,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #bhfd  ,,in ,,the ,,house ,,of  
,,representatives  ,july #cj1 #bjac ,ms4
 ,roybal-,allard introduced the         
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 for a period to be      
subsequently determined by the ,speaker1
 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 to  
improve oversight of nursing facilities 
under the ,medicare and ,medicaid       
programs by preventing inappropriate    
influence over surveyors1 and for other 
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,nursing ,home      
,patient ,protection and ,standards ,act
 of #bjac4  #b4 ,improving the rigor of 
testing for surveyors  7a7 ,medicare    
,section #ahai7;g77#b77;,e77iii7 of the 
,social ,security ,act 7#db ,u4,s4,c4   

#acie;i-#c7;g77#b77;,e77iii77 is amended
 by adding the following at the end3    
,the testing program must be            
sufficiently rigorous 7as determined by 
the ,secretary7 to ensure that surveyors
 are adequately prepared to survey and  
certify facilities in a consistent and  
accurate manner44  7b7 ,medicaid        
,section #aiai7;g77#b77;,e77iii7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7g77#b77;,e77iii77 is amended by  
adding the following at the end3 ,the   
testing program must be sufficiently    
rigorous 7as determined by the          
,secretary7 to ensure that surveyors are
 adequately prepared to survey and      
certify facilities in a consistent and  
accurate manner44  #c4 ,ensuring        
adequate staffing and training for      
,state surveys of nursing homes  7a7    
,medicare ,section #ahai7;g77#b77;,e7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie;i-#c7;g77#b77;,e77 is   
amended by adding at the end the        
following3  7iv7 ,adequate qualified    

staff for survey teams ,the ,secretary1 
in consultation with the advisory       
committee under subparagraph 7,f71 shall
 establish requirements for the         
qualifications and compensation of      
members of a survey team under this     
subsection and require that a ,state    
employs an adequate number of           
individuals as members of survey teams  
to ensure adequate oversight of skilled 
nursing facilities4  7v7 ,continuing    
education ,in addition to the training  
and testing program required under      
clause 7iii71 the ,secretary shall      
require that ,state and ,federal        
surveyors regularly complete an adequate
 amount 7as determined by the           
,secretary7 of continuing education     
courses that meet requirements          
determined by the ,secretary for content
 and the rigor of the material covered  
by such courses4 ,an individual shall   
not serve as a member of a survey team  
unless the individual is in compliance  
with the requirements of this clause4  4

  7b7 ,medicaid ,section                
#aiai7;g77#b77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acifr7g77#b77;,e77 is amended by adding
 at the end the following3  7iv7        
,adequate qualifed staff for survey     
teams ,the ,secretary1 in consultation  
with the advisory committee under       
subparagraph 7,f71 shall establish      
requirements for the qualifications and 
compensation of members of a survey team
 under this subsection and require that 
a ,state employs an adequate number of  
individuals as members of survey teams  
to ensure adequate oversight of skilled 
nursing facilities4  7v7 ,continuing    
education ,in addition to the training  
and testing program required under      
clause 7iii71 the ,secretary shall      
require that ,state and ,federal        
surveyors regularly complete an adequate
 amount 7as determined by the           
,secretary7 of continuing education     
courses that meet requirements          
determined by the ,secretary for content

 and the rigor of the material covered  
by such courses4 ,no individual shall   
serve as a member of a survey team      
unless the individual is in compliance  
with the requirements of this clause4  4
  #d4 ,ensuring the independence and    
impartiality of surveyors  7a7 ,in      
general  7#a7 ,medicare ,section        
#ahai7;g7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;i-#c7;g77 is       
amended by adding the following at the  
end3  7#f7 ,reporting of inaccuracies   
7,a7 ,covered individual defined ,for   
purposes of this paragraph1 the term    
covered individual means an individual--
  7i7 who is a member of a ,state survey
 team under this subsection2 or  7ii7   
who is an employee of the ,state        
department or agency that conducts      
surveys under this section4  7,b7       
,reporting requirement ,a covered       
individual shall report to the          
,secretary any instance in which the    
individual suspects that--  7i7 a survey
 under this subsection fails to report  

or under reports an issue in a facility 
that could impact the safety or quality 
of care of the residents in such        
facility2 or  7ii7 a member of the      
survey team or an employee of the ,state
 survey agency was inappropriately      
influenced 7through the offering of     
monetary awards or through undue        
pressure7 to alter the results of the   
survey4  7,c7 ,response to report ,if   
the ,secretary receives a report under  
subparagraph 7,b71 the ,secretary shall 
take appropriate action1 as determined  
by the ,secretary1 to ensure the        
accuracy of the survey4  7,d7 ,penalties
 for inappropriately influencing a      
surveyor ,subject to subparagraph 7,h71 
any individual 7including an employee of
 a skilled nursing facility or any      
affiliated corporate entity1 a          
representative of the skilled nursing   
facility industry1 a member of a ,state 
survey team1 an employee of the ,state  
department or agency that conducts      
surveys under this section1 or an       

elected official7 who attempts to       
inappropriately influence 7as defined by
 the ,secretary through regulations7 the
 results of a survey under this         
subsection1 or the actions of a member  
of a survey team or an employee of a    
survey agency1 shall be subject to a    
civil money penalty not to exceed       
#aj1jjj4 ,the provisions of section     
#aabh;,a 7other than subsections 7a7 and
 7b77 shall apply to a civil money      
penalty under the previous sentence in  
the same manner as such provisions apply
 to a penalty or proceeding under       
section #aabh;,a7a74  7,e7              
,whistleblower protections ,with respect
 to a covered individual1 any officer or
 employee of the ,state may not--  7i7  
discharge1 demote1 suspend1 threaten1   
harass1 or deny a promotion or other    
employment-related benefit to such      
individual1 or in any other manner      
discriminate against an individual in   
the terms and conditions of employment  
because the individual submitted a      

report under subparagraph 7,b72 or  7ii7
 file a complaint or a report against   
the individual with the appropriate     
,state professional disciplinary agency 
because the individual submitted a      
report under subparagraph 7,b74  7,f7   
,penalties for violating whistleblower  
protections ,subject to subparagraph    
7,h71 any officer or employee of a      
,state who engages in an activity that  
is prohibited by subparagraph 7,e7 shall
 be subject to a civil money penalty not
 to exceed #ej1jjj4 ,the provisions of  
section #aabh;,a 7other than subsections
 7a7 and 7b77 shall apply to a civil    
money penalty under the previous        
sentence in the same manner as such     
provisions apply to a penalty or        
proceeding under section #aabh;,a7a74   
7,g7 ,requirement to post notice ,each  
,state shall post conspicuously in an   
appropriate location a sign 7in a form  
specified by the ,secretary7 specifying 
the rights of covered individuals under 
this section4 ,such sign shall include--

  7i7 a statement that a covered        
individual may file a complaint with the
 ,secretary describing any violations of
 the provisions of this paragraph by an 
employee or officer of a ,state2 and    
7ii7 information concerning the form and
 manner in which such a complaint should
 be filed4  7,h7 ,construction related  
to legislative oversight ,for purposes  
of this paragraph1 to the extent that a 
member of a ,state legislature requests 
that a covered individual appear at a   
hearing of a committee of such          
legislature or asks questions of such   
individual during such a hearing1 the   
actions of such member shall not be     
construed in a manner that would subject
 such member to a penalty under this    
paragraph4  4  7#b7 ,medicaid ,section  
#aiai7;g7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acifr7g77 is amended by 
adding the following at the end3  7#f7  
,reporting of inaccuracies  7,a7        
,covered individual defined ,for        
purposes of this paragraph1 the term    

covered individual means an individual--
  7i7 who is a member of a ,state survey
 team under this subsection2 or  7ii7   
who is an employee of the ,state        
department or agency that conducts      
surveys under this section4  7,b7       
,reporting requirement ,a covered       
individual shall report to the          
,secretary any instance in which the    
individual suspects that--  7i7 a survey
 under this subsection fails to report  
or under reports an issue in a facility 
that could impact the safety or quality 
of care of the residents in such        
facility2 or  7ii7 a member of the      
survey team or an employee of the ,state
 survey agency was inappropriately      
influenced 7through the offering of     
monetary awards or through undue        
pressure7 to alter the results of the   
survey4  7,c7 ,response to report ,if   
the ,secretary receives a report under  
subparagraph 7,b71 the ,secretary shall 
take appropriate action1 as determined  
by the ,secretary1 to ensure the        

accuracy of the survey4  7,d7 ,penalties
 for inappropriately influencing a      
surveyor ,subject to subparagraph 7,h71 
any individual 7including an employee of
 a skilled nursing facility or any      
affiliated corporate entity1 a          
representative of the skilled nursing   
facility industry1 a member of a ,state 
survey team1 an employee of the ,state  
department or agency that conducts      
surveys under this section1 or an       
elected official7 who attempts to       
inappropriately influence 7as defined by
 the ,secretary through regulations7 the
 results of a survey under this         
subsection1 or the actions of a member  
of a survey team or an employee of a    
survey agency1 shall be subject to a    
civil money penalty not to exceed       
#aj1jjj4 ,the provisions of section     
#aabh;,a 7other than subsections 7a7 and
 7b77 shall apply to a civil money      
penalty under the previous sentence in  
the same manner as such provisions apply
 to a penalty or proceeding under       

section #aabh;,a7a74  7,e7              
,whistleblower protections ,with respect
 to a covered individual1 any officer or
 employee of the ,state may not--  7i7  
discharge1 demote1 suspend1 threaten1   
harass1 or deny a promotion or other    
employment-related benefit to such      
individual1 or in any other manner      
discriminate against an individual in   
the terms and conditions of employment  
because the individual submitted a      
report under subparagraph 7,b72 or  7ii7
 file a complaint or a report against   
the individual with the appropriate     
,state professional disciplinary agency 
because the individual submitted a      
report under subparagraph 7,b74  7,f7   
,penalties for violating whistleblower  
protections ,subject to subparagraph    
7,h71 any officer or employee of a      
,state who engages in an activity that  
is prohibited by subparagraph 7,e7 shall
 be subject to a civil money penalty not
 to exceed #ej1jjj4 ,the provisions of  
section #aabh;,a 7other than subsections

 7a7 and 7b77 shall apply to a civil    
money penalty under the previous        
sentence in the same manner as such     
provisions apply to a penalty or        
proceeding under section #aabh;,a7a74   
7,g7 ,requirement to post notice ,each  
,state shall post conspicuously in an   
appropriate location a sign 7in a form  
specified by the ,secretary7 specifying 
the rights of covered individuals under 
this section4 ,such sign shall include--
  7i7 a statement that a covered        
individual may file a complaint with the
 ,secretary describing any violations of
 the provisions of this paragraph by an 
employee or officer of a ,state2 and    
7ii7 information concerning the form and
 manner in which such a complaint should
 be filed4  7,h7 ,construction related  
to legislative oversight ,for purposes  
of this paragraph1 to the extent that a 
member of a ,state legislature requests 
that a covered individual appear at a   
hearing of a committee of such          
legislature or asks questions of such   

individual during such a hearing1 the   
actions of such member shall not be     
construed in a manner that would subject
 such member to a penalty under this    
paragraph4  4  7b7 ,conforming          
amendments  7#a7 ,section               
#ahai7;f77#b77;,b77iii77,i77c7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;f77#b77;,b77iii77,i77c77 is 
amended by inserting 1 a civil monetary 
penalty described in section            
#aiai7;g77#f77;,d7 of not less than     
#aj1jjj after of not less than #e1jjj4  
7#b7 ,section                           
#aiai7;f77#b77;,b77iii77,i77c7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7f77#b77;,b77iii77,i77c77 is      
amended by inserting 1 a civil monetary 
penalty described in 7g77#f77;,d7 of not
 less than #aj1jjj after of not less    
than #e1jjj4  #e4 ,advisory committee   
7a7 ,medicare ,section #ahai7;g77#b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#c7;g77#b77 is amended
 by adding at the end the following3    

7,f7 ,advisory ,committee  7i7          
,establishment ,the ,secretary shall    
establish an advisory committee on      
surveys under this paragraph4  7ii7     
,membership ,the membership of the      
advisory committee under clause 7i7     
shall include advocates for residents of
 skilled nursing facilities1 members of 
survey teams under this subsection1 and 
nursing home administrators4  7iii7     
,recommended standards ,the advisory    
committee under clause 7i7 shall make   
recommendations to the ,secretary on    
standards for--  7,i7 the adequate      
staffing of survey teams under this     
subsection2  7,,ii7 the training of     
members of such teams2 and  7,,iii7     
disclosing any contact between such     
members and individuals associated with 
skilled nursing facilities1 and limiting
 such contact to prevent inappropriate  
influence of such members by such       
individuals4  7iv7 ,other               
recommendations ,the advisory committee 
under clause 7i7 may also make          

recommendations to the ,secretary on any
 other issue that would improve the     
survey process under this paragraph4  4 
7b7 ,medicaid ,section #aiai7;g77#b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acifr7g77#b77 is amended by  
adding at the end the following3  7,f7  
,advisory ,committee  7i7 ,establishment
 ,the ,secretary shall establish an     
advisory committee on surveys under this
 paragraph4  7ii7 ,membership ,the      
membership of the advisory committee    
under clause 7i7 shall include advocates
 for residents of nursing facilities1   
members of survey teams under this      
subsection1 and nursing home            
administrators4  7iii7 ,recommended     
standards ,the advisory committee under 
clause 7i7 shall make recommendations to
 the ,secretary on standards for--  7,i7
 the adequate staffing of survey teams  
under this subsection2  7,,ii7 the      
training of members of such teams2 and  
7,,iii7 disclosing any contact between  
such members and individuals associated 

with nursing facilities1 and limiting   
such contact to prevent inappropriate   
influence of such members by such       
individuals4  7iv7 ,other               
recommendations ,the advisory committee 
under clause 7i7 may also make          
recommendations to the ,secretary on any
 other issue that would improve the     
survey process under this paragraph4  4 
#f4 ,review of surveys  7a7 ,medicare   
,section #ahai7;g77#b77;,d7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;g77#b77;,d77 is amended--   
7#a7 by striking ,each ,state and       
inserting the following3  7i7 ,in       
general ,each ,state  2 and  7#b7 by    
adding at the end the following new     
clause3  7ii7 ,review of surveys ,the   
supervisor of the survey team shall     
review each survey conducted under this 
subsection to ensure that any issues    
that impact quality of care that are    
identified by such surveys are          
consistently and appropriately described
 and rated by the survey team4  4  7b7  

,medicaid ,section #aiai7;g77#b77;,d7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acifr7g77#b77;,d77 is        
amended--  7#a7 by striking ,each ,state
 and inserting the following3  7i7 ,in  
general ,each ,state  2 and  7#b7 by    
adding at the end the following new     
clause3  7ii7 ,review of surveys ,the   
supervisor of the survey team shall     
review each survey conducted under this 
subsection to ensure that any issues    
that impact quality of care that are    
identified by such surveys are          
consistently and appropriately described
 and rated by the survey team4  4