Nursing Home Workforce Quality Act

I 116TH CONGRESS 1ST SESSION H. R. 4468 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 SEPTEMBER 24, 2019 Mr. EVANS (for himself and Mr. ESTES) 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 provi- sions 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 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4468 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 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4468 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 shall, in consultation 22 with such State, disapprove, for a period 23 not to exceed two years, a nurse aide train- 24 ing and competency evaluation program or 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4468 IH a nurse aide competency evaluation pro- 1 gram offered by or in a skilled nursing fa- 2 cility if such facility— 3 ‘‘(I) has been assessed a civil 4 monetary penalty under subsection 5 (h)(2)(B)(ii) or section 6 1919(h)(2)(A)(ii) of not less than 7 $10,697 for providing substandard 8 quality of care; and 9 ‘‘(II) has not, in the determina- 10 tion of the Secretary, corrected the 11 deficiencies in quality of care for 12 which such civil monetary penalty was 13 assessed. 14 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 15 The Secretary shall rescind a disapproval 16 under clause (i) upon demonstration by a 17 skilled nursing facility that all deficiencies 18 for which the civil monetary penalty de- 19 scribed in clause (i)(I) was assessed have 20 been remedied. For purposes of rescinding 21 disapproval under the previous sentence, 22 the Secretary may require additional over- 23 sight of the skilled nursing facility for a 24 period not to exceed the period of dis- 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4468 IH approval imposed under clause (i) with re- 1 spect to such facility.’’; and 2 (2) in subsection (h)(2)(B)(ii)(I), by striking 3 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 4 (b) MEDICAID.—Section 1919 of the Social Security 5 Act (42 U.S.C. 1396r) is amended— 6 (1) in subsection (f)(2)— 7 (A) in subparagraph (A)(iv)(I), by striking 8 ‘‘(unless the facility is described in subpara- 9 graph (B)(iii)(I))’’; 10 (B) in subparagraph (B)— 11 (i) in clause (i), by inserting ‘‘and’’ 12 after the semicolon; 13 (ii) in clause (ii), by striking ‘‘; and’’ 14 and inserting a period; 15 (iii) by striking clause (iii); and 16 (iv) by striking ‘‘A State may not del- 17 egate (through subcontract or otherwise) 18 its responsibility under clause (iii)(II) to 19 the nursing facility.’’; 20 (C) by striking subparagraphs (C) and 21 (D); and 22 (D) by adding at the end the following: 23 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 24 ING AND COMPETENCY EVALUATION PROGRAMS 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4468 IH AND NURSE AIDE COMPETENCY EVALUATION 1 PROGRAMS.— 2 ‘‘(i) IN GENERAL.—With respect to a 3 State, the Secretary shall, in consultation 4 with such State, disapprove, for a period 5 not to exceed two years, a nurse aide train- 6 ing and competency evaluation program or 7 a nurse aide competency evaluation pro- 8 gram offered by or in a nursing facility if 9 such facility— 10 ‘‘(I) has been assessed a civil 11 monetary penalty under section 12 1819(h)(2)(B)(ii) or subsection 13 (h)(2)(A)(ii) of not less than $10,697 14 for providing substandard quality of 15 care; and 16 ‘‘(II) has not, in the determina- 17 tion of the Secretary, corrected the 18 deficiencies in quality of care for 19 which such civil monetary penalty was 20 assessed. 21 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 22 The Secretary shall rescind a disapproval 23 under clause (i) upon demonstration by a 24 nursing facility that all deficiencies for 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4468 IH which the civil monetary penalty described 1 in clause (i)(I) was assessed have been 2 remedied. For purposes of rescinding dis- 3 approval under the previous sentence, the 4 Secretary may require additional oversight 5 of the nursing facility for a period not to 6 exceed the period of disapproval imposed 7 under clause (i) with respect to such facil- 8 ity.’’; and 9 (2) in subsection (h)(3)(C)(ii)(I), by striking 10 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 11 (c) REGULATIONS.—Not later than 180 days after 12 the date of enactment of this Act, the Secretary of Health 13 and Human Services shall promulgate regulations as nec- 14 essary to implement the amendments made by this section. 15 (d) APPLICABILITY.— 16 (1) IN GENERAL.— 17 (A) TIMING OF DETERMINATIONS.—The 18 amendments made by subsections (a)(1)(D) and 19 (b)(1)(D) of this section shall apply only to a 20 civil monetary penalty if the relevant covered 21 determination was made on or after the date of 22 enactment of this Act. 23 (B) COVERED DETERMINATION DE- 24 FINED.—The term ‘‘covered determination’’ 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4468 IH means, with respect to a skilled nursing facility 1 or a nursing facility in a State, a determination 2 by the State or the Secretary of Health and 3 Human Services that the facility has provided 4 a substandard quality of care for which a civil 5 monetary penalty described in section 6 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 7 Social Security Act (as such sections have been 8 amended by this Act) may be assessed. 9 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 10 (A) WAIVER.—With respect to a skilled 11 nursing facility or a nursing facility subject, on 12 the day before the date of enactment of this 13 Act, to a prohibition under item (a) of either 14 section 1819(f)(2)(B)(iii)(I) or section 15 1919(f)(2)(B)(iii)(I) of the Social Security Act 16 (as in effect on the day before such date of en- 17 actment), such prohibition shall no longer apply 18 to the facility on or after such date of enact- 19 ment. 20 (B) SURVEY OR CIVIL MONETARY PEN- 21 ALTY.—With respect to a skilled nursing facil- 22 ity or a nursing facility subject, on the day be- 23 fore the date of enactment of this Act, to a pro- 24 hibition under item (b) or (c) of either section 25 VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 4468 IH 1819(f)(2)(B)(iii)(I) or section 1 1919(f)(2)(B)(iii)(I) of the Social Security Act 2 (as in effect on the day before such date of en- 3 actment), such prohibition shall no longer apply 4 to the facility on or after such date of enact- 5 ment upon a determination by the Secretary of 6 Health and Human Services that the facility 7 has corrected the issue that resulted in such 8 prohibition. 9 Æ VerDate Sep 11 2014 03:11 Sep 27, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H4468.IH H4468 pamtmann on DSKBC07HB2PROD with BILLS