,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bhfd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #cj1 #bjac ,ms4 
,roybal-,all>d introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to improve ov]sight ( nurs+        
facilities "u ! ,m$ic>e & ,m$icaid      
programs by prev5t+ inappropriate       
influ5ce ov] surveyors1 & = o!r         
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,nurs+ ,home ,pati5t       
,protection & ,/&>ds ,act ( #bjac4  #b4 
,improv+ ! rigor ( te/+ = surveyors  7a7
 ,m$ic>e ,section                       
#ahai7;g77#b77;,e77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;g77#b77;,e77iii77 is am5d$  
by add+ ! foll[+ at ! end3 ,! te/+      

program mu/ be suffici5tly rigor\s 7z   
det]m9$ by ! ,secret>y7 to ensure t     
surveyors are adequately prep>$ to      
survey & c]tify facilities 9 a consi/5t 
& accurate mann]44  7b7 ,m$icaid        
,section #aiai7;g77#b77;,e77iii7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7g77#b77;,e77iii77 is am5d$ by    
add+ ! foll[+ at ! end3 ,! te/+ program 
mu/ be suffici5tly rigor\s 7z det]m9$ by
 ! ,secret>y7 to ensure t surveyors are 
adequately prep>$ to survey & c]tify    
facilities 9 a consi/5t & accurate      
mann]44  #c4 ,ensur+ adequate /aff+ &   
tra9+ = ,/ate surveys ( nurs+ homes  7a7
 ,m$ic>e ,section #ahai7;g77#b77;,e7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;i-#c7;g77#b77;,e77 is am5d$ by    
add+ at ! end ! foll[+3  7iv7 ,adequate 
qualifi$ /aff = survey teams ,!         
,secret>y1 9 consultation ) ! advisory  
committee "u subp>agraph 7,f71 %all     
e/abli% requirem5ts = ! qualifications &
 comp5sation ( memb]s ( a survey team "u
 ?is subsection & require t a ,/ate     

employs an adequate numb] ( individuals 
z memb]s ( survey teams to ensure       
adequate ov]sight ( skill$ nurs+        
facilities4  7v7 ,cont9u+ education ,9  
addition to ! tra9+ & te/+ program      
requir$ "u clause 7iii71 ! ,secret>y    
%all require t ,/ate & ,f$]al surveyors 
regul>ly complete an adequate am\nt 7z  
det]m9$ by ! ,secret>y7 ( cont9u+       
education c\rses t meet requirem5ts     
det]m9$ by ! ,secret>y = cont5t & !     
rigor ( ! mat]ial cov]$ by su* c\rses4  
,an individual %all n s]ve z a memb] ( a
 survey team unless ! individual is 9   
compliance ) ! requirem5ts ( ?is clause4
  4  7b7 ,m$icaid ,section              
#aiai7;g77#b77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7g77#b77;,e77
 is am5d$ by add+ at ! end ! foll[+3    
7iv7 ,adequate qualif$ /aff = survey    
teams ,! ,secret>y1 9 consultation ) !  
advisory committee "u subp>agraph 7,f71 
%all e/abli% requirem5ts = !            
qualifications & comp5sation ( memb]s ( 
a survey team "u ?is subsection &       

require t a ,/ate employs an adequate   
numb] ( individuals z memb]s ( survey   
teams to ensure adequate ov]sight (     
skill$ nurs+ facilities4  7v7 ,cont9u+  
education ,9 addition to ! tra9+ & te/+ 
program requir$ "u clause 7iii71 !      
,secret>y %all require t ,/ate & ,f$]al 
surveyors regul>ly complete an adequate 
am\nt 7z det]m9$ by ! ,secret>y7 (      
cont9u+ education c\rses t meet         
requirem5ts det]m9$ by ! ,secret>y =    
cont5t & ! rigor ( ! mat]ial cov]$ by   
su* c\rses4 ,no individual %all s]ve z a
 memb] ( a survey team unless !         
individual is 9 compliance ) !          
requirem5ts ( ?is clause4  4  #d4       
,ensur+ ! indep5d5ce & imp>tiality (    
surveyors  7a7 ,9 g5]al  7#a7 ,m$ic>e   
,section #ahai7;g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;i-#c7;g77 is 
am5d$ by add+ ! foll[+ at ! end3  7#f7  
,report+ ( inaccuracies  7,a7 ,cov]$    
individual def9$ ,= purposes ( ?is      
p>agraph1 ! t]m cov]$ individual means  
an individual--  7i7 :o is a memb] ( a  

,/ate survey team "u ?is subsection2 or 
7ii7 :o is an employee ( ! ,/ate        
dep>tm5t or ag5cy t conducts surveys "u 
?is section4  7,b7 ,report+ requirem5t  
,a cov]$ individual %all report to !    
,secret>y any in/ance 9 :i* ! individual
 suspects t--  7i7 a survey "u ?is      
subsection fails to report or "u reports
 an issue 9 a facility t c\ld impact !  
safety or quality ( c>e ( ! resid5ts 9  
su* facility2 or  7ii7 a memb] ( !      
survey team or an employee ( ! ,/ate    
survey ag5cy 0 inappropriately influ5c$ 
7?r\gh ! (f]+ ( monet>y aw>ds or ?r\gh  
undue pressure7 to alt] ! results ( !   
survey4  7,c7 ,response to report ,if ! 
,secret>y receives a report "u          
subp>agraph 7,b71 ! ,secret>y %all take 
appropriate action1 z det]m9$ by !      
,secret>y1 to ensure ! accuracy ( !     
survey4  7,d7 ,p5alties =               
inappropriately influ5c+ a surveyor     
,subject to subp>agraph 7,h71 any       
individual 7includ+ an employee ( a     
skill$ nurs+ facility or any affiliat$  

corporate entity1 a repres5tative ( !   
skill$ nurs+ facility indu/ry1 a memb] (
 a ,/ate survey team1 an employee ( !   
,/ate dep>tm5t or ag5cy t conducts      
surveys "u ?is section1 or an elect$    
(ficial7 :o attempts to inappropriately 
influ5ce 7z def9$ by ! ,secret>y ?r\gh  
regulations7 ! results ( a survey "u ?is
 subsection1 or ! actions ( a memb] ( a 
survey team or an employee ( a survey   
ag5cy1 %all be subject to a civil money 
p5alty n to exce$ #aj1jjj4 ,! provisions
 ( section #aabh;,a 7o!r ?an subsections
 7a7 & 7b77 %all apply to a civil money 
p5alty "u ! previ\s s5t5ce 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a7a74     
7,e7 ,:i/lebl[] protections ,) respect  
to a cov]$ individual1 any (fic] or     
employee ( ! ,/ate may n--  7i7 dis*>ge1
 demote1 susp5d1 ?reat51 h>ass1 or d5y a
 promotion or o!r employm5t-relat$      
b5efit to su* individual1 or 9 any o!r  
mann] discrim9ate aga9/ an individual 9 
! t]ms & conditions ( employm5t because 

! individual submitt$ a report "u       
subp>agraph 7,b72 or  7ii7 file a       
compla9t or a report aga9/ ! individual 
) ! appropriate ,/ate pr(essional       
discipl9>y ag5cy because ! individual   
submitt$ a report "u subp>agraph 7,b74  
7,f7 ,p5alties = violat+ :i/lebl[]      
protections ,subject to subp>agraph     
7,h71 any (fic] or employee ( a ,/ate :o
 engages 9 an activity t is prohibit$ by
 subp>agraph 7,e7 %all be subject to a  
civil money p5alty n to exce$ #ej1jjj4  
,! provisions ( section #aabh;,a 7o!r   
?an subsections 7a7 & 7b77 %all apply to
 a civil money p5alty "u ! previ\s      
s5t5ce 9 ! same mann] z su* provisions  
apply to a p5alty or proce$+ "u section 
#aabh;,a7a74  7,g7 ,requirem5t to po/   
notice ,ea* ,/ate %all po/ conspicu\sly 
9 an appropriate location a sign 79 a =m
 specifi$ by ! ,secret>y7 specify+ !    
rights ( cov]$ individuals "u ?is       
section4 ,su* sign %all include--  7i7 a
 /atem5t t a cov]$ individual may file a
 compla9t ) ! ,secret>y describ+ any    

violations ( ! provisions ( ?is p>agraph
 by an employee or (fic] ( a ,/ate2 &   
7ii7 in=mation conc]n+ ! =m & mann] 9   
:i* su* a compla9t %\ld be fil$4  7,h7  
,con/ruction relat$ to legislative      
ov]sight ,= purposes ( ?is p>agraph1 to 
! ext5t t a memb] ( a ,/ate legislature 
reque/s t a cov]$ individual appe> at a 
he>+ ( a committee ( su* legislature or 
asks que/ions ( su* individual dur+ su* 
a he>+1 ! actions ( su* memb] %all n be 
con/ru$ 9 a mann] t w\ld subject su*    
memb] to a p5alty "u ?is p>agraph4  4   
7#b7 ,m$icaid ,section #aiai7;g7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7g77 is am5d$ by add+ ! foll[+ at 
! end3  7#f7 ,report+ ( inaccuracies    
7,a7 ,cov]$ individual def9$ ,= purposes
 ( ?is p>agraph1 ! t]m cov]$ individual 
means an individual--  7i7 :o is a memb]
 ( a ,/ate survey team "u ?is           
subsection2 or  7ii7 :o is an employee (
 ! ,/ate dep>tm5t or ag5cy t conducts   
surveys "u ?is section4  7,b7 ,report+  
requirem5t ,a cov]$ individual %all     

report to ! ,secret>y any in/ance 9 :i* 
! individual suspects t--  7i7 a survey 
"u ?is subsection fails to report or "u 
reports an issue 9 a facility t c\ld    
impact ! safety or quality ( c>e ( !    
resid5ts 9 su* facility2 or  7ii7 a     
memb] ( ! survey team or an employee ( !
 ,/ate survey ag5cy 0 inappropriately   
influ5c$ 7?r\gh ! (f]+ ( monet>y aw>ds  
or ?r\gh undue pressure7 to alt] !      
results ( ! survey4  7,c7 ,response to  
report ,if ! ,secret>y receives a report
 "u subp>agraph 7,b71 ! ,secret>y %all  
take appropriate action1 z det]m9$ by ! 
,secret>y1 to ensure ! accuracy ( !     
survey4  7,d7 ,p5alties =               
inappropriately influ5c+ a surveyor     
,subject to subp>agraph 7,h71 any       
individual 7includ+ an employee ( a     
skill$ nurs+ facility or any affiliat$  
corporate entity1 a repres5tative ( !   
skill$ nurs+ facility indu/ry1 a memb] (
 a ,/ate survey team1 an employee ( !   
,/ate dep>tm5t or ag5cy t conducts      
surveys "u ?is section1 or an elect$    

(ficial7 :o attempts to inappropriately 
influ5ce 7z def9$ by ! ,secret>y ?r\gh  
regulations7 ! results ( a survey "u ?is
 subsection1 or ! actions ( a memb] ( a 
survey team or an employee ( a survey   
ag5cy1 %all be subject to a civil money 
p5alty n to exce$ #aj1jjj4 ,! provisions
 ( section #aabh;,a 7o!r ?an subsections
 7a7 & 7b77 %all apply to a civil money 
p5alty "u ! previ\s s5t5ce 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a7a74     
7,e7 ,:i/lebl[] protections ,) respect  
to a cov]$ individual1 any (fic] or     
employee ( ! ,/ate may n--  7i7 dis*>ge1
 demote1 susp5d1 ?reat51 h>ass1 or d5y a
 promotion or o!r employm5t-relat$      
b5efit to su* individual1 or 9 any o!r  
mann] discrim9ate aga9/ an individual 9 
! t]ms & conditions ( employm5t because 
! individual submitt$ a report "u       
subp>agraph 7,b72 or  7ii7 file a       
compla9t or a report aga9/ ! individual 
) ! appropriate ,/ate pr(essional       
discipl9>y ag5cy because ! individual   

submitt$ a report "u subp>agraph 7,b74  
7,f7 ,p5alties = violat+ :i/lebl[]      
protections ,subject to subp>agraph     
7,h71 any (fic] or employee ( a ,/ate :o
 engages 9 an activity t is prohibit$ by
 subp>agraph 7,e7 %all be subject to a  
civil money p5alty n to exce$ #ej1jjj4  
,! provisions ( section #aabh;,a 7o!r   
?an subsections 7a7 & 7b77 %all apply to
 a civil money p5alty "u ! previ\s      
s5t5ce 9 ! same mann] z su* provisions  
apply to a p5alty or proce$+ "u section 
#aabh;,a7a74  7,g7 ,requirem5t to po/   
notice ,ea* ,/ate %all po/ conspicu\sly 
9 an appropriate location a sign 79 a =m
 specifi$ by ! ,secret>y7 specify+ !    
rights ( cov]$ individuals "u ?is       
section4 ,su* sign %all include--  7i7 a
 /atem5t t a cov]$ individual may file a
 compla9t ) ! ,secret>y describ+ any    
violations ( ! provisions ( ?is p>agraph
 by an employee or (fic] ( a ,/ate2 &   
7ii7 in=mation conc]n+ ! =m & mann] 9   
:i* su* a compla9t %\ld be fil$4  7,h7  
,con/ruction relat$ to legislative      

ov]sight ,= purposes ( ?is p>agraph1 to 
! ext5t t a memb] ( a ,/ate legislature 
reque/s t a cov]$ individual appe> at a 
he>+ ( a committee ( su* legislature or 
asks que/ions ( su* individual dur+ su* 
a he>+1 ! actions ( su* memb] %all n be 
con/ru$ 9 a mann] t w\ld subject su*    
memb] to a p5alty "u ?is p>agraph4  4   
7b7 ,con=m+ am5dm5ts  7#a7 ,section     
#ahai7;f77#b77;,b77iii77,i77c7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;f77#b77;,b77iii77,i77c77 is 
am5d$ by ins]t+ 1 a civil monet>y p5alty
 describ$ 9 section #aiai7;g77#f77;,d7 (
 n less ?an #aj1jjj aft] ( n less ?an   
#e1jjj4  7#b7 ,section                  
#aiai7;f77#b77;,b77iii77,i77c7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7f77#b77;,b77iii77,i77c77 is am5d$
 by ins]t+ 1 a civil monet>y p5alty     
describ$ 9 7g77#f77;,d7 ( n less ?an    
#aj1jjj aft] ( n less ?an #e1jjj4  #e4  
,advisory committee  7a7 ,m$ic>e        
,section #ahai7;g77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#acie;i-#c7;g77#b77 is am5d$ by add+ at 
! end ! foll[+3  7,f7 ,advisory         
,committee  7i7 ,e/abli%m5t ,! ,secret>y
 %all e/abli% an advisory committee on  
surveys "u ?is p>agraph4  7ii7 ,memb]%ip
 ,! memb]%ip ( ! advisory committee "u  
clause 7i7 %all include advocates =     
resid5ts ( skill$ nurs+ facilities1     
memb]s ( survey teams "u ?is subsection1
 & nurs+ home adm9i/rators4  7iii7      
,recomm5d$ /&>ds ,! advisory committee  
"u clause 7i7 %all make recomm5dations  
to ! ,secret>y on /&>ds =--  7,i7 !     
adequate /aff+ ( survey teams "u ?is    
subsection2  7,,ii7 ! tra9+ ( memb]s (  
su* teams2 &  7,,iii7 disclos+ any      
contact betwe5 su* memb]s & individuals 
associat$ ) skill$ nurs+ facilities1 &  
limit+ su* contact to prev5t            
inappropriate influ5ce ( su* memb]s by  
su* individuals4  7iv7 ,o!r             
recomm5dations ,! advisory committee "u 
clause 7i7 may also make recomm5dations 
to ! ,secret>y on any o!r issue t w\ld  
improve ! survey process "u ?is         

p>agraph4  4  7b7 ,m$icaid ,section     
#aiai7;g77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr7g77#b77 is am5d$ 
by add+ at ! end ! foll[+3  7,f7        
,advisory ,committee  7i7 ,e/abli%m5t ,!
 ,secret>y %all e/abli% an advisory     
committee on surveys "u ?is p>agraph4   
7ii7 ,memb]%ip ,! memb]%ip ( ! advisory 
committee "u clause 7i7 %all include    
advocates = resid5ts ( nurs+ facilities1
 memb]s ( survey teams "u ?is           
subsection1 & nurs+ home adm9i/rators4  
7iii7 ,recomm5d$ /&>ds ,! advisory      
committee "u clause 7i7 %all make       
recomm5dations to ! ,secret>y on /&>ds  
=--  7,i7 ! adequate /aff+ ( survey     
teams "u ?is subsection2  7,,ii7 ! tra9+
 ( memb]s ( su* teams2 &  7,,iii7       
disclos+ any contact betwe5 su* memb]s &
 individuals associat$ ) nurs+          
facilities1 & limit+ su* contact to     
prev5t inappropriate influ5ce ( su*     
memb]s by su* individuals4  7iv7 ,o!r   
recomm5dations ,! advisory committee "u 
clause 7i7 may also make recomm5dations 

to ! ,secret>y on any o!r issue t w\ld  
improve ! survey process "u ?is         
p>agraph4  4  #f4 ,review ( surveys  7a7
 ,m$ic>e ,section #ahai7;g77#b77;,d7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;i-#c7;g77#b77;,d77 is am5d$--     
7#a7 by /rik+ ,ea* ,/ate & ins]t+ !     
foll[+3  7i7 ,9 g5]al ,ea* ,/ate  2 &   
7#b7 by add+ at ! end ! foll[+ new      
clause3  7ii7 ,review ( surveys ,!      
sup]visor ( ! survey team %all review   
ea* survey conduct$ "u ?is subsection to
 ensure t any issues t impact quality ( 
c>e t are id5tifi$ by su* surveys are   
consi/5tly & appropriately describ$ &   
rat$ by ! survey team4  4  7b7 ,m$icaid 
,section #aiai7;g77#b77;,d7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acifr7g77#b77;,d77 is am5d$--  7#a7 by 
/rik+ ,ea* ,/ate & ins]t+ ! foll[+3  7i7
 ,9 g5]al ,ea* ,/ate  2 &  7#b7 by add+ 
at ! end ! foll[+ new clause3  7ii7     
,review ( surveys ,! sup]visor ( !      
survey team %all review ea* survey      
conduct$ "u ?is subsection to ensure t  

any issues t impact quality ( c>e t are 
id5tifi$ by su* surveys are consi/5tly &
 appropriately describ$ & rat$ by !     
survey team4  4