,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #ieb  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #ab1 #bjae   
,ms4 ,s*ak[sky 7= h]self1 ,mr4          
,blum5au]1 ,mr4 ,rangel1 ,ms4 ,l(gr51   
,ms4 ,roybal-,all>d1 & ,mr4 ,payne7     
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 e/abli% a
 m9imum direct c>e regi/]$ nurse /aff+  
requirem5t at nurs+ facilities & skill$ 
nurs+ facilities "u ,m$ic>e & ,m$icaid &
 = o!r purposes4  #a4 ,%ort ,title ,?is 
,act may be cit$ z ! ,put a ,regi/]$    
,nurse 9 ! ,nurs+ ,home ,act ( #bjae4   
#b4 ,e/abli%m5t ( m9imum direct c>e     
regi/]$ nurse /aff+ requirem5t at nurs+ 
facilities & skill$ nurs+ facilities "u 
,m$ic>e & ,m$icaid  7a7 ,m$ic>e ,skill$ 

,nurs+ ,facilities ,section             
#ahai7;b77#d77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;i-#c7;b77#d77;,c77 is am5d$--     
7#a7 9 clause 7i7-- 7,a7 by /rik+       
,except z provid$ 9 clause 7ii71 a &    
ins]t+ ,a2 &  7,b7 by /rik+ all t foll[s
 resid5ts & ins]t+ a p]iod2 &  7#b7 by  
/rik+ clause 7ii7 & ins]t+ ! foll[+3    
7ii7 ,use ( ,direct ,c>e ,regi/]$ ,nurse
 ,a skill$ nurs+ facility mu/ use !     
s]vices ( at lea/ #a regi/]$ pr(essional
 nurse to provide assessm5t1            
surveillance1 & direct c>e to resid5ts  
#bd h\rs a day1 #g days a week4 ,9 !    
prec$+ s5t5ce1 ! t]m surveillance means 
! purposeful & ongo+ acquisition1       
int]pretation1 & syn!sis ( resid5ts'    
data = cl9ical decisionmak+4  4  7b7    
,m$icaid ,nurs+ ,facilities ,section    
#aiai7;b77#d77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7b77#d77;,c77
 is am5d$-- 7#a7 9 ! head+1 by /rik+ 2  
facility waiv]s2  7#b7 9 clause 7i7--   
7,a7 by /rik+ ,) respect to & all t     

foll[s ?r\gh clause 7ii71 mu/ provide & 
ins]t+ ,a nurs+ facility mu/ provide2 & 
7,b7 by /rik+ all t foll[s resid5ts &   
ins]t+ a p]iod2 &  7#c7 by /rik+ clauses
 7ii7 & 7iii7 & ins]t+ ! foll[+3  7ii7  
,use ( ,direct ,c>e ,regi/]$ ,nurse ,a  
nurs+ facility mu/ use ! s]vices ( at   
lea/ #a regi/]$ pr(essional nurse to    
provide assessm5t1 surveillance1 &      
direct c>e to resid5ts #bd h\rs a day1  
#g days a week4 ,9 ! prec$+ s5t5ce1 !   
t]m surveillance means ! purposeful &   
ongo+ acquisition1 int]pretation1 &     
syn!sis ( resid5ts' data = cl9ical      
decisionmak+4  4  7c7 ,effective ,date  
,! am5dm5ts made by ?is section %all    
apply ) respect to paym5ts made = items 
& s]vices furni%$ on or aft] ! fir/ day 
( ! fir/ cal5d> qu>t] beg9n+ on or aft] 
! date t is #a ye> aft] ! date ( !      
enactm5t ( ?is ,act4