and Human Services to promulgate standards for minimum nurse staffing levels in nursing facilities receiving Medicare or Medicaid payments.
Reinstitutes (Boren amendment) payment methodology, providing for payment of Medicaid services through the use of rates determined pursuant to the criteria under State Medicaid plan requirements as in effect on August 1, 1997. Establishes safe harbor rates.
Provides a permanent 1.50 percent increase of the Medicaid Federal medical assistance percentage (FMAP) for a State beginning with FY 2004.
Authorizes inclusion of: (1) financial accountability requirements in the survey and certification process with respect to facilities receiving Medicare or Medicaid payments; and (2) professionals trained in financial accounting and auditing in the multidisciplinary survey teams of professionals under Medicare and Medicaid.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1988 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1988
To amend titles XVIII and XIX of the Social Security Act to establish
minimum requirements for nurse staffing in nursing facilities receiving
payments under the Medicare or Medicaid Program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 9, 2003
Mr. Daschle (for Mr. Edwards) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to establish
minimum requirements for nurse staffing in nursing facilities receiving
payments under the Medicare or Medicaid Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSE.
(a) Short Title.--This Act may be cited as the ``Nursing Home
Staffing Act of 2003''.
(b) Purpose.--The purpose of this Act is to improve the quality of
care received by residents of nursing facilities through the
implementation of the minimum nurse staffing levels identified by the
Secretary of Health and Human Services in a report to Congress
submitted on March 21, 2002.
SEC. 2. IMPLEMENTATION OF NURSE STAFFING STANDARDS.
(a) In General.--Sections 1819(b)(4) and 1919(b)(4) of the Social
Security Act (42 U.S.C. 1395i-3(b)(4); 1396r(b)(4)) are each amended by
adding at the end the following new subparagraph:
``(D) Minimum staffing requirements.--
``(i) Deadline for compliance with minimum
standards.--With respect to facility services
provided after the date that is the end of the
2-year period beginning on the date of the
enactment of this subparagraph, a facility
shall comply with the minimum staffing levels
promulgated by the Secretary under clause (ii).
``(ii) Final regulations.--
``(I) In general.--Not later than 1
year after the date of the enactment of
this subparagraph, and consistent with
the provisions of this clause, the
Secretary shall promulgate standards
for minimum staffing levels for
facilities. Such standards shall
provide for sufficient staffing levels
during day, evening, and night shifts
to ensure that residents of nursing
facilities receive the level of care
necessary to meet the objectives of
subsection (b)(2), and shall provide
for appropriate adjustments to account
for resident case mix.
``(II) Minimum standards.--Subject
to subclause (III), standards
promulgated under subclause (I) shall
be, at a minimum, the HHS minimum nurse
staffing ratios (as defined in clause
(iii)).
``(III) Authority to phase in
facility compliance with standards.--If
the Secretary determines that
compliance with the HHS minimum nurse
staffing ratios is not feasible for
nursing facilities by the end of the 2-
year period applicable under clause
(i), the Secretary may delay the
implementation of the HHS minimum nurse
staffing ratios until the date that is
the end of the 5-year period that
begins on the date of the enactment of
this subparagraph. If the Secretary
delays implementation of the HHS
minimum nurse staffing ratios under the
previous sentence, the Secretary shall
phase in over such 5-year period
alternative minimum staffing standards
that gradually increase in each of the
years of the phase-in until the such
standards meet the HHS minimum nurse
staffing ratios.
``(IV) Counting.--In determining
compliance with the staffing levels
under this subparagraph, an individual
may not be counted while performing
services that are not direct nursing
care, such as administrative services,
food preparation, housekeeping,
laundry, maintenance services, or other
activities that are not direct nursing
care.
``(iii) HHS minimum nurse staffing
ratios.--The term `HHS minimum nurse staffing
ratios' means the minimum staffing levels
identified in the report to Congress entitled
`Appropriateness of Minimum Nurse Staffing
Ratios in Nursing Homes, Report to Congress:
Phase II Final' submitted by the Secretary on
March 21, 2002, which require--
``(I) from 2.4 to 2.8 hours of care
per resident per day by a certified
nurse aide, and
``(II) from 1.15 to 1.3 hours of
care per resident per day by a licensed
practical nurse, a licensed vocational
nurse, or a registered nurse, of which
from 0.55 to 0.75 hours of care per
resident per day shall be provided by a
registered nurse.
``(iv) Construction.--
``(I) Nonpreemption.--Nothing in
this subparagraph shall be construed as
prohibiting the Secretary or a State
(in the case of title XIX) from
imposing higher minimum staffing levels
on facilities than those imposed under
this subparagraph.
``(II) Minimum standards only.--
Compliance with the staffing
requirements imposed under this
subparagraph alone shall not be
construed as complying with the
requirement under paragraph (2) to
provide services to attain or maintain
the highest practicable physical,
mental, and psychosocial well-being of
each resident.
``(III) Supplementary
requirements.--The staffing
requirements of this subparagraph are
in addition to the requirements of
subparagraph (C).''.
(b) Posting of Staffing Information.--
(1) In general.--The first sentence of subparagraph (A) of
sections 1819(b)(8) and 1919(b)(8) of the Social Security Act
(42 U.S.C. 1395i-3(b)(8); 1396r(b)(8)) are each amended by
inserting before the period the following: ``, a description of
the minimum staffing requirements under paragraph (4)(D), and
the average number of hours of nursing care that residents of
the facility have received for each of the four previous
calendar quarters''.
(2) Reports.--Such sections are each amended by adding at
the end the following new subparagraph:
``(C) Reports of staffing data.--A facility shall
maintain records on nurse staffing, and shall submit
such reports of such records to the Secretary as the
Secretary may require for the administration and
enforcement of this section. Such records shall be
reviewed for accuracy as part of a standard survey
required under subsection (g)(2)(A).''.
SEC. 3. INCREASED RESOURCES.
(a) Reinstitution of Boren Amendment Payment Methodology.--
(1) In general.--Section 1902(a)(13) of the Social Security
Act (42 U.S.C. 1396a(a)(13)) is amended to read as follows:
``(13) provide for payment of services through the use of
rates determined pursuant to the criteria under this paragraph
as in effect on August 1, 1997;''.
(2) Establishment of safe harbor rates.--Section 1902 of
such Act (42 U.S.C. 1396a) is amended by adding at the end the
following: ``The Secretary may, by regulation, promulgate
standards or methodologies for determining rates that comply
with paragraph (13), and a State that pays rates that meet such
standards or methodologies is deemed to be in compliance with
paragraph (13).''.
(3) Effective date.--The amendment made by this subsection
shall apply to services furnished on or after the date that is
one year after the date of the enactment of this Act.
(b) Permanent 1.5 Percent Increase of Medicaid FMAP Beginning With
Fiscal Year 2004.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended by adding at the end the following: ``With
respect to calendar quarters beginning after October 1, 2003, the
Federal medical assistance percentage for a State determined under the
first sentence shall be increased by 1.50 percentage points.''.
(c) Financial Accountability.--
(1) In general.--Sections 1819(g)(2) and 1919(g)(2) of the
Social Security Act (42 U.S.C. 1395i-3(g)(2); 1396r(g)(2)) are
each amended--
(A) by redesignating subparagraphs (C), (D), and
(E) as subparagraphs (D), (E), and (F); and
(B) by inserting after subparagraph (B) the
following new subparagraph:
``(C) Financial accountability.--A standard or an
extended survey may include an examination of the
financial records of a facility to determine whether
payments made to the facility under this section for
services furnished to residents are being used in a
manner consistent with this section.''.
(2) Composition of multidisciplinary team.--Sections
1819(g)(2)(E)(i) and 1919(g)(2)(E)(i) of the Social Security
Act (42 U.S.C. 1395i-3(g)(2)(E)(i); 1396r(g)(2)(E)(i)) are each
amended by inserting after the period the following: ``This
multidisciplinary team may include professionals trained in
financial accounting and auditing.''
(3) Effective date.--The amendments made by paragraph (1)
shall apply to surveys conducted on or after the date of the
enactment of this Act.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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