HR 4614 IH
106th CONGRESS
2d Session
H. R. 4614
To amend title XVIII of the Social Security Act to require skilled
nursing facilities furnishing services to Medicare beneficiaries to submit data
to the Secretary of Health and Human Services with respect to nursing staff
levels of the facility, to require posting of staffing information by facilities
and the Secretary, to assess the adequacy of training requirements for certified
nurse aides, and provide for grants to improve the quality of care furnished in
nursing facilities.
IN THE HOUSE OF REPRESENTATIVES
June 8, 2000
Mr. STARK (for himself, Ms. ESHOO, Mr. GEORGE MILLER of California, Ms.
WOOLSEY, Ms. PELOSI, Ms. LEE, and Mr. LANTOS) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addition to the
Committee on Commerce, for a period to be subsequently 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 title XVIII of the Social Security Act to require skilled
nursing facilities furnishing services to Medicare beneficiaries to submit data
to the Secretary of Health and Human Services with respect to nursing staff
levels of the facility, to require posting of staffing information by facilities
and the Secretary, to assess the adequacy of training requirements for certified
nurse aides, and provide for grants to improve the quality of care furnished in
nursing facilities.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Nursing Staff
Accountability and Training Improvement Act of 2000'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
TITLE I--INFORMATION ON NURSING STAFF IN NURSING FACILITIES
Sec. 101. Submission of nursing staff level data to the secretary.
Sec. 102. Information on nursing facility staffing.
Sec. 103. Direct spending for administrative expenses of State agencies
determining compliance by providers of services with conditions of
participation.
Sec. 104. Comprehensive report on certified nurse aide training.
Sec. 105. Effective date.
TITLE II--GRANTS TO IMPROVE QUALITY OF NURSING HOME AND LONG-TERM CARE
Sec. 201. Improvement of training of long-term care professionals and
workers.
Sec. 202. Upward mobility of long-term care workers.
Sec. 203. Retention of long-term care professionals and workers in
medically underserved areas.
Sec. 204. Improvement in worker safety.
Sec. 205. Demonstration program to implement quality improvement models
in nursing facility settings.
TITLE I--INFORMATION ON NURSING STAFF IN NURSING
FACILITIES
SEC. 101. SUBMISSION OF NURSING STAFF LEVEL DATA TO THE SECRETARY.
(1) IN GENERAL- Section 1819(b) of the Social Security Act (42 U.S.C.
1395i-3(b)) is amended by adding at the end the following new
paragraph:
`(8) SUBMISSION OF DATA ON STAFFING LEVELS-
`(A) IN GENERAL- A skilled nursing facility shall submit to the
Secretary, in a form and manner determined by the Secretary, such data for
a covered period (as defined in subparagraph (C)) with respect to nursing
staff as is necessary for the Secretary to determine whether a resident of
the skilled nursing facility receives the level of care commensurate with
the assessment of the resident under this subsection. Such data shall
include the total number of nursing staff hours furnished during each
covered period by the facility to residents for which payment is made
under section 1888(e) broken down by total certified nurse aide hours,
total licensed practical or vocational nurse hours, and total registered
nurse hours.
`(B) ADJUSTMENT IN PAYMENT AMOUNT FOR INADEQUATE STAFFING- If the
nursing staff data discloses that the aggregate nursing staff hours
furnished during the covered period by the facility for residents for
which payment is made under section 1888(e) during the period is less than
the aggregate amount corresponding to the nursing staff hours which is the
basis of the case mix reimbursement (under section 1888(e)(4)(G)(i)) for
such residents for the facility for that period, the Secretary shall make
proportionate adjustments in the payment amounts determined under section
1888(e) to the facility.
`(C) COVERED PERIOD DEFINED-
`(i) IN GENERAL- For purposes of this paragraph, the term `covered
period' means the lesser of 32 days or the facility billing period
described in clause (ii).
`(ii) FACILITY BILLING PERIOD DESCRIBED- A facility billing period
referred to in clause (i) the aggregate number of days between periods
that the Secretary makes payment for claims for services furnished by
the facility under this title.'.
(2) INCLUSION OF NURSING STAFFING LEVELS IN ANNUAL SURVEY- Section
1819(g)(2)(A)(ii) of such Act (42 U.S.C. 1395i-3(g)(2)(A)(ii)) is
amended--
(A) by striking `and' at the end of subclause (II);
(B) by striking the period at the end of subclause (III) and inserting
`; and'; and
(C) by adding at the end the following new subclause:
`(IV) a review of the sufficiency and distribution of staffing in
the skilled nursing facility to meet the needs of residents 24 hours a
day, 7 days a week.'.
(3) DEVELOPMENT OF STANDARD COST REPORTING FORM FOR ALL SKILLED NURSING
FACILITIES- Section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e))
is amended by adding at the end the following new paragraph:
`(13) REQUIRED UNIFORM COST REPORTING FORMS- For cost reporting periods
beginning on or after October 1, 2001, a skilled nursing facility shall
submit to the Secretary a cost report for the cost reporting period involved
using the standard, uniform cost reporting form developed by the Secretary
for such purpose. Such standard, uniform form shall be developed in a manner
to enable the Secretary to assess amounts of direct patient care furnished
by
nursing staff of the facility and to determine whether payments made for such
care are appropriate.'.
(1) ANALYSIS OF SPENDING FOR PATIENT CARE IN AUDITS OF NURSING FACILITY
COST REPORTS-
(A) IN GENERAL- A State shall carry out periodic audits of cost
reports submitted by a nursing facility (as defined in section 1919(a) of
the Social Security Act (42 U.S.C. 1396r(a))) operating in the State. Such
audits shall (i) determine the aggregate expenditures made by the nursing
facility during the cost reporting period on direct patient care furnished
by licensed health professionals (as defined in subparagraph (G) of
section 1919(b)(5) of such Act (42 U.S.C. 1396r(b)(5))) and by nurse aides
(as defined in subparagraph (F) of such section) and (ii) compare such
aggregate expenditures to payments made by the State for such direct
patient care.
(B) STUDY- The Secretary of Health and Human Services shall conduct a
study to determine the feasibility of developing and administering a
standardized, uniform cost reporting form for all nursing facilities
furnishing services for which payment is made under title XIX of the
Social Security Act. Any such form should enable the Secretary to assess
the amount of direct patient care referred to in subparagraph (A)
furnished by each nursing facility and to determine whether payments made
for such direct patient care are appropriate.
(2) INCLUSION OF NURSING STAFFING LEVELS IN ANNUAL SURVEY- Section
1919(g)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1396r(g)(2)(A)(ii))
is amended--
(A) by striking `and' at the end of subclause (II);
(B) by striking the period at the end of subclause (III) and inserting
`; and'; and
(C) by adding at the end the following new subclause:
`(IV) a review of the sufficiency and distribution of staffing in
the skilled nursing facility to meet the needs of residents 24 hours a
day, 7 days a week.'.
SEC. 102. INFORMATION ON NURSING FACILITY STAFFING.
(1) IN GENERAL- Section 1819(b) of the Social Security Act (42 U.S.C.
1395i-3(b)), as amended by section 2(a), is further amended by adding at the
end the following new paragraph:
`(9) INFORMATION ON NURSE STAFFING-
`(A) IN GENERAL- A skilled nursing facility shall post daily for each
nursing unit of the facility and for each shift the current number of
licensed and unlicensed nursing staff directly responsible for resident
care and the current ratios of residents to staff, stated separately for
the ratio of the number of residents to such licensed nursing staff and
the ratio of the number of residents to such unlicensed nursing staff. The
information shall be displayed in a uniform manner and in a clearly
visible place. The facility shall also post in a clearly visible place
annual average daily staffing ratios per shift for the last cost reporting
period.
`(B) PUBLICATION OF DATA-
`(i) IN GENERAL- A skilled nursing facility shall, upon request,
make available to the public nursing staff data to the
same extent and in the same manner as cost reporting information.
`(ii) INTERNET- Not later than 60 days after the date of completion
of an annual survey under subsection (g)(2), the Secretary shall provide
for the publication on the Internet Site of the Department of Health and
Human Services known as Nursing Home Compare the facility-specific
nursing staff information collected under such survey. The Secretary
shall update such information periodically.'.
(2) PENALTY FOR FAILURE TO POST REQUIRED INFORMATION- Section 1819(h)(2)
of such Act (42 U.S.C. 1395i-3(h)(2)), is amended by adding at the end the
following new subparagraph:
`(F) MANDATORY CIVIL MONEY PENALTY FOR FAILURE TO POST REQUIRED
INFORMATION- Notwithstanding any other provision of law, the Secretary
shall impose a civil monetary penalty upon a skilled nursing facility that
fails to meet the posting requirement of subsection (b)(9). The penalty
shall be in the amount of $1,000 for each day upon which the facility
fails to meet fully such requirement. The provisions of section 1128A of
the Social Security Act (other than subsections (a) and (b)) shall apply
to civil money penalties under this subparagraph in the same manner as
they apply to a penalty or proceeding under section 1128A(a) of such
Act.'.
(1) IN GENERAL- Section 1919(b) of the Social Security Act (42 U.S.C.
1396r(b)) is amended by adding at the end the following new paragraph:
`(8) INFORMATION ON NURSE STAFFING-
`(A) IN GENERAL- A skilled nursing facility shall post daily for each
nursing unit of the facility and for each shift the current number of
licensed and unlicensed nursing staff directly responsible for resident
care and the current ratios of residents to staff, stated separately for
the ratio of the number of residents to such licensed nursing staff and
the ratio of the number of residents to such unlicensed nursing staff. The
information shall be displayed in a uniform manner and in a clearly
visible place. The facility shall also post in a clearly visible place
annual average daily staffing ratios per shift for the last cost reporting
period.
`(B) PUBLICATION OF DATA-
`(i) IN GENERAL- A skilled nursing facility shall, upon request,
make available to the public nursing staff data to the same extent and
in the same manner as cost reporting information.
`(ii) INTERNET- Not later than 60 days after the date of completion
of an annual survey under subsection (g)(2), the Secretary shall provide
for the publication on the Internet Site of the Department of Health and
Human Services known as Nursing Home Compare the facility-specific
nursing staff information collected under such survey. The Secretary
shall update such information periodically.'.
(2) Section 1919(h)(3) of such Act (42 U.S.C. 1396r(h)(3)), is amended
by adding at the end the following new subparagraph:
`(E) MANDATORY CIVIL MONEY PENALTY FOR FAILURE TO POST REQUIRED
INFORMATION- Notwithstanding any other provision of law, the Secretary
shall impose a civil monetary penalty upon a nursing facility that fails
to meet the posting requirement of subsection (b)(9). The penalty shall be
in the amount of $1,000 for each day upon which the facility fails to meet
fully such requirement. The provisions of section 1128A of the Social
Security Act (other than subsections (a) and (b)) shall apply to civil
money penalties under this subparagraph in the same manner as they apply
to a penalty or proceeding under section 1128A(a) of such Act. This
subparagraph shall not apply to a failure for which a civil money penalty
is imposed under section 1819(h)(2)(F).'.
SEC. 103. DIRECT SPENDING FOR ADMINISTRATIVE EXPENSES OF STATE AGENCIES
DETERMINING COMPLIANCE BY PROVIDERS OF SERVICES WITH CONDITIONS OF
PARTICIPATION.
(a) IN GENERAL- Section 1864 of the Social Security Act (42 U.S.C. 1395aa)
is amended by adding at the end the following new subsection:
`(f) APPROPRIATION OF CERTAIN FUNDS TO ADMINISTER THIS SECTION- The
Secretary shall pay expenses incurred in the administration of this section
from funds in the Federal Hospital Insurance Trust Fund (established under
section 1817) and the Federal Supplementary Medical Insurance Trust Fund
(established under section 1841), in such amounts from each of such trust
funds as the Secretary shall deem to be fair and equitable after taking into
consideration the expenses attributable to the administration of this section
with respect to items and services furnished under this title attributable to
parts A and B and under title XI with respect to those parts, without regard
to amounts appropriated in advance in appropriations Acts, in the same manner
as payments are made for services furnished directly to individuals entitled
to benefits under this title. The Secretary shall make such transfers of
monies between such trust funds as may be appropriate to settle accounts
between them in cases where expenses properly payable from one such trust fund
have been paid from the other trust fund.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
October 1, 2000.
SEC. 104. COMPREHENSIVE REPORT ON CERTIFIED NURSE AIDE TRAINING.
Not later than 18 months after the date of the enactment of this Act, the
Secretary of Health and Human Services shall submit to Congress a
comprehensive report on training of certified nurse aides, and shall include
in
that comprehensive report recommendations for the following:
(1) Whether training standards in effect on the date of the enactment of
this Act for certified nurse aides should be increased from 75 hours (the
Federal minimum number of hours of training for certification) to 160 hours,
or some other minimum standard.
(2) Whether Federal curriculum standards should require more focus on
each of the following:
(A) The recognition of the symptoms of malnutrition, dehydration,
pain, confusion, and anxiety.
(B) The prevention and treatment of infections, bed sores,
incontinence, and lack of mobility.
(C) Appropriate strategies for preventing physical and mental abuse of
residents of nursing facilities, such as conflict resolution and stress
management.
(D) Appropriate care for residents diagnosed with dementia or
dementia-related disease.
(E) Care for residents with diminished visual or audio
acuity.
SEC. 105. EFFECTIVE DATE.
The amendments made by sections 101 and 102 take effect on the first day
of the first month that begins at least 6 months after the date of the
enactment of this Act.
TITLE II--GRANTS TO IMPROVE QUALITY OF NURSING HOME AND LONG-TERM
CARE
SEC. 201. IMPROVEMENT OF TRAINING OF LONG-TERM CARE PROFESSIONALS AND
WORKERS.
(1) ESTABLISHMENT OF TRAINING CENTERS- The Secretary shall, in
accordance with the provisions of this section, award grants to a qualified
entity to establish education and training programs for individuals who
furnish direct resident care services in nursing facilities, including
registered professional nurses, licensed practical nurses, and certified
nurse aides.
(2) DISCRETION TO AWARD GRANTS TO EXISTING TRAINING PROGRAMS- The
Secretary may award grants to fund programs of such education and training
carried out by the following:
(B) An accredited educational institution.
(C) An institutional health care provider, including a nursing
facility.
(3) PRIORITY OF GRANT AWARDS- In awarding grants under this section, the
Secretary shall give priority to nursing facilities with approved
applications filed in partnership with labor representatives.
(4) DEADLINE FOR INITIAL GRANT AWARDS- The Secretary shall award grants
under this section by not later than 6 months after the date of the
enactment of this Act.
(1) APPLICATIONS REQUIRED- Each qualified or other entity referred to in
subsection (a) that wishes to receive a grant under this section shall
submit an application at such time, in such form, and complete with such
information as the Secretary shall by regulation require, except that any
such application shall include at least--
(A) a statement of the objectives for which the grant is sought;
and
(B) a description of the types of programs and activities for which
the grant is sought.
(2) NOTICE OF APPROVAL OR DISAPPROVAL- Each qualified or other entity
referred to in subsection (a) submitting an application under paragraph (1)
shall, not later than 60 days after the date of its submission, be notified
in writing as to whether such application is approved or disapproved.
(3) REQUIREMENT OF PRIOR APPROVAL FROM COLLECTIVE BARGAINING AGENCY- In
the case of a nursing facility applying for a grant under this section that
has a collective bargaining agent, the application filed by the facility
shall include written approval from that agent for the facility's proposed
use of the grant award.
(c) DURATION- A grant under this section may extend over a period of not
more than three years.
(d) ANNUAL APPROVAL- The provision of payments under a grant under this
section shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for each fiscal year to make the
payments.
(1) AUTHORIZED USES- A grant made under this section may be used only to
carry out to establish or fund education and training centers for
individuals who furnish direct resident care services in nursing facilities.
Each qualified or other entity referred to in subsection (a) awarded a grant
under this section shall develop curricula and interdisciplinary programs to
enhance direct care workers' abilities to provide quality care, including
for the following:
(A) New training that focuses on--
(i) recognizing signs of malnutrition, dehydration, pain, confusion,
and anxiety,
(ii) prevention and treatment of infections, bed sores,
incontinence, and lack of mobility,
(iii) strategies for preventing abuse of residents of nursing
facilities, such as conflict resolution and stress management,
and
(iv) recognizing symptoms in residents of nursing facilities of
dementia or dementia-related disease.
(B) Continuing education for licensed providers in the care of the
chronically ill and disabled or gerontological nursing, or both.
(2) PROHIBITED USES- A grant may not be used to pay for the minimum
number of training hours required for certified nurse aide
certification.
(f) REPORTS- A qualified or other entity referred to in subsection (a)
awarded a grant under this section shall submit to the Secretary such reports,
and within such time frames, as the Secretary may require.
(g) REGULATIONS- Any regulations to carry out this section shall be
prescribed not later than 60 days after the date of enactment of this
section.
(h) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated to the Secretary $25,000,000
for each of fiscal years 2001, 2002, and 2003. 60 percent of such
appropriation shall be payable from the Federal Hospital Insurance Trust Fund,
and 40 percent of such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under title XVIII of the Social
Security Act (42 U.S.C. 1395i, 1395t).
(i) DEFINITIONS- In this section:
(1) The term `Secretary' means the Secretary of Health and Human
Services.
(2) The term `qualified entity' means--
(A) a nursing facility as defined in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a));
(B) a skilled nursing facility (as defined in section 1819(a) of such
Act (42 U.S.C. 1395i-3(a));
(D) a community-based nonprofit organization;
(E) a State long-term care Ombudsman; community-based citizen advocacy
groups;
(F) a State deparment on aging; and
(G) such other entities approved by the Secretary.
SEC. 202. UPWARD MOBILITY OF LONG-TERM CARE WORKERS.
(1) IN GENERAL- The Secretary shall, in accordance with the provisions
of this section, award grants to qualified entities to provide for such
additional or advanced education and training of certified nursing aides who
furnish services in the facility. Such education and training shall be
designed to enable such staff to provide care in accordance with the
limitations of State nurse practice laws or regulations and with principles
of nurse delegations.
(2) PRIORITY OF GRANT AWARDS- In awarding grants under this section, the
Secretary shall give priority to nursing facilities with approved
applications filed in partnership with labor representatives.
(3) DEADLINE FOR INITIAL GRANT AWARDS- The Secretary shall award grants
under this section by not later than 6 months after the date of the
enactment of this Act.
(1) APPLICATIONS REQUIRED- Each qualified entity that wishes to receive
a grant under this section shall submit an application at such time, in such
form, and complete with such information as the Secretary shall by
regulation require, except that any such application shall include at
least--
(A) a statement of the objectives for which the grant is sought;
and
(B) a description of the types of programs and activities for which
the grant is sought.
(2) NOTICE OF APPROVAL OR DISAPPROVAL- Each qualified entity submitting
an application under paragraph (1) shall, not later than 60 days after the
date of its submission, be notified in writing as to whether such
application is approved or disapproved.
(3) REQUIREMENT OF PRIOR APPROVAL FROM COLLECTIVE BARGAINING AGENCY- In
the case of a nursing facility applying for a grant under this section that
has a collective bargaining agent, the application filed by the facility
shall include written approval from that agent for the facility's proposed
use of the grant award.
(c) DURATION- A grant under this section may extend over a period of not
more than three years.
(d) ANNUAL APPROVAL- The provision of payments under a grant under this
section shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for each fiscal year to make the
payments.
(e) USE OF GRANT FUNDS- A grant made under this section may be used only
to carry out to establish education and training programs referred to in
subsection (a)(1).
(f) REPORTS- A qualified entity awarded a grant under this section shall
submit to the Secretary such reports, and within such time frames, as the
Secretary may require.
(g) REGULATIONS- Any regulations to carry out this section shall be
prescribed not later than 60 days after the date of enactment of this
section.
(h) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated to the Secretary $25,000,000
for each of fiscal years 2001, 2002, and 2003. 60 percent of such
appropriation shall be payable from the Federal Hospital Insurance Trust Fund,
and 40 percent of such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under title XVIII of the Social
Security Act (42 U.S.C. 1395i, 1395t).
(i) DEFINITIONS- In this section:
(1) The term `Secretary' means the Secretary of Health and Human
Services.
(2) The term `qualified entity' means--
(A) a nursing facility as defined in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a));
(B) a skilled nursing facility (as defined in section 1819(a) of such
Act (42 U.S.C. 1395i-3(a));
(D) a community-based nonprofit organization;
(E) a State long-term care Ombudsman; community-based citizen advocacy
groups;
(F) a State deparment on aging; and
(G) such other entities approved by the Secretary.
SEC. 203. RETENTION OF LONG-TERM CARE PROFESSIONALS AND WORKERS IN MEDICALLY
UNDERSERVED AREAS.
(1) IN GENERAL- The Secretary shall, in accordance with the provisions
of this section, award grants to nursing facilities to establish programs to
retain individuals who furnish direct resident care services in nursing
facilities located in medically underserved areas, including registered
professional nurses, licensed practical nurses, and certified nurse
aides.
(2) DEADLINE FOR INITIAL GRANT AWARDS- The Secretary shall award grants
under this section by not later than 6 months after the date of the
enactment of this Act.
(1) APPLICATIONS REQUIRED- Each nursing facility that wishes to receive
a grant under this section shall submit an application at such time, in such
form, and complete with such information as the Secretary shall by
regulation require, except that any such application shall include at
least--
(A) a statement of the objectives for which the grant is sought;
and
(B) a description of the types of programs and activities for which
the grant is sought.
(2) NOTICE OF APPROVAL OR DISAPPROVAL- Each nursing facility submitting
an application under paragraph (1) shall, not later than 60 days after the
date of its submission, be notified in writing as to whether such
application is approved or disapproved.
(c) DURATION- A grant under this section may extend over a period of not
more than three years.
(d) ANNUAL APPROVAL- The provision of payments under a grant under this
section shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for each fiscal year to make the
payments.
(1) AUTHORIZED USES- A grant made under this section shall be used by
the nursing facility, with respect to individuals who furnish direct
resident care services in nursing facilities, including registered
professional nurses, licensed practical nurses, and certified nurse aides,
to do any or all of the following:
(A) Increase the salary of such individuals.
(B) Reimburse all or part of the outstanding balance of any education
loan undertaken by the individual.
(C) Reduce payments due under other obligations imposed under an
agreement of a program under the Public Health Service Act (42 U.S.C. 201
et seq.).
(D) With respect to certified nurse aides, subsidize the costs of (i)
the employee share of employer-based health care coverage, and (ii) child
care expenses of the aides.
(E) Subsidize the costs of transportation to and from the nursing
facility of such individuals.
(2) PROHIBITED USES- A grant may not be used by a nursing facility to
offset salary and benefits that would be otherwise payable by the facility
to such individuals in the absence of the grant.
(f) REPORTS- A nursing facility awarded a grant under this section shall
submit to the Secretary such reports, and within such time frames, as the
Secretary may require. The report shall include such information and data as
the Secretary requires to determine compliance of the nursing facility with
the provisions of this section.
(g) REGULATIONS- Any regulations to carry out this section shall be
prescribed not later than 60 days after the date of enactment of this
section.
(h) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated to the Secretary $25,000,000
for each of fiscal years 2001, 2002, and 2003. 60 percent of such
appropriation shall be payable from the Federal Hospital Insurance Trust Fund,
and 40 percent of such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under title XVIII of the Social
Security Act (42 U.S.C. 1395i, 1395t).
(i) DEFINITIONS- In this section:
(1) The term `Secretary' means the Secretary of Health and Human
Services.
(2) The term `nursing facility' has the meaning given that term in
section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)), and
includes a skilled nursing facility (as defined in section 1819(a) of such
Act (42 U.S.C. 1395i-3(a)).
SEC. 204. IMPROVEMENT IN WORKER SAFETY.
(1) IN GENERAL- The Secretary shall, in accordance with the provisions
of this section, award grants to nursing facilities to establish model
workplace safety programs. Such programs shall be designed to result in a
significant reduction in the incidence of accidents and injuries at the
nursing facility to employees of the nursing facility.
(2) PRIORITY OF GRANT AWARDS- In awarding grants under this section, the
Secretary shall give priority to nursing facilities with approved
applications filed in partnership with labor representatives.
(3) DEADLINE FOR INITIAL GRANT AWARDS- The Secretary shall award grants
under this section by not later than 6 months after the date of the
enactment of this Act.
(4) COORDINATION WITH THE SECRETARY OF LABOR- The Secretary shall
coordinate the implementation of the grant program established under this
section with the Secretary of Labor.
(1) APPLICATIONS REQUIRED- Each nursing facility that wishes to receive
a grant under this section shall submit an application at such time, in such
form, and complete with such information as the Secretary shall by
regulation require, except that any such application shall include at
least--
(A) a statement of the objectives for which the grant is
sought;
(B) a description of the types of programs and activities for which
the grant is sought;
(C) a plan for the timely implementation of the program and evaluation
of the program in the facility; and
(D) consultation with a State long-term care Ombudsman or a
community-based citizen advocacy group.
(2) NOTICE OF APPROVAL OR DISAPPROVAL- Each nursing facility submitting
an application under paragraph (1) shall, not later than 60 days after the
date of its submission, be notified in writing as to whether such
application is approved or disapproved.
(3) REQUIREMENT OF PRIOR APPROVAL FROM COLLECTIVE BARGAINING AGENCY- In
the case of a nursing facility applying for a grant under this section that
has a collective bargaining agent, the application filed by the facility
shall include written approval from that agent for the facility's proposed
use of the grant award.
(c) DURATION- A grant under this section may extend over a period of not
more than three years.
(d) ANNUAL APPROVAL- The provision of payments under a grant under this
section shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for each fiscal year to make the
payments.
(e) USE OF GRANT FUNDS- A grant made under this section may be used only
to establish and carry out the model workplace safety program referred to in
subsection (a)(1).
(f) REPORTS- A nursing facility awarded a grant under this section shall
submit to the Secretary such reports, and within such time frames, as the
Secretary may require.
(g) REGULATIONS- Any regulations to carry out this section shall be
prescribed not later than 60 days after the date of enactment of this
section.
(h) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated to the Secretary $25,000,000
for each of fiscal years 2001, 2002, and 2003. 60 percent of such
appropriation shall be payable from the Federal Hospital Insurance Trust Fund,
and 40 percent of such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under title XVIII of the Social
Security Act (42 U.S.C. 1395i, 1395t).
(i) DEFINITIONS- In this section:
(1) The term `Secretary' means the Secretary of Health and Human
Services.
(2) The term `nursing facility' has the meaning given that term in
section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)), and
includes a skilled nursing facility (as defined in section 1819(a) of such
Act (42 U.S.C. 1395i-3(a)).
(3) The term `model safety workplace program' means a program certified
by an appropriate worker safety training expert (as determined by the
Secretary) to reduce the incidence of accidents and injuries at nursing
facilities, including such accidents and injuries associated with the
lifting and transportation of residents of the facility, stress reduction
activities, and compliance with workplace safety standards (such as
standards to reduce accidental needle stick injuries).
SEC. 205. DEMONSTRATION PROGRAM TO IMPLEMENT QUALITY IMPROVEMENT MODELS IN
NURSING FACILITY SETTINGS.
(a) QUALITY IMPROVEMENT MODELS-
(1) IN GENERAL- The Secretary shall provide for a demonstration project
under this section under which grants are made to 4 States to implement
innovative quality improvement models (described in paragraph (2) to improve
the quality of care furnished to residents of nursing facilities operating
in the State.
(2) MODELS DESCRIBED- A model referred to in paragraph (1) is a model
developed by the Agency for Healthcare Research and Quality, the American
Medical Directors Association, and the Nutrician Institute to reduce the
incidence and prevalence of infections, bed sores, incontinence, and lack of
mobility among such residents.
(1) APPLICATIONS REQUIRED- Each State that wishes to receive a grant
under this section shall submit an application at such time, in such form,
and complete with such information as the Secretary shall by regulation
require, except that any such application shall include at least--
(A) a statement of the objectives for which the grant is
sought;
(B) a description of the types of programs and activities for which
the grant is sought; and
(C) consultation with a State long-term care Ombudsman or a
community-based citizen advocacy group.
(2) NOTICE OF APPROVAL OR DISAPPROVAL- Each State submitting an
application under paragraph (1) shall, not later than 60 days after the date
of its submission, be notified in writing as to whether such application is
approved or disapproved.
(c) DURATION- A grant under this section may extend over a period of not
more than three years.
(d) ANNUAL APPROVAL- The provision of payments under a grant under this
section shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for each fiscal year to make the
payments.
(e) USE OF GRANT FUNDS- A grant made under this section may be used only
to carry out to innovative quality improvement models referred to in
subsection (a).
(1) IN GENERAL- A State awarded a grant under this section shall submit
to the Secretary such reports, and within such time frames, as the Secretary
may require.
(2) REVIEW BY GAO- The Comptroller General of the United States shall
submit to Congress a report on the results of the demonstration project
under this section, including in such report an analysis of the models
developed by each State and the effectiveness of each such model in reducing
incontinence and pressure sores among residents of nursing facilities in
each such State.
(g) REGULATIONS- Any regulations to carry out this section shall be
prescribed not later than 60 days after the date of enactment of this
section.
(h) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out this
section, there are authorized to be appropriated to the Secretary $25,000,000
for each of fiscal years 2001, 2002, and 2003. 60 percent of such
appropriation shall be payable from the Federal Hospital Insurance Trust Fund,
and 40 percent of such appropriation shall be payable from the Federal
Supplementary Medical Insurance Trust Fund under title XVIII of the Social
Security Act (42 U.S.C. 1395i, 1395t).
(i) DEFINITIONS- In this section:
(1) The term `Secretary' means the Secretary of Health and Human
Services.
(2) The term `nursing facility' has the meaning given that term in
section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)), and
includes a skilled nursing facility (as defined in section 1819(a) of such
Act (42 U.S.C. 1395i-3(a)).
END