Ensuring Seniors’ Access to Quality Care Act

II 116TH CONGRESS 1ST SESSION S. 2993 To amend titles XVIII and XIX of the Social Security Act with respect to nursing facility requirements, and for other purposes. IN THE SENATE OF THE UNITED STATES DECEMBER 5, 2019 Mr. WARNER (for himself and Mr. SCOTT of South Carolina) 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 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 ‘‘Ensuring Seniors’ Ac- 4 cess to Quality Care Act’’. 5 SEC. 2. TRAINING AND COMPETENCY EVALUATION PRO- 6 GRAMS. 7 (a) MEDICARE.—Section 1819 of the Social Security 8 Act (42 U.S.C. 1395i–3) is amended— 9 (1) in subsection (f)(2)— 10 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2993 IS (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)— 5 (I) by striking ‘‘(subject to clause 6 (iii))’’; and 7 (II) by inserting ‘‘and’’ after the 8 semicolon; 9 (ii) in clause (ii), by striking ‘‘; and’’ 10 and inserting a period; 11 (iii) by striking clause (iii); and 12 (iv) by striking ‘‘A State may not del- 13 egate (through subcontract or otherwise) 14 its responsibility under clause (iii)(II) to 15 the skilled nursing facility.’’; 16 (C) by striking subparagraphs (C) and 17 (D); and 18 (D) by adding at the end the following: 19 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 20 ING AND COMPETENCY EVALUATION PROGRAMS 21 AND NURSE AIDE COMPETENCY EVALUATION 22 PROGRAMS.— 23 ‘‘(i) IN GENERAL.—With respect to a 24 State, the Secretary shall, in consultation 25 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2993 IS with such State, disapprove, for a period 1 not to exceed 2 years, a nurse aide train- 2 ing and competency evaluation program or 3 a nurse aide competency evaluation pro- 4 gram offered by or in a skilled nursing fa- 5 cility if such facility— 6 ‘‘(I) has been assessed a civil 7 monetary penalty under subsection 8 (h)(2)(B)(ii) or section 9 1919(h)(2)(A)(ii) of not less than 10 $10,697 for providing substandard 11 quality of care; and 12 ‘‘(II) has not, in the determina- 13 tion of the Secretary, corrected the 14 deficiencies in quality of care for 15 which such civil monetary penalty was 16 assessed. 17 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 18 The Secretary shall rescind a disapproval 19 under clause (i) upon demonstration by a 20 skilled nursing facility that— 21 ‘‘(I) all deficiencies for which the 22 civil monetary penalty described in 23 clause (i)(I) was assessed have been 24 remedied; 25 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2993 IS ‘‘(II) the facility has not received 1 deficiencies related to direct patient 2 harm for substandard quality of care 3 deficiencies in the prior 2 years; and 4 ‘‘(III) the Secretary certifies that 5 the civil monetary penalty assessed 6 under clause (i)(I) did not result in 7 immediate jeopardy for direct patient 8 harm or injury related to an abuse or 9 neglect deficiency. 10 For purposes of rescinding disapproval 11 under this clause, the Secretary may re- 12 quire additional oversight of the skilled 13 nursing facility for a period not to exceed 14 the period of disapproval imposed under 15 clause (i) with respect to such facility.’’; 16 and 17 (2) in subsection (h)(2)(B)(ii)(I), by striking 18 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 19 (b) MEDICAID.—Section 1919 of the Social Security 20 Act (42 U.S.C. 1396r) 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 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2993 IS (B) in subparagraph (B)— 1 (i) in clause (i), by inserting ‘‘and’’ 2 after the semicolon; 3 (ii) in clause (ii), by striking ‘‘; and’’ 4 and inserting a period; 5 (iii) by striking clause (iii); and 6 (iv) by striking ‘‘A State may not del- 7 egate (through subcontract or otherwise) 8 its responsibility under clause (iii)(II) to 9 the nursing facility.’’; 10 (C) by striking subparagraphs (C) and 11 (D); and 12 (D) by adding at the end the following: 13 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 14 ING AND COMPETENCY EVALUATION PROGRAMS 15 AND NURSE AIDE COMPETENCY EVALUATION 16 PROGRAMS.— 17 ‘‘(i) IN GENERAL.—With respect to a 18 State, the Secretary shall, in consultation 19 with such State, disapprove, for a period 20 not to exceed 2 years, a nurse aide train- 21 ing and competency evaluation program or 22 a nurse aide competency evaluation pro- 23 gram offered by or in a nursing facility if 24 such facility— 25 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2993 IS ‘‘(I) has been assessed a civil 1 monetary penalty under section 2 1819(h)(2)(B)(ii) or subsection 3 (h)(2)(A)(ii) of not less than $10,697 4 for providing substandard quality of 5 care; and 6 ‘‘(II) has not, in the determina- 7 tion of the Secretary, corrected the 8 deficiencies in quality of care for 9 which such civil monetary penalty was 10 assessed. 11 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 12 The Secretary shall rescind a disapproval 13 under clause (i) upon demonstration by a 14 nursing facility that— 15 ‘‘(I) all deficiencies for which the 16 civil monetary penalty described in 17 clause (i)(I) was assessed have been 18 remedied; 19 ‘‘(II) the facility has not received 20 deficiencies related to direct patient 21 harm for substandard quality of care 22 deficiencies in the prior 2 years; and 23 ‘‘(III) the Secretary certifies that 24 the civil monetary penalty assessed 25 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2993 IS under clause (i)(I) did not result in 1 immediate jeopardy for direct patient 2 harm or injury related to an abuse or 3 neglect deficiency. 4 For purposes of rescinding disapproval 5 under this clause, the Secretary may re- 6 quire additional oversight of the nursing 7 facility for a period not to exceed the pe- 8 riod of disapproval imposed under clause 9 (i) with respect to such facility.’’; and 10 (2) in subsection (h)(3)(C)(ii)(I), by striking 11 ‘‘$10,000’’ and inserting ‘‘$21,393’’. 12 (c) REGULATIONS.—Not later than 180 days after 13 the date of enactment of this Act, the Secretary of Health 14 and Human Services shall promulgate regulations as nec- 15 essary to implement the amendments made by this section. 16 (d) APPLICABILITY.— 17 (1) IN GENERAL.— 18 (A) TIMING OF DETERMINATIONS.—The 19 amendments made by subsections (a)(1)(D) and 20 (b)(1)(D) of this section shall apply only to a 21 civil monetary penalty if the relevant covered 22 determination was made on or after the date of 23 enactment of this Act. 24 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2993 IS (B) COVERED DETERMINATION DE- 1 FINED.—The term ‘‘covered determination’’ 2 means, with respect to a skilled nursing facility 3 or a nursing facility in a State, a determination 4 by the State or the Secretary of Health and 5 Human Services that the facility has provided 6 a substandard quality of care for which a civil 7 monetary penalty described in section 8 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 9 Social Security Act (as such sections have been 10 amended by this Act) may be assessed. 11 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 12 (A) WAIVER.—With respect to a skilled 13 nursing facility or a nursing facility subject, on 14 the day before the date of enactment of this 15 Act, to a prohibition under item (a) of either 16 section 1819(f)(2)(B)(iii)(I) or section 17 1919(f)(2)(B)(iii)(I) of the Social Security Act 18 (as in effect on the day before such date of en- 19 actment), such prohibition shall no longer apply 20 to the facility on or after such date of enact- 21 ment. 22 (B) SURVEY OR CIVIL MONETARY PEN- 23 ALTY.—With respect to a skilled nursing facil- 24 ity or a nursing facility subject, on the day be- 25 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 2993 IS fore the date of enactment of this Act, to a pro- 1 hibition under item (b) or (c) of either section 2 1819(f)(2)(B)(iii)(I) or section 3 1919(f)(2)(B)(iii)(I) of the Social Security Act 4 (as in effect on the day before such date of en- 5 actment), such prohibition shall no longer apply 6 to the facility on or after such date of enact- 7 ment upon a determination by the Secretary of 8 Health and Human Services that the facility 9 has corrected the issue that resulted in such 10 prohibition. 11 SEC. 3. PERMITTING MEDICARE AND MEDICAID PRO- 12 VIDERS TO ACCESS THE NATIONAL PRACTI- 13 TIONER DATA BANK TO CONDUCT EMPLOYEE 14 BACKGROUND CHECKS. 15 Section 1921(b)(6) of the Social Security Act (42 16 U.S.C. 1396r–2(b)(6)) is amended— 17 (1) by striking ‘‘and other health care entities 18 (as defined in section 431 of the Health Care Qual- 19 ity Improvement Act of 1986)’’ and inserting ‘‘, 20 other health care entities (as defined in section 431 21 of the Health Care Quality Improvement Act of 22 1986), providers of services (as defined in section 23 1861(u)), suppliers (as defined in section 1861(d)), 24 VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 2993 IS and providers of items or services under a State plan 1 under this title (or a waiver of such a plan)’’; and 2 (2) by striking ‘‘such hospitals or other health 3 care entities’’ and inserting ‘‘such hospitals, health 4 care entities, providers, or suppliers’’. 5 Æ VerDate Sep 11 2014 23:41 Dec 11, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S2993.IS S2993 pamtmann on DSKBC07HB2PROD with BILLS