,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #ecgc  ,,in ,,the ,,house ,,of  
,,representatives  ,july #ca1 #bjad ,ms4
 ,schakowsky 7for herself1 ,ms4 ,matsui1
 ,ms4 ,roybal-,allard1 ,mr4 ,payne1 and 
,mr4 ,rangel7 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  
establish a minimum direct care         
registered nurse staffing requirement at
 nursing facilities and skilled nursing 
facilities under ,medicare and ,medicaid
 and for other purposes4  #a4 ,short    
,title ,this ,act may be cited as the   
,put a ,registered ,nurse in the        
,nursing ,home ,act of #bjad4  #b4      
,establishment of minimum direct care   

registered nurse staffing requirement at
 nursing facilities and skilled nursing 
facilities under ,medicare and ,medicaid
  7a7 ,medicare ,skilled ,nursing       
,facilities ,section #ahai7;b77#d77;,c7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;i-#c7;b77#d77;,c77 is   
amended--  7#a7 in clause 7i7--  7,a7 by
 striking ,except as provided in clause 
7ii71 a and inserting ,a2 and  7,b7 by  
striking all that follows residents and 
inserting a period2 and  7#b7 by        
striking clause 7ii7 and inserting the  
following3  7ii7 ,use of ,direct ,care  
,registered ,nurse ,a skilled nursing   
facility must use the services of at    
least #a registered professional nurse  
to provide assessment1 surveillance1 and
 direct care to residents #bd hours a   
day1 #g days a week4 ,in the preceding  
sentence1 the term surveillance means   
the purposeful and ongoing acquisition1 
interpretation1 and synthesis of        
residents' data for clinical decision   
making4  4  7b7 ,medicaid ,nursing      

,facilities ,subparagraph 7,c7 of       
section #aiai7;b77#d77;,c7 of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7b77#d77;,c77 is amended--  7#a7  
in the heading1 by striking 2 facility  
waivers2  7#b7 in clause 7i7--  7,a7 by 
striking ,with respect to and all that  
follows through clause 7ii71 must       
provide and inserting ,a nursing        
facility must provide2 and  7,b7 by     
striking all that follows residents and 
inserting a period2 and  7#c7 by        
striking clauses 7ii7 and 7iii7 and     
inserting the following3  7ii7 ,use of  
,direct ,care ,registered ,nurse ,a     
nursing facility must use the services  
of at least #a registered professional  
nurse to provide assessment1            
surveillance1 and direct care to        
residents #bd hours a day1 #g days a    
week4 ,in the preceding sentence1 the   
term surveillance means the purposeful  
and ongoing acquisition1 interpretation1
 and synthesis of residents' data for   
clinical decisionmaking4  4  7c7        

,effective ,date ,the amendments made by
 this section shall apply with respect  
to payments made for items and services 
furnished on or after the first day of  
the first calendar quarter beginning on 
the date that is #a year after the date 
of the enactment of this ,act4