PREPARE LTC Act

II 117TH CONGRESS 1ST SESSION S. 230 To amend titles XVIII and XIX of the Social Security Act to codify certain infection control and emergency preparedness regulations, to prohibit a reduction in the frequency of surveys of skilled nursing facilities and nursing facilities, and to prohibit the waiver of certain reporting require- ments, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 4, 2021 Mr. MENENDEZ 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 codify certain infection control and emergency pre- paredness regulations, to prohibit a reduction in the fre- quency of surveys of skilled nursing facilities and nursing facilities, and to prohibit the waiver of certain reporting requirements, 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 ‘‘Promoting Restoration 4 of Emergency Preparedness and Advancing Response to 5 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 230 IS Epidemics in Long-Term Care Act’’ or the ‘‘PREPARE 1 LTC Act’’. 2 SEC. 2. CODIFYING INFECTION CONTROL AND EMERGENCY 3 PREPAREDNESS REGULATIONS FOR SKILLED 4 NURSING FACILITIES AND NURSING FACILI- 5 TIES AS A REQUIREMENT FOR PARTICIPA- 6 TION UNDER THE MEDICARE AND MEDICAID 7 PROGRAMS. 8 (a) INFECTION CONTROL REGULATIONS.— 9 (1) MEDICARE.—Section 1819(d)(3) of the So- 10 cial Security Act (42 U.S.C. 1395i–3(d)(3)) is 11 amended— 12 (A) by redesignating subparagraphs (A) 13 and (B) as clauses (i) and (ii), respectively, and 14 moving such clauses 2 ems to the right; 15 (B) by striking ‘‘ENVIRONMENT.— A 16 skilled nursing facility must—’’ and inserting 17 ‘‘ENVIRONMENT.— 18 ‘‘(A) IN GENERAL.—A skilled nursing fa- 19 cility must—’’; and 20 (C) by adding at the end the following new 21 subparagraph: 22 ‘‘(B) APPLICATION STATEMENT.—For pur- 23 poses of carrying out this paragraph, the Sec- 24 retary shall apply by reference the provisions of 25 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 230 IS section 483.80 of title 42, Code of Federal Reg- 1 ulations (as in effect on the date of the enact- 2 ment of the Promoting Restoration of Emer- 3 gency Preparedness and Advancing Response to 4 Epidemics in Long-Term Care Act), except in 5 applying subsection (g) of such regulation— 6 ‘‘(i) any reference to COVID–19 shall 7 be treated as a reference to an infectious 8 disease outbreak, as defined in subpara- 9 graph (C); and 10 ‘‘(ii) any reference to ventilator capac- 11 ity shall be treated as a reference to med- 12 ical equipment and supplies critical to the 13 infectious disease outbreak, including ven- 14 tilator capacity. 15 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE- 16 FINED.—For purposes of subparagraph (B), 17 the term ‘infectious disease outbreak’ means 18 any of the following periods: 19 ‘‘(i) COVID–19 EMERGENCY PE- 20 RIOD.—The emergency period described in 21 section 1135(g)(1)(B). 22 ‘‘(ii) OTHER INFECTIOUS DISEASE 23 OUTBREAK PERIODS.— 24 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 230 IS ‘‘(I) The period beginning on the 1 date a nationwide emergency related 2 to a public health emergency is de- 3 clared by the President pursuant to 4 the National Emergencies Act or the 5 Robert T. Stafford Disaster Relief 6 and Emergency Assistance Act and 7 ending on the date that is 6 months 8 after the date on which the declara- 9 tion pursuant to the Stafford Act, a 10 Major Disaster Declaration, or the 11 National Emergencies Act, as applica- 12 ble, ends, whichever is the latest. 13 ‘‘(II) The period during which 14 there exists a public health emergency 15 related to an infectious disease out- 16 break declared by the Secretary pur- 17 suant to section 319 of the Public 18 Health Service Act. 19 ‘‘(III) With respect to a skilled 20 nursing facility in a State with respect 21 to which the Governor has declared an 22 emergency or major disaster (as de- 23 fined by the State) with respect to an 24 infectious disease outbreak, the period 25 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 230 IS for which such declaration is in effect 1 with respect to such State.’’. 2 (2) MEDICAID.—Section 1919(d)(3) of the So- 3 cial Security Act (42 U.S.C. 1396r(d)(3)) is amend- 4 ed— 5 (A) by redesignating subparagraphs (A) 6 and (B) as clauses (i) and (ii), respectively, and 7 moving such clauses 2 ems to the right; 8 (B) by striking ‘‘ENVIRONMENT.— A nurs- 9 ing facility must—’’ and inserting ‘‘ENVIRON- 10 MENT.— 11 ‘‘(A) IN GENERAL.—A nursing facility 12 must—’’; and 13 (C) by adding at the end the following new 14 subparagraph: 15 ‘‘(B) APPLICATION STATEMENT.—For pur- 16 poses of carrying out this paragraph, the Sec- 17 retary shall apply by reference the provisions of 18 section 483.80 of title 42, Code of Federal Reg- 19 ulations (as in effect on the date of the enact- 20 ment of the Promoting Restoration of Emer- 21 gency Preparedness and Advancing Response to 22 Epidemics in Long-Term Care Act), except in 23 applying subsection (g) of such regulation— 24 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 230 IS ‘‘(i) any reference to COVID–19 shall 1 be treated as a reference to an infectious 2 disease outbreak, as defined in subpara- 3 graph (C); and 4 ‘‘(ii) any reference to ventilator capac- 5 ity shall be treated as a reference to med- 6 ical equipment and supplies critical to the 7 infectious disease outbreak, including ven- 8 tilator capacity. 9 ‘‘(C) INFECTIOUS DISEASE OUTBREAK DE- 10 FINED.—The term ‘infectious disease outbreak’ 11 has the meaning given such term in section 12 1819(d)(3)(C).’’. 13 (b) EMERGENCY PREPAREDNESS REGULATIONS.— 14 (1) MEDICARE.—Section 1819(d) of such Act 15 (42 U.S.C. 1395i–3(d)) is amended by adding at the 16 end the following new paragraph: 17 ‘‘(5) EMERGENCY PREPAREDNESS.—A skilled 18 nursing facility shall meet the requirements applica- 19 ble to skilled nursing facilities under the provisions 20 of section 483.73 of title 42, Code of Federal Regu- 21 lations (as in effect on the date of the enactment of 22 the Promoting Restoration of Emergency Prepared- 23 ness and Advancing Response to Epidemics in Long- 24 Term Care Act).’’. 25 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 230 IS (2) MEDICAID.—Section 1919(d) of such Act 1 (42 U.S.C. 1396r(d)) is amended by adding at the 2 end the following new paragraph: 3 ‘‘(5) EMERGENCY PREPAREDNESS.—A nursing 4 facility shall meet the requirements applicable to 5 nursing facilities under the provisions of section 6 483.73 of title 42, Code of Federal Regulations (as 7 in effect on the date of the enactment of the Pro- 8 moting Restoration of Emergency Preparedness and 9 Advancing Response to Epidemics in Long-Term 10 Care Act).’’. 11 (c) REQUIREMENT TO ISSUE GUIDANCE.—Not later 12 than 90 days after the date of the enactment of this Act, 13 the Secretary of Health and Human Services shall issue 14 guidance to carry out the amendments made by this sec- 15 tion. 16 (d) PUBLIC AVAILABILITY OF DATA ON DEFI- 17 CIENCIES IN INFECTION CONTROL AND DIRECT CARE 18 STAFFING IN SKILLED NURSING FACILITIES.—Not later 19 than 2 weeks after the beginning of a period of an infec- 20 tious disease outbreak (as defined in subparagraph (C) of 21 subsection (d)(3) of section 1819 of the Social Security 22 Act (42 U.S.C. 1395i–3), as added by subsection (a)(1)), 23 (or, in the case of the COVID–19 emergency period de- 24 scribed in section 1135(g)(1)(B) of such Act (42 U.S.C. 25 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 230 IS 1320b–5(g)(1)(B)), not later than 60 days after the date 1 of the enactment of this Act), the Administrator of the 2 Centers for Medicare & Medicaid Services shall make pub- 3 licly available on the internet website of the Centers for 4 Medicare & Medicaid Services data on deficiencies identi- 5 fied during the survey process described under subsection 6 (g) of such section 1819, with respect to infection control 7 and direct care staffing in a skilled nursing facility (as 8 defined in subsection (a) of such section 1819). Such data 9 so posted, with respect to an infectious disease outbreak 10 (as so defined), shall be updated every two weeks until 11 the end of the period of such outbreak. 12 SEC. 3. PROHIBITION ON REDUCING FREQUENCY OF 13 STANDARD SURVEYS. 14 (a) MEDICARE.—Section 1819(g)(2)(A)(iii) of such 15 Act (42 U.S.C. 1395i–3(g)(2)(A)(iii)) is amended by add- 16 ing at the end the following new subclause: 17 ‘‘(III) PROHIBITION ON REDUC- 18 ING FREQUENCY OF SURVEYS CON- 19 DUCTED DURING AN INFECTIOUS DIS- 20 EASE OUTBREAK.—The Secretary 21 shall not reduce the frequency of sur- 22 veys conducted under this section dur- 23 ing an infectious disease outbreak (as 24 defined in subsection (d)(3)(C)).’’. 25 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 230 IS (b) MEDICAID.—Section 1919(g)(2)(A)(iii) of such 1 Act (42 U.S.C. 1396r(g)(2)(A)(iii)) is amended by adding 2 at the end the following new subclause: 3 ‘‘(I) PROHIBITION ON REDUCING 4 FREQUENCY OF SURVEYS CONDUCTED 5 DURING AN INFECTIOUS DISEASE 6 OUTBREAK.—The Secretary shall not 7 reduce the frequency of surveys con- 8 ducted under this section during an 9 infectious disease outbreak (as defined 10 in section 1819(d)(3)(C)).’’. 11 SEC. 4. PROHIBITION ON WAIVING SUBMISSIONS OF DI- 12 RECT CARE STAFFING INFORMATION. 13 Section 1128I(g) of the Social Security Act (42 14 U.S.C. 1320a–7j(g)) is amended— 15 (1) in paragraph (3), by striking ‘‘and’’ at the 16 end; 17 (2) in paragraph (4), by striking the period and 18 inserting ‘‘; and’’; 19 (3) by inserting after paragraph (4) the fol- 20 lowing new paragraph: 21 ‘‘(5) shall be submitted not less frequently than 22 quarterly, on a schedule specified by the Secretary.’’; 23 and 24 VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 230 IS (4) by adding at the end the following new sen- 1 tence: ‘‘The Secretary shall not waive the require- 2 ments of this subsection in the case of an infectious 3 disease outbreak (as defined in section 4 1819(d)(3)(C)).’’. 5 SEC. 5. GAO STUDY AND REPORT. 6 Not later than one year after the end of the COVID– 7 19 emergency period (as described in section 8 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 9 1320b–5(g)(1)(B))), the Comptroller General of the 10 United States shall submit to the Committee on Ways and 11 Means of the House of Representatives and the Committee 12 on Finance of the Senate a report analyzing deficiencies 13 during such period in infection control measures and di- 14 rect care staffing requirements for skilled nursing facilities 15 (as defined in section 1819(a) of the Social Security Act 16 (42 U.S.C. 1395i–3(a))), as reported by the Administrator 17 under section 2(d). 18 SEC. 6. EFFECTIVE DATE. 19 The amendments made by this Act shall apply with 20 respect to skilled nursing facilities and nursing facilities 21 beginning on the date of the enactment of this Act. 22 Æ VerDate Sep 11 2014 19:27 Feb 20, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S230.IS S230 pamtmann on DSKBC07HB2PROD with BILLS