Ensuring Seniors’ Access to Quality Care Act

I 118TH CONGRESS 1ST SESSION H. R. 3227 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 MAY 11, 2023 Mr. ESTES (for himself and Mr. CONNOLLY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration 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 ‘‘Ensuring Seniors’ Ac- 4 cess to Quality Care Act’’. 5 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3227 IH SEC. 2. TRAINING AND COMPETENCY EVALUATION PRO- 1 GRAMS. 2 (a) MEDICARE.—Section 1819(f)(2) of the Social Se- 3 curity Act (42 U.S.C. 1395i–3(f)(2)) is amended— 4 (1) in subparagraph (A)(iv)(I), by striking 5 ‘‘(unless the facility is described in subparagraph 6 (B)(iii)(I))’’; 7 (2) in subparagraph (B)— 8 (A) in clause (i)— 9 (i) by striking ‘‘(subject to clause 10 (iii))’’; and 11 (ii) by inserting ‘‘and’’ after the semi- 12 colon; 13 (B) in clause (ii), by striking ‘‘; and’’ and 14 inserting a period; and 15 (C) by striking clause (iii); 16 (3) by striking ‘‘A State may not delegate 17 (through subcontract or otherwise) its responsibility 18 under clause (iii)(II) to the skilled nursing facility.’’; 19 (4) by striking subparagraphs (C) and (D); and 20 (5) by adding at the end the following: 21 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 22 ING AND COMPETENCY EVALUATION PROGRAMS 23 AND NURSE AIDE COMPETENCY EVALUATION 24 PROGRAMS.— 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3227 IH ‘‘(i) IN GENERAL.—With respect to a 1 State, the Secretary shall, in consultation 2 with such State, disapprove, for a period 3 not to exceed 2 years, a nurse aide train- 4 ing and competency evaluation program or 5 a nurse aide competency evaluation pro- 6 gram offered by or in a skilled nursing fa- 7 cility if such facility— 8 ‘‘(I) has been assessed a civil 9 monetary penalty under subsection 10 (h)(2)(B)(ii) or section 11 1919(h)(2)(A)(ii) of not less than 12 $10,697 for providing substandard 13 quality of care; and 14 ‘‘(II) has not, in the determina- 15 tion of the Secretary, corrected the 16 deficiencies in quality of care for 17 which such civil monetary penalty was 18 assessed. 19 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 20 The Secretary shall rescind a disapproval 21 under clause (i) upon demonstration by a 22 skilled nursing facility that— 23 ‘‘(I) all deficiencies for which the 24 civil monetary penalty described in 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3227 IH clause (i)(I) was assessed have been 1 remedied; 2 ‘‘(II) the facility has not received 3 deficiencies related to direct patient 4 harm for substandard quality of care 5 deficiencies in the prior 2 years; and 6 ‘‘(III) the Secretary certifies that 7 the civil monetary penalty assessed 8 under clause (i)(I) did not result in 9 immediate jeopardy for direct patient 10 harm or injury related to an abuse or 11 neglect deficiency. 12 For purposes of rescinding disapproval 13 under this clause, the Secretary may re- 14 quire additional oversight of the skilled 15 nursing facility for a period not to exceed 16 the period of disapproval imposed under 17 clause (i) with respect to such facility.’’. 18 (b) MEDICAID.—Section 1919(f)(2) of the Social Se- 19 curity Act (42 U.S.C. 1396r(f)(2)) is amended— 20 (1) in subparagraph (A)(iv)(I), by striking 21 ‘‘(unless the facility is described in subparagraph 22 (B)(iii)(I))’’; 23 (2) in subparagraph (B)— 24 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3227 IH (A) in clause (i), by inserting ‘‘and’’ after 1 the semicolon; 2 (B) in clause (ii), by striking ‘‘; and’’ and 3 inserting a period; 4 (C) by striking clause (iii); and 5 (D) by striking ‘‘A State may not delegate 6 (through subcontract or otherwise) its responsi- 7 bility under clause (iii)(II) to the nursing facil- 8 ity.’’; 9 (3) by striking subparagraphs (C) and (D); and 10 (4) by adding at the end the following: 11 ‘‘(C) DISAPPROVAL OF NURSE AIDE TRAIN- 12 ING AND COMPETENCY EVALUATION PROGRAMS 13 AND NURSE AIDE COMPETENCY EVALUATION 14 PROGRAMS.— 15 ‘‘(i) IN GENERAL.—With respect to a 16 State, the Secretary shall, in consultation 17 with such State, disapprove, for a period 18 not to exceed 2 years, a nurse aide train- 19 ing and competency evaluation program or 20 a nurse aide competency evaluation pro- 21 gram offered by or in a nursing facility if 22 such facility— 23 ‘‘(I) has been assessed a civil 24 monetary penalty under section 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3227 IH 1819(h)(2)(B)(ii) or subsection 1 (h)(2)(A)(ii) of not less than $10,697 2 for providing substandard quality of 3 care; and 4 ‘‘(II) has not, in the determina- 5 tion of the Secretary, corrected the 6 deficiencies in quality of care for 7 which such civil monetary penalty was 8 assessed. 9 ‘‘(ii) RESCISSION OF DISAPPROVAL.— 10 The Secretary shall rescind a disapproval 11 under clause (i) upon demonstration by a 12 nursing facility that— 13 ‘‘(I) all deficiencies for which the 14 civil monetary penalty described in 15 clause (i)(I) was assessed have been 16 remedied; 17 ‘‘(II) the facility has not received 18 deficiencies related to direct patient 19 harm for substandard quality of care 20 deficiencies in the prior 2 years; and 21 ‘‘(III) the Secretary certifies that 22 the civil monetary penalty assessed 23 under clause (i)(I) did not result in 24 immediate jeopardy for direct patient 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3227 IH harm or injury related to an abuse or 1 neglect deficiency. 2 For purposes of rescinding disapproval 3 under this clause, the Secretary may re- 4 quire additional oversight of the nursing 5 facility for a period not to exceed the pe- 6 riod of disapproval imposed under clause 7 (i) with respect to such facility.’’. 8 (c) REGULATIONS.—Not later than 180 days after 9 the date of enactment of this Act, the Secretary of Health 10 and Human Services shall promulgate regulations as nec- 11 essary to implement the amendments made by this section. 12 (d) APPLICABILITY.— 13 (1) IN GENERAL.— 14 (A) TIMING OF DETERMINATIONS.—The 15 amendments made by subsections (a)(4) and 16 (b)(4) of this section shall apply only to a civil 17 monetary penalty if the relevant covered deter- 18 mination was made on or after the date of en- 19 actment of this Act. 20 (B) COVERED DETERMINATION DE- 21 FINED.—The term ‘‘covered determination’’ 22 means, with respect to a skilled nursing facility 23 or a nursing facility in a State, a determination 24 by the State or the Secretary of Health and 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3227 IH Human Services that the facility has provided 1 a substandard quality of care for which a civil 2 monetary penalty described in section 3 1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 4 Social Security Act (as such sections have been 5 amended by this Act) may be assessed. 6 (2) PREVIOUSLY PROHIBITED PROGRAMS.— 7 (A) WAIVER.—With respect to a skilled 8 nursing facility or a nursing facility subject, on 9 the day before the date of enactment of this 10 Act, to a prohibition under item (a) of either 11 section 1819(f)(2)(B)(iii)(I) or section 12 1919(f)(2)(B)(iii)(I) of the Social Security Act 13 (as in effect on the day before such date of en- 14 actment), such prohibition shall no longer apply 15 to the facility on or after such date of enact- 16 ment. 17 (B) SURVEY OR CIVIL MONETARY PEN- 18 ALTY.—With respect to a skilled nursing facil- 19 ity or a nursing facility subject, on the day be- 20 fore the date of enactment of this Act, to a pro- 21 hibition under item (b) or (c) of either section 22 1819(f)(2)(B)(iii)(I) or section 23 1919(f)(2)(B)(iii)(I) of the Social Security Act 24 (as in effect on the day before such date of en- 25 VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3227 IH actment), such prohibition shall no longer apply 1 to the facility on or after such date of enact- 2 ment upon a determination by the Secretary of 3 Health and Human Services that the facility 4 has corrected the issue that resulted in such 5 prohibition. 6 SEC. 3. PERMITTING MEDICARE AND MEDICAID PRO- 7 VIDERS TO ACCESS THE NATIONAL PRACTI- 8 TIONER DATA BANK TO CONDUCT EMPLOYEE 9 BACKGROUND CHECKS. 10 Section 1921(b)(6) of the Social Security Act (42 11 U.S.C. 1396r–2(b)(6)) is amended— 12 (1) by striking ‘‘and other health care entities 13 (as defined in section 431 of the Health Care Qual- 14 ity Improvement Act of 1986)’’ and inserting ‘‘, 15 other health care entities (as defined in section 431 16 of the Health Care Quality Improvement Act of 17 1986), providers of services (as defined in section 18 1861(u)), suppliers (as defined in section 1861(d)), 19 and providers of items or services under a State plan 20 under this title (or a waiver of such a plan)’’; and 21 (2) by striking ‘‘such hospitals or other health 22 care entities’’ and inserting ‘‘such hospitals, health 23 care entities, providers, or suppliers’’. 24 Æ VerDate Sep 11 2014 21:06 May 22, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H3227.IH H3227 pbinns on DSKJLVW7X2PROD with $$_JOB