,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #dgjd  ,,in ,,the ,,house ,,of  
,,representatives  ,december #bj1       
#bjag,ms4 ,wasserman ,schultz 7for      
herself and ,mr4 ,walberg7 introduced   
the following bill2 which was referred  
to the ,committee on ,energy and        
,commerce1 and in addition to the       
,committee on ,ways and ,means1 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 codify the    
emergency preparedness final rule for   
skilled nursing facilities and nursing  
facilities as conditions of             
participation under the ,medicare and   
,medicaid programs1 and for other       
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,nursing ,home      
,comfortable ,air ,ready for            
,emergencies ,act or the ,nursing ,home 

,,care ,act4  #b4 ,codifying ,emergency 
,preparedness rule for skilled nursing  
facilities and nursing facilities as    
conditions of participation under       
,medicare and ,medicaid programs  7a7   
,medicare ,section #ahai7;a7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;a77 is amended--  7#a7 in   
paragraph 7#b71 by striking at the end  
and2  7#b7 in paragraph 7#c71 by        
striking the period at the end and      
inserting 2 and2  7#c7 by inserting     
after paragraph 7#c7 the following new  
paragraph3  7#d7 beginning not later    
than the date of the enactment of this  
paragraph--  7,a7 meets the emergency   
preparedness requirements applicable to 
skilled nursing facilities under the    
final rule ,medicare and ,medicaid      
,programs2 ,emergency ,preparedness     
,requirements for ,medicare and         
,medicaid ,participating ,providers and 
,suppliers as published by the ,centers 
for ,medicare  ,medicaid ,services on   
,september #af1 #bjaf 7#ha ,fed4 ,reg4  

#fchei72 and  7,b7 has in place         
alternative sources of energy capable of
 powering heating1 ventilation1 and air 
conditioning systems for at least #if   
hours after a catastrophic natural      
disaster4  2 and  7#d7 by adding at the 
end the following3 ,nothing in paragraph
 7#d77;,b7 shall be construed to require
 a skilled nursing facility to          
continuously maintain a supply of fuel  
on its premise1 as long as such facility
 is able to demonstrate to the          
,secretary the ability of the facility  
to obtain any fuel necessary to satisfy 
such paragraph4 4  7b7 ,medicaid        
,section #aiai7;a7 of the ,social       
,security ,act 7#db ,u4,s4,c4 #acifr7a77
 is amended--  7#a7 in paragraph 7#b71  
by striking at the end and2  7#b7 in    
paragraph 7#c71 by striking the period  
at the end and inserting 2 and2  7#c7 by
 inserting after paragraph 7#c7 the     
following new paragraph3  7#d7 beginning
 not later than the date of the         
enactment of this paragraph--  7,a7     

meets the emergency preparedness        
requirements applicable to nursing      
facilities under the final rule         
,medicare and ,medicaid ,programs2      
,emergency ,preparedness ,requirements  
for ,medicare and ,medicaid             
,participating ,providers and ,suppliers
 as published by the ,centers for       
,medicare  ,medicaid ,services on       
,september #af1 #bjaf 7#ha ,fed4 ,reg4  
#fchei72 and  7,b7 has in place         
alternative sources of energy capable of
 powering heating1 ventilation1 and air 
conditioning systems for at least #if   
hours after a catastrophic natural      
disaster4  2 and  7#d7 by adding at the 
end the following new sentence3 ,nothing
 in paragraph 7#d77;,b7 shall be        
construed to require a nursing facility 
to continuously maintain a supply of    
fuel on its premise1 as long as such    
facility is able to demonstrate to the  
,secretary the ability of the facility  
to obtain any fuel necessary to satisfy 
such paragraph4 4  7c7 ,civil money     

penalties  7#a7 ,increased penalty ,in  
the case of a determination to impose a 
civil money penalty under section       
#ahai7;h77#b77;,b77ii7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;h77#b77;,b77ii77 or section 
#aiai7;h77#b77;,c77ii7 of such ,act 7#db
 ,u4,s4,c4 #acifr7h77#b77;,c77ii771 with
 respect to a violation of paragraph    
7#d7 of section #ahai7;a7 of such ,act  
7#db ,u4,s4,c4 #acie;i-#c7;a77 or of    
paragraph 7#d7 of section #aiai7;a7 of  
such ,act 7#db ,u4,s4,c4 #acifr7a771 as 
added by subsections 7a7 and 7b71       
respectively1 such penalty shall be     
three times the amount that would       
otherwise be imposed pursuant to the    
interim final rule1 relating to the     
adjustment of civil money penalties for 
inflation1 promulgated by the           
,department of ,health and ,human       
,services on ,september #f1 #bjaf 7#ha  
,fed4 ,reg4 #faech74 ,nothing in this   
paragraph shall be construed as limiting
 the discretion of the ,secretary of    

,health and ,human ,services in         
determining the amount of a civil       
monetary penalty that would otherwise be
 imposed before application of this     
paragraph4  7#b7 ,additional penalty    
7,a7 ,medicare ,section                 
#ahai7;h77#b77;,b77ii7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;h77#b77;,b77ii77 is         
amended-- 7i7 in subclause 7,i71 by     
inserting 1 subject to subclause 7,v71  
after exceed2 and  7ii7 by adding at the
 end the following new subclause3  7,v7 
,increased penalty ,in the case of      
noncompliance described in subclause    
7,i7 of a skilled nursing facility that 
results in the death of a resident of   
the facility1 the ,secretary may impose 
an additional civil money penalty under 
such subclause in an amount not to      
exceed #ajj1jjj4  4  7,b7 ,medicaid     
,section #aiai7;h77#c77;,c77ii7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7h77#c77;,c77ii77 is amended-- 7i7
 in subclause 7,i71 by inserting 1      

subject to subclause 7,v71 after exceed2
 and  7ii7 by adding at the end the     
following new subclause3  7,v7          
,increased penalty ,in the case of      
noncompliance described in subclause    
7,i7 of a nursing facility that results 
in the death of a resident of the       
facility1 the ,secretary may impose an  
additional civil monetary penalty under 
such subclause in an amount not to      
exceed #ajj1jjj4  4  7#c7 ,state survey 
agencies compliance review ,the         
,secretary of ,health and ,human        
,services shall direct ,state survey    
agencies1 in consultation with emergency
 preparedness experts1 to review        
findings related to the final rule      
,medicare and ,medicaid ,programs2      
,emergency ,preparedness ,requirements  
for ,medicare and ,medicaid             
,participating ,providers and ,suppliers
 as published by the ,centers for       
,medicare  ,medicaid ,services on       
,september #af1 #bjaf 7#ha ,fed4 ,reg4  
#fchei7 and make a determination of     

whether a skilled nursing facility or   
nursing facility is substantially       
compliant or non-compliant 7as defined  
by the ,secretary7 with such rule1 with 
special attention given to ,ftags       
,e-#jjja1 ,e-#jjjd1 ,e-#jjac1 ,e-#jjbj1 
,e-#jjbe1 ,e-#jjcf1 #jjcg1 and ,e-#jjda4
 ,if a ,state survey agency makes a     
determination of substantial            
non-compliance for any such facility in 
a ,state1 the agency shall then inform  
those facilities of that finding1 and   
request that this be noted as an        
indicator on ,nursing ,home ,compare4   
#c4 ,loan fund  7a7 ,establishment ,the 
,secretary of ,health and ,human        
,services shall1 subject to subsection  
7e71 establish a loan program that      
provides loans to qualifying nursing    
facilities and skilled nursing          
facilities for costs relating to coming 
into compliance with the requirement of 
paragraph 7#d7 of section #ahai7;a7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#c7;a77 and paragraph 

7#d7 of section #aiai7;a7 of such ,act  
7#db ,u4,s4,c4 #acifr7a771 as added by  
section #b4  7b7 ,application ,no loan  
may be provided under this section to a 
qualifying nursing facility or skilled  
nursing facility1 except pursuant to an 
application that is submitted and       
approved in a time1 manner1 and form    
specified by the ,secretary4 ,a loan    
under this section shall be on such     
terms and conditions and meet such      
requirements as the ,secretary          
determines appropriate4  7c7 ,selection 
7#a7 ,in general ,the ,secretary shall  
establish criteria for selecting among  
qualifying nursing facilities and       
skilled nursing facilities that apply   
for a loan under this section4  7#b7    
,qualifying facilities ,for purposes of 
this section1 qualifying nursing        
facilities and skilled nursing          
facilities are nursing facilities under 
section #aiai of the ,social ,security  
,act 7#db ,u4,s4,c4 #acifr7 and skilled 
nursing facilities under section #ahai  

of such ,act 7#db ,u4,s4,c4 #acie;i-#c7 
that--  7,a7 have a monthly rate of less
 than #f1jjj for private rooms2 or  7,b7
 have fewer than #ej beds4  7d7 ,fees   
,the ,secretary may charge such fees as 
determined appropriate with respect to a
 loan issued under this section1 in an  
amount established annually by the      
,secretary1 as necessary to reduce to   
zero the cost 7as defined in section    
#ejb of the ,federal ,credit ,reform    
,act of #aiij7 to the ,department of    
,health and ,human ,services of making  
loans under this section1 which amounts 
shall be paid to and retained by the    
,secretary4  7e7 ,limitation            
,commitments for loans authorized under 
this section shall not exceed-- 7#a7    
#ej1jjj1jjj in fiscal year #bjah2  7#b7 
#ej1jjj1jjj in fiscal year #bjai2 and   
7#c7 #ajj1jjj1jjj for the duration of   
the loan program4  #d4 ,prioritization  
under all-hazards public health         
emergency preparedness and response plan
  7a7 ,in general ,section              

#cai;,c-#a7;b77#b77;,a7 of the ,public  
,health ,service ,act 7#db ,u4,s4,c4    
#bdg;d-#c;a7b77#b77;,a77 is amended--   
7#a7 in clause 7viii71 by striking at   
the end and2  7#b7 in clause 7ix71 by   
adding at the end and2 and  7#c7 by     
inserting after clause 7ix7 the         
following new clause3  7x7 a description
 of-- 7,i7 the measures the entity has  
in place prioritizing nursing facilities
 and skilled nursing facilities with    
respect to public health emergency      
preparedness in the same manner as such 
plan prioritizes hospitals1 while       
ensuring that1 in prioritizing nursing  
facilities1 skilled nursing facilities1 
and hospitals1 the entity retains the   
discretion to prioritize among such     
facilities2 and  7,,ii7 information on  
the plans of each electric utility      
company within the entity's jurisdiction
 to ensure that such facilities remain  
functioning or return to functioning as 
soon as practicable during power outages
 caused by natural hazards1 including   

severe weather events2  4  7b7          
,effective date ,the amendments made by 
subsection 7a7 shall apply with respect 
to cooperative agreements awarded on or 
after the date of the enactment of this 
,act4