Quality Care for Nursing Home Residents and Workers During COVID–19 and Beyond Act

I 117TH CONGRESS 1ST SESSION H. R. 598 To amend titles XVIII and XIX of the Social Security Act to improve the quality of care in skilled nursing facilities under the Medicare pro- gram and nursing facilities under the Medicare program during the COVID–19 emergency period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 28, 2021 Ms. SCHAKOWSKY (for herself and Mr. TAKANO) introduced the following bill; which was referred to the Committee on Ways and Means, and in addi- tion to the Committee on Energy and Commerce, for a period to be sub- sequently 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 the quality of care in skilled nursing facilities under the Medicare program and nursing facilities under the Medicare program during the COVID–19 emergency period, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Quality Care for Nurs- 4 ing Home Residents and Workers During COVID–19 and 5 Beyond Act’’. 6 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 598 IH TITLE I—ADDRESSING COVID–19 1 SEC. 101. IMPROVING QUALITY OF CARE IN SKILLED NURS- 2 ING FACILITIES AND NURSING FACILITIES 3 DURING COVID–19 EMERGENCY PERIOD. 4 (a) MEDICARE.—Section 1819 of the Social Security 5 Act (42 U.S.C. 1395i–3) is amended by adding at the end 6 the following new subsection: 7 ‘‘(k) ADDITIONAL REQUIREMENTS DURING CERTAIN 8 PUBLIC HEALTH EMERGENCY.— 9 ‘‘(1) SKILLED NURSING FACILITIES.— 10 ‘‘(A) IN GENERAL.—During the portion of 11 the emergency period defined in paragraph 12 (1)(B) of section 1135(g) beginning on or after 13 the date of the enactment of this subsection, a 14 skilled nursing facility shall comply with the 15 quality of care requirements described in sub- 16 paragraph (B), the worker safety requirements 17 described in subparagraph (C), and the trans- 18 parency requirements described in subpara- 19 graph (D). 20 ‘‘(B) QUALITY OF CARE REQUIREMENTS.— 21 The quality of care requirements described in 22 this subparagraph are each of the following: 23 ‘‘(i) Employ, on a full-time basis, an 24 onsite infection preventionist who— 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 598 IH ‘‘(I) has primary professional 1 training in nursing, medical tech- 2 nology, microbiology, epidemiology, or 3 other related field; 4 ‘‘(II) is qualified by education, 5 training, experience or certification; 6 and 7 ‘‘(III) has completed specialized 8 training in infection prevention and 9 control. 10 ‘‘(ii) In the case of a resident who 11 elects to reside with a family member of 12 such resident for any portion of the emer- 13 gency period described in subparagraph 14 (A), guarantee the right of such resident to 15 resume residency in the facility at any time 16 during the 180-day period immediately fol- 17 lowing the end of such emergency period. 18 ‘‘(iii) Notwithstanding subparagraphs 19 (A) and (B) of subsection (c)(2), permit a 20 resident to remain in the facility and not 21 discharge or transfer the resident from the 22 facility unless— 23 ‘‘(I) the State survey agency ap- 24 proves the discharge or transfer; 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 598 IH ‘‘(II) in the case of a transfer, 1 the transfer is to a facility dedicated 2 to the care of residents who have been 3 diagnosed with COVID–19 if the resi- 4 dent has been diagnosed with 5 COVID–19, or a facility dedicated to 6 the care of residents who have not 7 been diagnosed with COVID–19 if the 8 resident has not been diagnosed with 9 COVID–19; 10 ‘‘(III) before effecting the dis- 11 charge or transfer, the facility records 12 the reasons in the resident’s clinical 13 record; 14 ‘‘(IV) at least 72 hours in ad- 15 vance of the discharge or transfer, the 16 facility provides a notice of the dis- 17 charge or transfer to the resident (or 18 legal representative of the resident, if 19 applicable), including the reasons 20 therefor and the items described in 21 clause (iii) of subsection (c)(2)(B); 22 and 23 ‘‘(V) the resident (or legal rep- 24 resentative of the resident, if applica- 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 598 IH ble) acknowledges receipt of the notice 1 described in subclause (IV) and pro- 2 vides written consent to the discharge 3 or transfer. 4 ‘‘(iv) Test (on a weekly basis) each 5 resident for COVID–19, or, in the case 6 that the facility does not have a sufficient 7 number of testing kits for COVID–19, 8 screen each resident for symptoms of 9 COVID–19 and report (on a daily basis 10 until the facility has a sufficient number of 11 such testing kits) to the State survey agen- 12 cy that the facility does not have a suffi- 13 cient number of such testing kits and what 14 steps the facility is taking to procure a suf- 15 ficient number of such testing kits. 16 ‘‘(v) Ensure there is an adequate 17 number of employees to assist residents in 18 communicating with family members and 19 friends through phone calls, e-mail, and 20 virtual communications on at least a week- 21 ly basis, without regard to whether a resi- 22 dent has been diagnosed with COVID–19. 23 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 598 IH ‘‘(C) WORKER SAFETY REQUIREMENTS.— 1 The worker safety requirements described in 2 this subparagraph are each of the following: 3 ‘‘(i) In the case the facility is not oth- 4 erwise subject to the Occupational Safety 5 and Health Act of 1970 (or a State occu- 6 pational safety and health plan that is ap- 7 proved under section 18(c) of such Act), 8 comply with the Bloodborne Pathogens 9 standard under section 1910.1030 of title 10 29, Code of Federal Regulations (or a suc- 11 cessor regulation). 12 ‘‘(ii) In the case of a predicted short- 13 age of personal protective equipment, re- 14 port such predicted shortage to the State 15 health department of the State in which 16 the facility is located at least 24 hours in 17 advance of when such predicted shortage is 18 expected to occur. 19 ‘‘(iii) Educate each employee on the 20 transmission of COVID–19. 21 ‘‘(iv) Notwithstanding any other pro- 22 vision of law, provide at least two weeks of 23 paid sick leave to each employee. 24 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 598 IH ‘‘(v) Before each employee’s shift, test 1 the employee for COVID–19, or, in the 2 case that the facility does not have a suffi- 3 cient number of testing kits for COVID– 4 19, screen each employee for symptoms of 5 COVID–19 and report (on a daily basis 6 until the facility has a sufficient number of 7 such testing kits) to the State survey agen- 8 cy that the facility does not have a suffi- 9 cient number of such testing kits and what 10 steps the facility is taking to procure a suf- 11 ficient number of such testing kits. 12 ‘‘(D) TRANSPARENCY REQUIREMENTS.— 13 The transparency requirements described in 14 this subparagraph are each of the following: 15 ‘‘(i) Report (on a daily basis) to the 16 State survey agency, the Centers for Medi- 17 care & Medicaid Services, and the Centers 18 for Disease Control and Prevention each of 19 the following: 20 ‘‘(I) The number of confirmed 21 and suspected cases of COVID–19 22 among residents and staff, including 23 the age and race or ethnicity of such 24 residents and staff. 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 598 IH ‘‘(II) The number of deaths re- 1 lated to COVID–19 among residents 2 and staff, including the age and race 3 or ethnicity of such residents and 4 staff. 5 ‘‘(III) The total number of 6 deaths (without regard to whether a 7 death is related to COVID–19) among 8 residents and staff. 9 ‘‘(IV) The amount of personal 10 protective equipment available and 11 any projected need regarding such 12 equipment. 13 ‘‘(V) Information on staffing lev- 14 els that would otherwise be required 15 to be submitted through the Payroll- 16 Based Journal of the Centers for 17 Medicare & Medicaid Services. 18 ‘‘(VI) The number of residents 19 and staff who have been tested for 20 COVID–19. 21 ‘‘(ii) In the case that a resident or 22 employee is diagnosed with COVID–19 or 23 dies as a result of COVID–19, notify all 24 residents, legal representatives of residents, 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 598 IH and employees not later than 12 hours 1 after such diagnosis is made or such death 2 occurs. 3 ‘‘(iii) At any time three or more resi- 4 dents or employees have newly onset 5 COVID–19 symptoms, notify all residents, 6 legal representatives of residents, and em- 7 ployees not later than 72 hours after such 8 three or more residents or employees are 9 known to the facility. 10 ‘‘(iv) In the case that a resident or 11 employee is suspected to have or is diag- 12 nosed with COVID–19, post a notice of 13 such suspicion or diagnosis at each en- 14 trance of the facility for the remaining por- 15 tion of the emergency period described in 16 subparagraph (A). 17 ‘‘(v) For each day of the portion of 18 the emergency period described in subpara- 19 graph (A), post a notice at each entrance 20 of the facility with the information re- 21 quired under subsection (b)(8) for such 22 day. 23 ‘‘(2) STATES AND FEDERAL GOVERNMENT.— 24 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 598 IH ‘‘(A) PUBLIC AVAILABILITY OF INFORMA- 1 TION.— 2 ‘‘(i) IN GENERAL.—As soon as pos- 3 sible, but not later than 24 hours after re- 4 ceiving any information required under 5 paragraph (1)(D)(i), the Administrator of 6 the Centers for Medicare & Medicaid Serv- 7 ices, in coordination with the Director of 8 the Centers for Disease Control and Pre- 9 vention, shall make such information pub- 10 licly available on the Nursing Home Com- 11 pare website of the Centers for Medicare & 12 Medicaid Services and the COVIDView 13 website of the Centers for Disease Control 14 and Prevention. 15 ‘‘(ii) HIPAA COMPLIANT INFORMA- 16 TION ONLY.—Information may only be 17 made publicly available under clause (i) if 18 the disclosure of such information would 19 otherwise be permitted under the Federal 20 regulations (concerning the privacy of indi- 21 vidually identifiable health information) 22 promulgated under section 264(c) of the 23 Health Insurance Portability and Account- 24 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 598 IH ability Act of 1996 (42 U.S.C. 1320d–2 1 note). 2 ‘‘(B) DESIGNATION OF COVID–19 FACILI- 3 TIES.—For purposes of paragraph 4 (1)(B)(iii)(II)— 5 ‘‘(i) the Administrator of the Centers 6 for Medicare & Medicaid Services shall 7 specify criteria (which shall include the 8 provision of the services of a registered 9 nurse on a 24-hour basis) for each State 10 survey agency to carry out the designation 11 requirement described in clause (ii) with 12 respect to skilled nursing facilities; and 13 ‘‘(ii) each State survey agency shall 14 designate a skilled nursing facility in the 15 State as a facility dedicated to the care of 16 residents who have been diagnosed with 17 COVID–19 if such facility meets the cri- 18 teria specified by the Administrator under 19 clause (i). 20 ‘‘(C) MONITORING AND SURVEYS.—A 21 State survey agency shall— 22 ‘‘(i) provide onsite monitoring (or, if 23 onsite monitoring is not feasible, remote 24 monitoring) of all skilled nursing facilities 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 598 IH with at least one resident or employee who 1 has been diagnosed with COVID–19; 2 ‘‘(ii) in addition to surveys required 3 under subsection (g), conduct a survey of 4 a skilled nursing facility, in the same man- 5 ner and subject to the same requirements 6 applicable to standard surveys conducted 7 under subsection (g), if the facility has a 8 ratio of the number of deaths resulting 9 from COVID–19 to the number of 10 COVID–19 diagnoses that exceeds 5 per- 11 cent, or the State survey agency receives a 12 COVID–19 or staffing related immediate 13 jeopardy complaint regarding the facility; 14 and 15 ‘‘(iii) ensure that each survey team 16 that conducts a survey under clause (ii) 17 has adequate personal protective equip- 18 ment while conducting such survey. 19 ‘‘(3) CIVIL MONEY PENALTIES.—The Secretary 20 shall impose a civil money penalty against the opera- 21 tors of a skilled nursing facility in an amount equal 22 to $10,000 per day for each violation of a require- 23 ment described in subparagraph (B), (C), or (D) of 24 paragraph (1) or the reporting of false information 25 VerDate Sep 11 2014 18:49 Feb 12, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H598.IH H598 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 598 IH under clause (i) of such subparagraph (D). The pro- 1 visions of section 1128A (other than subsections (a) 2 and (b)) shall apply to a civil money penalty under 3 the previous sentence in the same manner as such 4 provisions apply to a penalty or proceeding under 5 section 1128A(a).’’. 6 (b) MEDICAID.—Section 1919 of the Social Security 7 Act (42 U.S.C. 1396r) is amended by adding at the end 8 the following new subsection: 9 ‘‘(k) ADDITIONAL REQUIREMENTS DURING CERTAIN 10 PUBLIC HEALTH EMERGENCY.— 11 ‘‘(1) NURSING FACILITIES.— 12 ‘‘(A) IN GENERAL.—During the portion of 13 the emergency period defined in paragraph 14 (1)(B) of section 1135(g) beginning on or after 15 the date of the enactment of this subsection, a 16 nursing facility shall comply with the quality of 17 care requ [Text truncated for display. Full text available on Congress.gov.]