Quality Care for Nursing Home Residents Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 5216 To amend titles XVIII and XIX of the Social Security Act to revise minimum nurse staffing requirements for skilled nursing facilities under the Medi- care program and for nursing facilities under the Medicaid program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 21, 2019 Ms. SCHAKOWSKY (for herself, Mrs. HAYES, Mr. GARAMENDI, Mr. RYAN, Mr. CARSON of Indiana, Ms. MOORE, Ms. ROYBAL-ALLARD, Mrs. CAROLYN B. MALONEY of New York, Mrs. DINGELL, Ms. DELAURO, Ms. BASS, Ms. JOHNSON of Texas, Mr. DANNY K. DAVIS of Illinois, Mr. HASTINGS, Mr. PAYNE, Ms. MATSUI, Ms. UNDERWOOD, Ms. JAYAPAL, Ms. PRESSLEY, Ms. JUDY CHU of California, Ms. CLARKE of New York, Mr. KHANNA, Mr. DEUTCH, Mr. DESAULNIER, Ms. LEE of California, and Mr. TONKO) introduced the following bill; which was referred to the Com- mittee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To amend titles XVIII and XIX of the Social Security Act to revise minimum nurse staffing requirements for skilled nursing facilities under the Medicare program and for nursing facilities under the Medicaid program, 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 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 2 •HR 5216 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Quality Care for Nurs- 2 ing Home Residents Act of 2019’’. 3 SEC. 2. MINIMUM NURSE STAFFING REQUIREMENTS FOR 4 SKILLED NURSING FACILITIES UNDER MEDI- 5 CARE PROGRAM AND NURSING FACILITIES 6 UNDER MEDICAID PROGRAM. 7 (a) MEDICARE.— 8 (1) IN GENERAL.—Subparagraph (C) of section 9 1819(b)(4) of the Social Security Act (42 U.S.C. 10 1395i–3(b)(4)) is amended— 11 (A) in clause (i)— 12 (i) by amending the clause heading to 13 read as follows: ‘‘GENERAL REQUIRE- 14 MENTS BEFORE 2020’’; and 15 (ii) by striking ‘‘Except as provided in 16 clause (ii),’’ and inserting ‘‘Except as pro- 17 vided in clause (iii), with respect to skilled 18 nursing facility services provided before 19 January 1, 2020,’’; 20 (B) by redesignating clause (ii) as clause 21 (iii); and 22 (C) by inserting after clause (i) the fol- 23 lowing new clause: 24 ‘‘(ii) GENERAL REQUIREMENTS AFTER 25 2019.— 26 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 3 •HR 5216 IH ‘‘(I) IN GENERAL.—With respect 1 to skilled nursing facility services pro- 2 vided on or after January 1, 2020, a 3 skilled nursing facility must— 4 ‘‘(aa) provide nursing serv- 5 ices that are sufficient to meet 6 the nursing needs of its residents 7 on a 24-hour basis, to be divided 8 into day shifts, evening shifts, 9 and night shifts; 10 ‘‘(bb) provide for minimum 11 nurse staffing levels with respect 12 to each such shift, in accordance 13 with this clause; and 14 ‘‘(cc) ensure that, in car- 15 rying out items (aa) and (bb), a 16 total minimum of 4.1 hours of 17 care is provided per resident per 18 day, with 0.75 hours of care of 19 such total minimum provided by 20 a registered professional nurse, 21 0.54 hours of care of such total 22 minimum provided by a licensed 23 practical nurse, and 2.81 hours 24 of care of such total minimum 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 4 •HR 5216 IH provided by a nurse aide (as de- 1 fined in paragraph (5)(F)). 2 ‘‘(II) DAY SHIFTS.—With respect 3 to a day shift, the skilled nursing fa- 4 cility must have— 5 ‘‘(aa) at least 1 registered 6 professional nurse for every 28 7 residents, with a minimum of 8 0.29 hours of care provided per 9 resident during each such shift; 10 ‘‘(bb) at least 1 licensed 11 practical nurse for every 40 resi- 12 dents, with a minimum of 0.20 13 hours of care provided per resi- 14 dent during each such shift; and 15 ‘‘(cc) at least 1 nurse aide 16 (as defined in paragraph (5)(F)) 17 for every 7 residents, with a min- 18 imum of 1.14 hours of care pro- 19 vided per resident during each 20 such shift. 21 ‘‘(III) EVENING SHIFTS.—With 22 respect to an evening shift, the skilled 23 nursing facility must have— 24 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 5 •HR 5216 IH ‘‘(aa) at least 1 registered 1 professional nurse for every 30 2 residents, with a minimum of 3 0.26 hours of care provided per 4 resident during each such shift; 5 ‘‘(bb) at least 1 licensed 6 practical nurse for every 40 resi- 7 dents, with a minimum of 0.20 8 hours of care provided per resi- 9 dent during each such shift; and 10 ‘‘(cc) at least 1 nurse aide 11 (as defined in paragraph (5)(F)) 12 for every 7 residents, with a min- 13 imum of 1.14 hours of care pro- 14 vided per resident during each 15 such shift. 16 ‘‘(IV) NIGHT SHIFTS.—With re- 17 spect to a night shift, the skilled nurs- 18 ing facility must have— 19 ‘‘(aa) at least 1 registered 20 professional nurse for every 40 21 residents, with a minimum of 22 0.20 hours of care provided per 23 resident during such shift; 24 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 6 •HR 5216 IH ‘‘(bb) at least 1 licensed 1 practical nurse for every 56 resi- 2 dents, with a minimum of 0.14 3 hours of care provided per resi- 4 dent during such shift; and 5 ‘‘(cc) at least 1 nurse aide 6 (as defined in paragraph (5)(F)) 7 for every 15 residents, with a 8 minimum of 0.53 hours of care 9 provided per resident during such 10 shift. 11 ‘‘(V) SECRETARIAL AUTHORITY 12 TO ESTABLISH HIGHER MINIMUM 13 NURSE STAFFING LEVELS.—The Sec- 14 retary may establish and require 15 skilled nursing facilities (or, at the 16 Secretary’s discretion, only skilled 17 nursing facilities that have a higher 18 percentage of residents with extensive 19 care needs, as determined by the Sec- 20 retary) to provide for minimum nurse 21 staffing levels that are higher than 22 the levels required under this clause. 23 ‘‘(VI) RULE OF CONSTRUCTION 24 REGARDING STATE AUTHORITY TO ES- 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 7 •HR 5216 IH TABLISH HIGHER MINIMUM NURSE 1 STAFFING LEVELS.—Nothing in this 2 clause may be construed as preventing 3 a State from establishing or requiring 4 skilled nursing facilities in the State 5 to provide for minimum nurse staffing 6 levels that are higher than the levels 7 required under this clause. 8 ‘‘(VII) CLARIFICATION WITH RE- 9 SPECT TO MINIMUM HOURS OF CARE 10 PROVIDED PER RESIDENT REQUIRE- 11 MENTS.—In complying with the min- 12 imum hours of care provided per resi- 13 dent requirements under this clause, a 14 skilled nursing facility may not count 15 any time spent by a registered profes- 16 sional nurse, licensed practical nurse, 17 or nurse aide on administrative serv- 18 ices towards compliance with such re- 19 quirements. 20 ‘‘(VIII) DEFINITIONS.—In this 21 clause: 22 ‘‘(aa) ADMINISTRATIVE 23 SERVICES.—The term ‘adminis- 24 trative services’ means food prep- 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 8 •HR 5216 IH aration, housekeeping, laundry 1 services, maintenance services, 2 and other noncaregiving-related 3 services, as determined by the 4 Secretary. 5 ‘‘(bb) DAY SHIFT.—The 6 term ‘day shift’ means, with re- 7 spect to a day and a skilled nurs- 8 ing facility, an assigned work 9 shift that is a period of 8 con- 10 secutive hours, beginning not 11 sooner than 6 a.m. in the time 12 zone in which such facility is lo- 13 cated and not later than 8 a.m. 14 in such time zone. 15 ‘‘(cc) EVENING SHIFT.—The 16 term ‘evening shift’ means, with 17 respect to a day and a skilled 18 nursing facility, an assigned work 19 shift that is a period of 8 con- 20 secutive hours, beginning not 21 sooner than 2 p.m. in the time 22 zone in which such facility is lo- 23 cated and not later than 4 p.m. 24 in such time zone. 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 9 •HR 5216 IH ‘‘(dd) NIGHT SHIFT.—The 1 term ‘night shift’ means, with re- 2 spect to a day and a skilled nurs- 3 ing facility, an assigned work 4 shift that is a period of 8 con- 5 secutive hours, beginning not 6 sooner than 10 p.m. in the time 7 zone in which such facility is lo- 8 cated and not later than mid- 9 night in such time zone.’’. 10 (2) ENFORCEMENT.—Section 1819(h) of the 11 Social Security Act (42 U.S.C. 1395i–3(h)) is 12 amended— 13 (A) in paragraph (1), by striking ‘‘If a 14 State finds, on the basis of a standard’’ and in- 15 serting ‘‘Subject to paragraph (7), if a State 16 finds, on the basis of a standard’’; 17 (B) in paragraph (2), by striking ‘‘With 18 respect to’’ and inserting ‘‘Subject to paragraph 19 (7), with respect to’’; and 20 (C) by adding at the end the following new 21 paragraph: 22 ‘‘(7) SPECIAL ENFORCEMENT PROCESS WITH 23 RESPECT TO MINIMUM NURSE STAFFING REQUIRE- 24 MENTS.— 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 10 •HR 5216 IH ‘‘(A) IN GENERAL.—If a State finds, on 1 the basis of a standard, extended, or partial ex- 2 tended survey under subsection (g)(2) or other- 3 wise, that a skilled nursing facility does not 4 meet the minimum staffing requirements of 5 clause (ii) of subsection (b)(4)(C) with respect 6 to skilled nursing facility services provided on 7 or after January 1, 2020, the State shall rec- 8 ommend to the Secretary that the Secretary 9 take such actions as described in subclauses (I) 10 and (II) of subparagraph (B)(i). 11 ‘‘(B) SECRETARIAL AUTHORITY.— 12 ‘‘(i) IN GENERAL.—With respect to 13 any skilled nursing facility in a State, if 14 the Secretary finds, or pursuant to a rec- 15 ommendation of the State under subpara- 16 graph (A) finds, that a skilled nursing fa- 17 cility does not meet the minimum staffing 18 requirements of clause (ii) of subsection 19 (b)(4)(C) with respect to skilled nursing 20 facility services provided on or after Janu- 21 ary 1, 2020, the Secretary shall— 22 ‘‘(I) deny any further payments 23 under this title with respect to all in- 24 dividuals entitled to benefits under 25 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 11 •HR 5216 IH this title who are admitted to the fa- 1 cility after the effective date of the 2 finding; and 3 ‘‘(II) impose a civil money pen- 4 alty in an amount not to exceed 5 $10,000 for each day of noncompli- 6 ance. The provisions of section 1128A 7 (other than subsections (a) and (b)) 8 shall apply to a civil money penalty 9 under the previous sentence in the 10 same manner as such provisions apply 11 to a penalty or proceeding under sec- 12 tion 1128A(a). 13 ‘‘(ii) REDUCTION OF CIVIL MONEY 14 PENALTIES IN CERTAIN CIR- 15 CUMSTANCES.—Subject to clause (iii), in 16 the case where a skilled nursing facility 17 self-reports and promptly corrects a defi- 18 ciency for which a penalty was imposed 19 under clause (i)(II) not later than 10 cal- 20 endar days after the date of such imposi- 21 tion, the Secretary may reduce the amount 22 of the penalty imposed by— 23 ‘‘(I) not more than 50 percent; or 24 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 12 •HR 5216 IH ‘‘(II) in the case that the facility 1 was penalized under this subsection 2 within the three-year period preceding 3 the date of such imposition, not more 4 than 25 percent. 5 ‘‘(iii) PROHIBITIONS ON REDUCTION 6 FOR CERTAIN DEFICIENCIES.— 7 ‘‘(I) REPEAT DEFICIENCIES.— 8 The Secretary may not reduce the 9 amount of a penalty under clause (ii) 10 if the Secretary had reduced a penalty 11 imposed on the skilled nursing facility 12 in the preceding year under such 13 clause with respect to a repeat defi- 14 ciency. 15 ‘‘(II) CERTAIN OTHER DEFI- 16 CIENCIES.—The Secretary may not 17 reduce the amount of a penalty under 18 clause (ii) if the penalty is imposed on 19 the skilled nursing facility for a defi- 20 ciency that is found to result in a pat- 21 tern of harm or widespread harm, im- 22 mediately jeopardizes the health or 23 safety of a resident or residents of the 24 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 13 •HR 5216 IH facility, or results in the death of a 1 resident of the facility. 2 ‘‘(iv) REPEATED NONCOMPLIANCE.— 3 In the case of a skilled nursing facility 4 which, on three consecutive standard sur- 5 veys conducted under subsection (g)(2), 6 has been found as not meeting the min- 7 imum staffing requirements of clause (ii) 8 of subsection (b)(4)(C) with respect to 9 skilled nursing facility services provided on 10 or after January 1, 2020, the Secretary 11 may (regardless of the remedies provided 12 for under clause (i))— 13 ‘‘(I) appoint temporary manage- 14 ment to oversee the operation of the 15 facility and to assure the health and 16 safety of the facility’s residents in ac- 17 cordance with clause (iii) of para- 18 graph (2)(B), except that ‘the min- 19 imum staffing requirements of clause 20 (ii) of subsection (b)(4)(C)’ shall be 21 substituted for ‘all the requirements 22 of subsections (b), (c), and (d)’ under 23 such clause; 24 VerDate Sep 11 2014 22:02 Dec 10, 2019 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5216.IH H5216 kjohnson on DSK79L0C42 with BILLS 14 •HR 5216 IH ‘‘(II) monitor the facility under 1 subsection (g)(4)(B) with respect to 2 such minimum staffing requirements 3 until the facility has demonstrated to 4 the satisfaction of the Secretary that 5 the facility is in compliance, and will 6 remain in compliance, with such min- 7 imum staffing requirements; or 8 ‘‘(III) subject to section 9 1128I(h), terminate the facility’s par- 10 ticipation under this title. 11 If the facility’s participation under this 12 title is [Text truncated for display. Full text available on Congress.gov.]