Nursing Home Patient Protection and Standards Act - Amends title XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to require testing programs in skilled nursing facility (SNF) survey and certification techniques to be sufficiently rigorous to ensure that surveyors are adequately prepared to survey and certify SNFs in a consistent and accurate manner.
Directs the Secretary of Health and Human Services (HHS) to establish requirements: (1) for the qualification and compensation of members of a survey team; and (2) that a state employs an adequate number of individuals as members of survey teams to ensure adequate oversight of SNFs. Requires the Secretary, in addition to the training and testing program, to require that state and federal surveyors regularly complete an adequate number of continuing education courses meeting certain requirements for content and rigor of material.
Requires covered individuals to report to the Secretary instances where surveys fail to report or under report an issue in a facility that could impact the safety or quality of care of its residents. Adds whistleblower protections for such individuals.
Adds penalties for inappropriately influencing a surveyor.
Requires the Secretary to establish an advisory committee on surveys.
Requires survey team supervisors to review each conducted survey to ensure that any identified issues affecting quality of care are consistently and appropriately described and rated.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6261 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 6261
To amend titles XVIII and XIX of the Social Security Act to improve
oversight of nursing facilities under the Medicare and Medicaid
programs by ensuring adequate, trained surveyors, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 29, 2010
Ms. Roybal-Allard 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 improve
oversight of nursing facilities under the Medicare and Medicaid
programs by ensuring adequate, trained surveyors, 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.
This Act may be cited as the ``Nursing Home Patient Protection and
Standards Act''.
SEC. 2. IMPROVING THE RIGOR OF TESTING FOR SURVEYORS.
(a) Medicare.--Section 1819(g)(2)(E)(iii) of the Social Security
Act (42 U.S.C. 1395i-3(g)(2)(E)(iii)) is amended by adding the
following at the end: ``The testing program must be sufficiently
rigorous (as determined by the Secretary) to ensure that surveyors are
adequately prepared to survey and certify facilities in a consistent
and accurate manner.''
(b) Medicaid.--Section 1919(g)(2)(E)(iii) of the Social Security
Act (42 U.S.C. 1396r(g)(2)(E)(iii)) is amended by adding the following
at the end: ``The testing program must be sufficiently rigorous (as
determined by the Secretary) to ensure that surveyors are adequately
prepared to survey and certify facilities in a consistent and accurate
manner.''
SEC. 3. ENSURING ADEQUATE STAFFING AND TRAINING FOR STATE SURVEYS OF
NURSING HOMES.
(a) Medicare.--Section 1819(g)(2)(E) of the Social Security Act (42
U.S.C. 1395i-3(g)(2)(E)) is amended by adding at the end the following:
``(iv) Adequate qualified staff for survey
teams.--The Secretary, in consultation with the
advisory committee under subparagraph (F),
shall establish requirements--
``(I) for the qualifications and
compensation of members of a survey
team under this subsection; and
``(II) that a State employs an
adequate number of individuals as
members of survey teams to ensure
adequate oversight of skilled nursing
facilities.
``(v) Continuing education.--In addition to
the training and testing program required under
clause (iii), the Secretary shall require that
State and Federal surveyors regularly complete
an adequate amount (as determined by the
Secretary) of continuing education courses that
meet requirements determined by the Secretary
for content and the rigor of the material
covered by such courses. An individual shall
not serve as a member of a survey team unless
the individual is in compliance with the
requirements of this clause.''.
(b) Medicaid.--Section 1919(g)(2)(E) of the Social Security Act (42
U.S.C. 1396r(g)(2)(E)) is amended by adding at the end the following:
``(iv) Adequate qualifed staff for survey
teams.--The Secretary, in consultation with the
advisory committee under subparagraph (F),
shall establish requirements--
``(I) for the qualifications and
compensation of members of a survey
team under this subsection; and
``(II) that a State employs an
adequate number of individuals as
members of survey teams to ensure
adequate oversight of nursing
facilities.
``(v) Continuing education.--In addition to
the training and testing program required under
clause (iii), the Secretary shall require that
State and Federal surveyors regularly complete
an adequate amount (as determined by the
Secretary) of continuing education courses that
meet requirements determined by the Secretary
for content and the rigor of the material
covered by such courses. No individual shall
serve as a member of a survey team unless the
individual is in compliance with the
requirements of this clause.''.
SEC. 4. ENSURING THE INDEPENDENCE AND IMPARTIALITY OF SURVEYORS.
(a) Whistle Blower Protections.--
(1) Medicare.--Section 1819(g) of the Social Security Act
(42 U.S.C. 1395i-3(g)) is amended by adding the following at
the end:
``(6) Reporting of inaccuracies.--
``(A) Reporting requirement.--A covered individual
shall report to the Secretary any instance in which the
individual suspects that--
``(i) a survey under this subsection fails
to report or under reports an issue in a
facility that could impact the safety or
quality of care of the residents in such
facility; or
``(ii) a member of the survey team or an
employee of the State survey agency was
inappropriately induced (through the offering
of monetary awards or through undue pressure)
to alter the results of the survey.
``(B) Responses to report.--If the Secretary
receives a report under subparagraph (A), the Secretary
shall take appropriate action, as determined by the
Secretary, to ensure the accuracy of the survey.
``(C) Whistle blower protections.--With respect to
a covered individual, a State may not--
``(i) discharge, demote, suspend, threaten,
harass, or deny a promotion or other
employment-related benefit to such individual,
or in any other manner discriminate against an
individual in the terms and conditions of
employment because the individual submitted a
report under subparagraph (A); or
``(ii) file a complaint or a report against
the individual with the appropriate State
professional disciplinary agency because the
individual submitted a report under
subparagraph (A).
``(D) Remedy for violations.--If the Secretary
finds that a State has violated the prohibitions under
subparagraph (C), the Secretary shall provide for an
appropriate remedy.
``(E) Requirement to post notice.--Each State shall
post conspicuously in an appropriate location a sign
(in a form specified by the Secretary) specifying the
rights of covered individuals under this section. Such
sign shall include a statement that a covered
individual may file a complaint with the Secretary
against the State for violating the provisions of this
paragraph and information with respect to the manner of
filing such a complaint.
``(F) Covered individual defined.--For purposes of
this paragraph, the term `covered individual' means an
individual--
``(i) who is a member of a State survey
team under this subsection; or
``(ii) who is an employee of the State
department or agency that conducts surveys
under this section.''.
(2) Medicaid.--Section 1919(g) of the Social Security Act
(42 U.S.C. 1396r(g)) is amended by adding the following at the
end:
``(6) Reporting of inaccuracies.--
``(A) Reporting requirement.--A covered individual
shall report to the Secretary any instance in which the
individual suspects that--
``(i) a survey under this subsection fails
to report or under reports an issue in a
facility that could impact the safety or
quality of care of the residents in such
facility; or
``(ii) a member of the survey team or an
employee of the State survey agency was
inappropriately induced (through the offering
of monetary awards or through undue pressure)
to alter the results of the survey.
``(B) Response to reports.--If the Secretary
receives a report under subparagraph (A), the Secretary
shall take appropriate action, as determined by the
Secretary, to ensure the accuracy of the survey.
``(C) Whistle blower protections.--With respect to
a covered individual, a State may not--
``(i) discharge, demote, suspend, threaten,
harass, or deny a promotion or other
employment-related benefit to such individual,
or in any other manner discriminate against an
individual in the terms and conditions of
employment because the individual submitted a
report under subparagraph (A); or
``(ii) file a complaint or a report against
the individual with the appropriate State
professional disciplinary agency because the
individual submitted a report under
subparagraph (A).
``(D) Penalties for retaliation.--If the Secretary
finds that a State has violated the prohibitions under
subparagraph (C), the Secretary shall provide for a
reduction of the payment otherwise made to the State
under section 1903(a)(7), with respect to a quarter,
equal to 5 percent. A State that is dissatisfied with
the Secretary's findings under this subparagraph may
obtain reconsideration and review of the findings under
section 1116 in the same manner as a State may seek
reconsideration and review under that section of the
Secretary's determination under section 1116(a)(1).
``(E) Requirement to post notice.--Each State shall
post conspicuously in an appropriate location a sign
(in a form specified by the Secretary) specifying the
rights of covered individuals under this section. Such
sign shall include a statement that a covered
individual may file a complaint with the Secretary
against the State for violating the provisions of this
paragraph and information with respect to the manner of
filing such a complaint.
``(F) Covered individual defined.--For purposes of
this paragraph, the term `covered individual' means an
individual--
``(i) who is a member of a State survey
team under this subsection; or
``(ii) who is an employee of the State
department or agency that conducts surveys
under this section.''.
(b) Penalties for Inappropriately Influencing a Surveyor.--
(1) Medicare.--Section 1819(g)(2)(E) of the Social Security
Act (42 U.S.C. 1395i-3(g)(2)(E)), as amended by section 3(a),
is further amended by adding the following at the end:
``(vi) Penalties for inappropriately
influencing a surveyor.--Any individual
(including an employee of a skilled nursing
facility or any affiliated corporate entity, a
representative of the skilled nursing facility
industry, a member of a State survey team, an
employee of the State department or agency that
conducts surveys under this section, or an
elected official) who attempts to
inappropriately influence, as determined by the
Secretary through regulations, the results of a
survey under this subsection or the actions of
a member of a survey team or an employee of a
survey agency under this subsection shall be
subject to a civil money penalty not to exceed
$10,000. The provisions of section 1128A (other
than subsections (a) and (b)) shall apply to a
civil money penalty under the previous sentence
in the same manner as such provisions apply to
a penalty or proceeding under section
1128A(a).''.
(2) Medicaid.--Section 1919(g)(2)(E) of the Social Security
Act (42 U.S.C. 1396r(g)(2)(E)), as amended by section 3(b), is
further amended by adding at the end the following:
``(vi) Penalties for inappropriately
influencing a surveyor.--Any individual
(including an employee of a nursing facility or
any affiliated corporate entity, a
representative of the nursing facility
industry, a member of a State survey team, an
employee of the State department or agency that
conducts surveys under this section, or an
elected official) who attempts to
inappropriately influence, as determined by the
Secretary through regulations, the results of a
survey under this subsection or the actions of
a member of a survey team or an employee of a
survey agency under this subsection shall be
subject to a civil money penalty not to exceed
$10,000. The provisions of section 1128A (other
than subsections (a) and (b)) shall apply to a
civil money penalty under the previous sentence
in the same manner as such provisions apply to
a penalty or proceeding under section
1128A(a).''.
(3) Conforming amendments.--
(A) Section 1819(f)(2)(B)(iii)(I)(c) of the Social
Security Act is amended by inserting ``, a civil
monetary penalty described in section 1919(g)(2)(E)(vi)
of not less than $10,000'' after ``of not less than
$5,000''.
(B) Section 1919(f)(2)(B)(iii)(I)(c) of the Social
Security Act is amended by inserting ``, a civil
monetary penalty described in (g)(2)(E)(vi) of not less
than $10,000'' after ``of not less than $5,000''.
SEC. 5. ADVISORY COMMITTEE.
(a) Medicare.--Section 1819(g)(2) of the Social Security Act (42
U.S.C. 1395i-3(g)(2)) is amended by adding at the end the following:
``(F) Advisory committee.--
``(i) Establishment.--The Secretary shall
establish an advisory committee on surveys
under this paragraph.
``(ii) Membership.--The membership of the
advisory committee under clause (i) shall
include advocates for residents of skilled
nursing facilities, members of survey teams
under this subsection, and nursing home
administrators, directors of nursing,
registered nurses, and other skilled nursing
facility stakeholders.
``(iii) Recommended standards.--The
advisory committee under clause (i) shall make
recommendations to the Secretary on standards
for--
``(I) the adequate staffing of
survey teams under this subsection;
``(II) the training of members of
such teams; and
``(III) disclosing any contact
between such members and individuals
associated with skilled nursing
facilities, and limiting such contact
to prevent inappropriate influence of
such members by such individuals.
``(iv) Other recommendations.--The advisory
committee under clause (i) may also make
recommendations to the Secretary on any other
issue that would improve the survey process
under this paragraph.''.
(b) Medicaid.--Section 1919(g)(2) of the Social Security Act (42
U.S.C. 1396r(g)(2)) is amended by adding at the end the following:
``(F) Advisory committee.--
``(i) Establishment.--The Secretary shall
establish an advisory committee on surveys
under this paragraph.
``(ii) Membership.--The membership of the
advisory committee under clause (i) shall
include advocates for residents of nursing
facilities, members of survey teams under this
subsection, and nursing home administrators.
``(iii) Recommended standards.--The
advisory committee under clause (i) shall make
recommendations to the Secretary on standards
for--
``(I) the adequate staffing of
survey teams under this subsection;
``(II) the training of members of
such teams; and
``(III) disclosing any contact
between such members and individuals
associated with nursing facilities, and
limiting such contact to prevent
inappropriate influence of such members
by such individuals.
``(iv) Other recommendations.--The advisory
committee under clause (i) may also make
recommendations to the Secretary on any other
issue that would improve the survey process
under this paragraph.''.
SEC. 6. REVIEW OF SURVEYS.
(a) Medicare.--Section 1819(g)(2)(D) of the Social Security Act (42
U.S.C. 1395i-3(g)(2)(D)) is amended--
(1) by striking ``Each State'' and inserting the following:
``(i) In general.--Each State''; and
(2) by adding at the end the following new clause:
``(ii) Review of surveys.--The supervisors
of the survey teams shall review each survey
conducted under this subsection to ensure that
any issues that impact quality of care that are
identified by such surveys are consistently and
appropriately described and rated by the survey
teams.''.
(b) Medicaid.--Section 1919(g)(2)(D) of the Social Security Act (42
U.S.C. 1396r(g)(2)(D)) is amended--
(1) by striking ``Each State'' and inserting the following:
``(i) In general.--Each State''; and
(2) by adding at the end the following new clause:
``(ii) Review of surveys.--The supervisors
of the survey teams shall review each survey
conducted under this subsection to ensure that
any issues that impact quality of care that are
identified by such surveys are consistently and
appropriately described and rated by the survey
teams.''.
<all>
Introduced in House
Introduced in House
Referred to House Ways and Means
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.
Referred to House Energy and Commerce
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