,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dgjd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #bj1         
#bjag,ms4 ,wass]man ,s*ultz 7= h]self & 
,mr4 ,walb]g7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = 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 codify ! em]g5cy prep>$ness f9al
 rule = skill$ nurs+ facilities & nurs+ 
facilities z conditions ( p>ticipation  
"u ! ,m$ic>e & ,m$icaid programs1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,nurs+ ,home ,com=table
 ,air ,ready = ,em]g5cies ,act or !     
,nurs+ ,home ,,c>e ,act4  #b4 ,codify+  
,em]g5cy ,prep>$ness rule = skill$ nurs+
 facilities & nurs+ facilities z        
conditions ( p>ticipation "u ,m$ic>e &  
,m$icaid programs  7a7 ,m$ic>e ,section 

#ahai7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;a77 is       
am5d$--  7#a7 9 p>agraph 7#b71 by /rik+ 
at ! end &2  7#b7 9 p>agraph 7#c71 by   
/rik+ ! p]iod at ! end & ins]t+ 2 &2    
7#c7 by ins]t+ aft] p>agraph 7#c7 !     
foll[+ new p>agraph3  7#d7 beg9n+ n lat]
 ?an ! date ( ! enactm5t ( ?is          
p>agraph--  7,a7 meets ! em]g5cy        
prep>$ness requirem5ts applicable to    
skill$ nurs+ facilities "u ! f9al rule  
,m$ic>e & ,m$icaid ,programs2 ,em]g5cy  
,prep>$ness ,requirem5ts = ,m$ic>e &    
,m$icaid ,p>ticipat+ ,provid]s &        
,suppli]s z publi%$ by ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices on ,septemb] 
#af1 #bjaf 7#ha ,f$4 ,reg4 #fchei72 &   
7,b7 has 9 place alt]native s\rces (    
en]gy capable ( p[]+ heat+1 v5tilation1 
& air condition+ sy/ems = at lea/ #if   
h\rs aft] a cata/rophic natural disa/]4 
2 &  7#d7 by add+ at ! end ! foll[+3    
,no?+ 9 p>agraph 7#d77;,b7 %all be      
con/ru$ to require a skill$ nurs+       
facility to cont9u\sly ma9ta9 a supply (

 fuel on its premise1 z long z su*      
facility is able to demon/rate to !     
,secret>y ! ability ( ! facility to     
obta9 any fuel necess>y to satisfy su*  
p>agraph4 4  7b7 ,m$icaid ,section      
#aiai7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr7a77 is am5d$--    
7#a7 9 p>agraph 7#b71 by /rik+ at ! end 
&2  7#b7 9 p>agraph 7#c71 by /rik+ !    
p]iod at ! end & ins]t+ 2 &2  7#c7 by   
ins]t+ aft] p>agraph 7#c7 ! foll[+ new  
p>agraph3  7#d7 beg9n+ n lat] ?an ! date
 ( ! enactm5t ( ?is p>agraph--  7,a7    
meets ! em]g5cy prep>$ness requirem5ts  
applicable to nurs+ facilities "u ! f9al
 rule ,m$ic>e & ,m$icaid ,programs2     
,em]g5cy ,prep>$ness ,requirem5ts =     
,m$ic>e & ,m$icaid ,p>ticipat+ ,provid]s
 & ,suppli]s z publi%$ by ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices on ,septemb] 
#af1 #bjaf 7#ha ,f$4 ,reg4 #fchei72 &   
7,b7 has 9 place alt]native s\rces (    
en]gy capable ( p[]+ heat+1 v5tilation1 
& air condition+ sy/ems = at lea/ #if   
h\rs aft] a cata/rophic natural disa/]4 

2 &  7#d7 by add+ at ! end ! foll[+ new 
s5t5ce3 ,no?+ 9 p>agraph 7#d77;,b7 %all 
be con/ru$ to require a nurs+ facility  
to cont9u\sly ma9ta9 a supply ( fuel on 
its premise1 z long z su* facility is   
able to demon/rate to ! ,secret>y !     
ability ( ! facility to obta9 any fuel  
necess>y to satisfy su* p>agraph4 4  7c7
 ,civil money p5alties  7#a7 ,increas$  
p5alty ,9 ! case ( a det]m9ation to     
impose a civil money p5alty "u section  
#ahai7;h77#b77;,b77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;h77#b77;,b77ii77 or section 
#aiai7;h77#b77;,c77ii7 ( su* ,act 7#db  
,u4,s4,c4 #acifr7h77#b77;,c77ii771 )    
respect to a violation ( p>agraph 7#d7 (
 section #ahai7;a7 ( su* ,act 7#db      
,u4,s4,c4 #acie;i-#c7;a77 or ( p>agraph 
7#d7 ( section #aiai7;a7 ( su* ,act 7#db
 ,u4,s4,c4 #acifr7a771 z add$ by        
subsections 7a7 & 7b71 respectively1 su*
 p5alty %all be ?ree times ! am\nt t    
w\ld o!rwise be impos$ pursuant to !    
int]im f9al rule1 relat+ to ! adju/m5t (

 civil money p5alties = inflation1      
promulgat$ by ! ,dep>tm5t ( ,heal? &    
,human ,s]vices on ,septemb] #f1 #bjaf  
7#ha ,f$4 ,reg4 #faech74 ,no?+ 9 ?is    
p>agraph %all be con/ru$ z limit+ !     
discretion ( ! ,secret>y ( ,heal? &     
,human ,s]vices 9 det]m9+ ! am\nt ( a   
civil monet>y p5alty t w\ld o!rwise be  
impos$ be=e application ( ?is p>agraph4 
7#b7 ,additional p5alty  7,a7 ,m$ic>e   
,section #ahai7;h77#b77;,b77ii7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;h77#b77;,b77ii77 is am5d$-- 
7i7 9 subclause 7,i71 by ins]t+ 1       
subject to subclause 7,v71 aft] exce$2 &
  7ii7 by add+ at ! end ! foll[+ new    
subclause3  7,v7 ,increas$ p5alty ,9 !  
case ( noncompliance describ$ 9         
subclause 7,i7 ( a skill$ nurs+ facility
 t results 9 ! dea? ( a resid5t ( !     
facility1 ! ,secret>y may impose an     
additional civil money p5alty "u su*    
subclause 9 an am\nt n to exce$         
#ajj1jjj4  4  7,b7 ,m$icaid ,section    
#aiai7;h77#c77;,c77ii7 ( ! ,social      

,security ,act 7#db ,u4,s4,c4           
#acifr7h77#c77;,c77ii77 is am5d$-- 7i7 9
 subclause 7,i71 by ins]t+ 1 subject to 
subclause 7,v71 aft] exce$2 &  7ii7 by  
add+ at ! end ! foll[+ new subclause3   
7,v7 ,increas$ p5alty ,9 ! case (       
noncompliance describ$ 9 subclause 7,i7 
( a nurs+ facility t results 9 ! dea? ( 
a resid5t ( ! facility1 ! ,secret>y may 
impose an additional civil monet>y      
p5alty "u su* subclause 9 an am\nt n to 
exce$ #ajj1jjj4  4  7#c7 ,/ate survey   
ag5cies compliance review ,! ,secret>y (
 ,heal? & ,human ,s]vices %all direct   
,/ate survey ag5cies1 9 consultation )  
em]g5cy prep>$ness exp]ts1 to review    
f9d+s relat$ to ! f9al rule ,m$ic>e &   
,m$icaid ,programs2 ,em]g5cy ,prep>$ness
 ,requirem5ts = ,m$ic>e & ,m$icaid      
,p>ticipat+ ,provid]s & ,suppli]s z     
publi%$ by ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices on ,septemb] #af1 #bjaf 7#ha   
,f$4 ,reg4 #fchei7 & make a det]m9ation 
( :e!r a skill$ nurs+ facility or nurs+ 
facility is sub/antially compliant or   

non-compliant 7z def9$ by ! ,secret>y7 )
 su* rule1 ) special att5tion giv5 to   
,ftags ,e-#jjja1 ,e-#jjjd1 ,e-#jjac1    
,e-#jjbj1 ,e-#jjbe1 ,e-#jjcf1 #jjcg1 &  
,e-#jjda4 ,if a ,/ate survey ag5cy makes
 a det]m9ation ( sub/antial             
non-compliance = any su* facility 9 a   
,/ate1 ! ag5cy %all !n in=m ^?          
facilities ( t f9d+1 & reque/ t ?is be  
not$ z an indicator on ,nurs+ ,home     
,comp>e4  #c4 ,loan fund  7a7           
,e/abli%m5t ,! ,secret>y ( ,heal? &     
,human ,s]vices %all1 subject to        
subsection 7e71 e/abli% a loan program t
 provides loans to qualify+ nurs+       
facilities & skill$ nurs+ facilities =  
co/s relat+ to com+ into compliance ) ! 
requirem5t ( p>agraph 7#d7 ( section    
#ahai7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;a77 &        
p>agraph 7#d7 ( section #aiai7;a7 ( su* 
,act 7#db ,u4,s4,c4 #acifr7a771 z add$  
by section #b4  7b7 ,application ,no    
loan may be provid$ "u ?is section to a 
qualify+ nurs+ facility or skill$ nurs+ 

facility1 except pursuant to an         
application t is submitt$ & approv$ 9 a 
"t1 mann]1 & =m specifi$ by ! ,secret>y4
 ,a loan "u ?is section %all be on su*  
t]ms & conditions & meet su* requirem5ts
 z ! ,secret>y det]m9es appropriate4    
7c7 ,selection  7#a7 ,9 g5]al ,!        
,secret>y %all e/abli% crit]ia = select+
 among qualify+ nurs+ facilities &      
skill$ nurs+ facilities t apply = a loan
 "u ?is section4  7#b7 ,qualify+        
facilities ,= purposes ( ?is section1   
qualify+ nurs+ facilities & skill$ nurs+
 facilities are nurs+ facilities "u     
section #aiai ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr7 & skill$ nurs+  
facilities "u section #ahai ( su* ,act  
7#db ,u4,s4,c4 #acie;i-#c7 t--  7,a7 h a
 mon?ly rate ( less ?an #f1jjj = private
 rooms2 or  7,b7 h few] ?an #ej b$s4    
7d7 ,fees ,! ,secret>y may *>ge su* fees
 z det]m9$ appropriate ) respect to a   
loan issu$ "u ?is section1 9 an am\nt   
e/abli%$ annually by ! ,secret>y1 z     
necess>y to r$uce to z]o ! co/ 7z def9$ 

9 section #ejb ( ! ,f$]al ,cr$it ,re=m  
,act ( #aiij7 to ! ,dep>tm5t ( ,heal? & 
,human ,s]vices ( mak+ loans "u ?is     
section1 :i* am\nts %all be paid to &   
reta9$ by ! ,secret>y4  7e7 ,limitation 
,commitm5ts = loans au?oriz$ "u ?is     
section %all n exce$-- 7#a7 #ej1jjj1jjj 
9 fiscal ye> #bjah2  7#b7 #ej1jjj1jjj 9 
fiscal ye> #bjai2 &  7#c7 #ajj1jjj1jjj =
 ! duration ( ! loan program4  #d4      
,prioritization "u all-haz>ds public    
heal? em]g5cy prep>$ness & response plan
  7a7 ,9 g5]al ,section                 
#cai;,c-#a7;b77#b77;,a7 ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bdg;d-#c;a7b77#b77;,a77 is am5d$-- 7#a7
 9 clause 7viii71 by /rik+ at ! end &2  
7#b7 9 clause 7ix71 by add+ at ! end &2 
&  7#c7 by ins]t+ aft] clause 7ix7 !    
foll[+ new clause3  7x7 a description   
(-- 7,i7 ! measures ! entity has 9 place
 prioritiz+ nurs+ facilities & skill$   
nurs+ facilities ) respect to public    
heal? em]g5cy prep>$ness 9 ! same mann] 
z su* plan prioritizes hospitals1 :ile  

ensur+ t1 9 prioritiz+ nurs+ facilities1
 skill$ nurs+ facilities1 & hospitals1 !
 entity reta9s ! discretion to          
prioritize among su* facilities2 &      
7,,ii7 in=mation on ! plans ( ea*       
electric utility company )9 ! entity's  
jurisdiction to ensure t su* facilities 
rema9 function+ or return to function+ z
 soon z practicable dur+ p[] outages    
caus$ by natural haz>ds1 includ+ sev]e  
wea!r ev5ts2  4  7b7 ,effective date ,! 
am5dm5ts made by subsection 7a7 %all    
apply ) respect to coop]ative agreem5ts 
aw>d$ on or aft] ! date ( ! enactm5t (  
?is ,act4