Nursing Home Workforce Quality Act

I 116TH CONGRESS 1ST SESSION H. R. 1265 To amend titles XVIII and XIX of the Social Security Act with respect to nursing facility requirements, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 14, 2019 Mr. DUFFY (for himself, Mr. PETERSON, and Mr. GIANFORTE) 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 consider- ation 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 with respect to nursing facility 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 ‘‘Nursing Home Work- 4 force Quality Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 2 •HR 1265 IH (1) Nursing facilities are an integral component 1 of the continuum of care for Medicare and Medicaid 2 patients. 3 (2) Many nursing facilities have in-house edu- 4 cational programs approved by the Centers for Medi- 5 care & Medicaid Services to train individuals as cer- 6 tified nursing aides to provide extensive, direct care. 7 (3) The ability to provide this training is crit- 8 ical for nursing facilities to ensure that— 9 (A) residents receive the highest quality 10 care; 11 (B) caregivers are trained on the most 12 timely best practices and clinical standards; and 13 (C) facilities can— 14 (i) sustain appropriate staffing levels; 15 and 16 (ii) recruit and retain qualified staff. 17 SEC. 3. TRAINING AND COMPETENCY EVALUATION PRO- 18 GRAMS. 19 (a) MEDICARE.—Section 1819 of the Social Security 20 Act (42 U.S.C. 1395i–3) is amended— 21 (1) in subsection (f)(2)— 22 (A) in subparagraph (A)(iv)(I), by striking 23 ‘‘(unless the facility is described in subpara- 24 graph (B)(iii)(I))’’; 25 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 3 •HR 1265 IH (B) in subparagraph (B)— 1 (i) in clause (i)— 2 (I) by striking ‘‘(subject to clause 3 (iii))’’; and 4 (II) by inserting ‘‘and’’ after the 5 semicolon; 6 (ii) in clause (ii), by striking ‘‘; and’’ 7 and inserting a period; 8 (iii) by striking clause (iii); and 9 (iv) by striking ‘‘A State may not del- 10 egate (through subcontract or otherwise) 11 its responsibility under clause (iii)(II) to 12 the skilled nursing facility.’’; 13 (C) by striking subparagraphs (C) and 14 (D); and 15 (D) by adding at the end the following: 16 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 17 ING AND COMPETENCY EVALUATION PROGRAMS 18 AND NURSE AIDE COMPETENCY EVALUATION 19 PROGRAMS.— 20 ‘‘(i) IN GENERAL.—With respect to a 21 State, the Secretary may, in consultation 22 with such State, disapprove a nurse aide 23 training and competency evaluation pro- 24 gram or a nurse aide competency evalua- 25 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 4 •HR 1265 IH tion program offered by or in a skilled 1 nursing facility if such facility— 2 ‘‘(I) has been assessed a civil 3 monetary penalty under subsection 4 (h)(2)(B)(ii) or section 5 1919(h)(2)(A)(ii) of not less than 6 $10,697 for providing substandard 7 quality of care; and 8 ‘‘(II) has not, in the determina- 9 tion of the Secretary, corrected the 10 deficiencies in quality of care for 11 which such civil monetary penalty was 12 assessed. 13 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 14 The Secretary shall rescind a disapproval 15 under clause (i) upon demonstration by a 16 facility that all deficiencies for which the 17 civil monetary penalty described in clause 18 (i)(I) was assessed have been remedied.’’; 19 and 20 (2) in subsection (h)(2)(B)(ii)(I), by striking 21 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 22 (b) MEDICAID.—Section 1919 of the Social Security 23 Act (42 U.S.C. 1396r) is amended— 24 (1) in subsection (f)(2)— 25 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 5 •HR 1265 IH (A) in subparagraph (A)(iv)(I), by striking 1 ‘‘(unless the facility is described in subpara- 2 graph (B)(iii)(I))’’; 3 (B) in subparagraph (B)— 4 (i) in clause (i), by inserting ‘‘and’’ 5 after the semicolon; 6 (ii) in clause (ii), by striking ‘‘; and’’ 7 and inserting a period; 8 (iii) by striking clause (iii); and 9 (iv) by striking ‘‘A State may not del- 10 egate (through subcontract or otherwise) 11 its responsibility under clause (iii)(II) to 12 the nursing facility.’’; 13 (C) by striking subparagraphs (C) and 14 (D); and 15 (D) by adding at the end the following: 16 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 17 ING AND COMPETENCY EVALUATION PROGRAMS 18 AND NURSE AIDE COMPETENCY EVALUATION 19 PROGRAMS.— 20 ‘‘(i) IN GENERAL.—With respect to a 21 State, the Secretary may, in consultation 22 with such State, disapprove a nurse aide 23 training and competency evaluation pro- 24 gram or a nurse aide competency evalua- 25 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 6 •HR 1265 IH tion program offered by or in a nursing fa- 1 cility if such facility— 2 ‘‘(I) has been assessed a civil 3 monetary penalty under section 4 1819(h)(2)(B)(ii) or subsection 5 (h)(2)(A)(ii) of not less than $10,697 6 for providing substandard quality of 7 care; and 8 ‘‘(II) has not, in the determina- 9 tion of the Secretary, corrected the 10 deficiencies in quality of care for 11 which such civil monetary penalty was 12 assessed. 13 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 14 The Secretary shall rescind a disapproval 15 under clause (i) upon demonstration by a 16 facility that all deficiencies for which the 17 civil monetary penalty described in clause 18 (i)(I) was assessed have been remedied.’’; 19 and 20 (2) in subsection (h)(3)(C)(ii)(I), by striking 21 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 22 (c) REGULATIONS.—Not later than 180 days after 23 the date of enactment of this Act, the Secretary of Health 24 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 7 •HR 1265 IH and Human Services shall promulgate regulations as nec- 1 essary to implement the amendments made by this section. 2 (d) APPLICABILITY.— 3 (1) IN GENERAL.— 4 (A) TIMING OF DETERMINATIONS.—The 5 amendments made by subsections (a)(1)(D) and 6 (b)(1)(D) of this section shall apply only to a 7 civil monetary penalty if the relevant covered 8 determination was made on or after the date of 9 enactment of this Act. 10 (B) COVERED DETERMINATION DE- 11 FINED.—The term ‘‘covered determination’’ 12 means, with respect to a facility in a State, a 13 determination by the State or the Secretary of 14 Health and Human Services that the facility 15 has provided a substandard quality of care for 16 which a civil monetary penalty described in sec- 17 tion 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) 18 of the Social Security Act (as such sections 19 have been amended by this Act) may be as- 20 sessed. 21 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 22 (A) WAIVER.—With respect to a facility 23 subject, on the day before the date of enact- 24 ment of this Act, to a prohibition under item 25 VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS 8 •HR 1265 IH (a) of either section 1819(f)(2)(B)(iii)(I) or sec- 1 tion 1919(f)(2)(B)(iii)(I) of the Social Security 2 Act (as in effect on the day before such date of 3 enactment), such prohibition shall no longer 4 apply to the facility on or after such date of en- 5 actment. 6 (B) SURVEY OR CIVIL MONETARY PEN- 7 ALTY.—With respect to a facility subject, on 8 the day before the date of enactment of this 9 Act, to a prohibition under item (b) or (c) of ei- 10 ther section 1819(f)(2)(B)(iii)(I) or section 11 1919(f)(2)(B)(iii)(I) of the Social Security Act 12 (as in effect on the day before such date of en- 13 actment), such prohibition shall no longer apply 14 to the facility on or after such date of enact- 15 ment upon a determination by the Secretary of 16 Health and Human Services that the facility 17 has corrected the issue that resulted in such 18 prohibition. 19 Æ VerDate Sep 11 2014 03:04 Feb 28, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H1265.IH H1265 kjohnson on DSK79L0C42 with BILLS