,i #aafth ,,congress #ast ,session ,h4 ,r4 #abfe ,,in ,,the ,,house ,,of ,,representatives ,february #ad1 #bjai,mr4 ,duffy 7for himself1 ,mr4 ,peterson1 and ,mr4 ,gianforte7 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 with respect to nursing facility requirements1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,nursing ,home ,workforce ,quality ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,nursing facilities are an integral component of the continuum of care for ,medicare and ,medicaid patients4 7#b7 ,many nursing facilities have in-house educational programs approved by the ,centers for ,medicare ,medicaid ,services to train individuals as certified nursing aides to provide extensive1 direct care4 7#c7 ,the ability to provide this training is critical for nursing facilities to ensure that-- 7,a7 residents receive the highest quality care2 7,b7 caregivers are trained on the most timely best practices and clinical standards2 and 7,c7 facilities can-- 7i7 sustain appropriate staffing levels2 and 7ii7 recruit and retain qualified staff4 #c4 ,training and competency evaluation programs 7a7 ,medicare ,section #ahai of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7 is amended-- 7#a7 in subsection 7f77#b7-- 7,a7 in subparagraph 7,a77iv77,i71 by striking 7unless the facility is described in subparagraph 7,b77iii77,i772 7,b7 in subparagraph 7,b7-- 7i7 in clause 7i7-- 7,i7 by striking 7subject to clause 7iii772 and 7,,ii7 by inserting and after the semicolon2 7ii7 in clause 7ii71 by striking 2 and and inserting a period2 7iii7 by striking clause 7iii72 and 7iv7 by striking ,a ,state may not delegate 7through subcontract or otherwise7 its responsibility under clause 7iii77,,ii7 to the skilled nursing facility42 7,c7 by striking subparagraphs 7,c7 and 7,d72 and 7,d7 by adding at the end the following3 7,c7 ,disapproval of nurse aide training and competency evaluation programs and nurse aide competency evaluation programs 7i7 ,in general ,with respect to a ,state1 the ,secretary may1 in consultation with such ,state1 disapprove a nurse aide training and competency evaluation program or a nurse aide competency evaluation program offered by or in a skilled nursing facility if such facility-- 7,i7 has been assessed a civil monetary penalty under subsection 7h77#b77;,b77ii7 or section #aiai7;h77#b77;,a77ii7 of not less than #aj1fig for providing substandard quality of care2 and 7,,ii7 has not1 in the determination of the ,secretary1 corrected the deficiencies in quality of care for which such civil monetary penalty was assessed4 7ii7 ,rescission of disapproval ,the ,secretary shall rescind a disapproval under clause 7i7 upon demonstration by a facility that all deficiencies for which the civil monetary penalty described in clause 7i77,i7 was assessed have been remedied4 2 and 7#b7 in subsection 7h77#b77;,b77ii77,i71 by striking #aj1jjj and inserting #ba1cic4 7b7 ,medicaid ,section #aiai of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7 is amended-- 7#a7 in subsection 7f77#b7-- 7,a7 in subparagraph 7,a77iv77,i71 by striking 7unless the facility is described in subparagraph 7,b77iii77,i772 7,b7 in subparagraph 7,b7-- 7i7 in clause 7i71 by inserting and after the semicolon2 7ii7 in clause 7ii71 by striking 2 and and inserting a period2 7iii7 by striking clause 7iii72 and 7iv7 by striking ,a ,state may not delegate 7through subcontract or otherwise7 its responsibility under clause 7iii77,,ii7 to the nursing facility42 7,c7 by striking subparagraphs 7,c7 and 7,d72 and 7,d7 by adding at the end the following3 7,c7 ,disapproval of nurse aide training and competency evaluation programs and nurse aide competency evaluation programs 7i7 ,in general ,with respect to a ,state1 the ,secretary may1 in consultation with such ,state1 disapprove a nurse aide training and competency evaluation program or a nurse aide competency evaluation program offered by or in a nursing facility if such facility-- 7,i7 has been assessed a civil monetary penalty under section #ahai7;h77#b77;,b77ii7 or subsection 7h77#b77;,a77ii7 of not less than #aj1fig for providing substandard quality of care2 and 7,,ii7 has not1 in the determination of the ,secretary1 corrected the deficiencies in quality of care for which such civil monetary penalty was assessed4 7ii7 ,rescission of disapproval ,the ,secretary shall rescind a disapproval under clause 7i7 upon demonstration by a facility that all deficiencies for which the civil monetary penalty described in clause 7i77,i7 was assessed have been remedied4 2 and 7#b7 in subsection 7h77#c77;,c77ii77,i71 by striking #aj1jjj and inserting #ba1cic4 7c7 ,regulations ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall promulgate regulations as necessary to implement the amendments made by this section4 7d7 ,applicability 7#a7 ,in general 7,a7 ,timing of determinations ,the amendments made by subsections 7a77#a77;,d7 and 7b77#a77;,d7 of this section shall apply only to a civil monetary penalty if the relevant covered determination was made on or after the date of enactment of this ,act4 7,b7 ,covered determination defined ,the term covered determination means1 with respect to a facility in a ,state1 a determination by the ,state or the ,secretary of ,health and ,human ,services that the facility has provided a substandard quality of care for which a civil monetary penalty described in section #ahai7;f77#b77;,c77i77,i7 or #aiai7;f77#b77;,c77i77,i7 of the ,social ,security ,act 7as such sections have been amended by this ,act7 may be assessed4 7#b7 ,previously prohibited programs 7,a7 ,waiver ,with respect to a facility subject1 on the day before the date of enactment of this ,act1 to a prohibition under item 7a7 of either section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 of the ,social ,security ,act 7as in effect on the day before such date of enactment71 such prohibition shall no longer apply to the facility on or after such date of enactment4 7,b7 ,survey or civil monetary penalty ,with respect to a facility subject1 on the day before the date of enactment of this ,act1 to a prohibition under item 7b7 or 7c7 of either section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 of the ,social ,security ,act 7as in effect on the day before such date of enactment71 such prohibition shall no longer apply to the facility on or after such date of enactment upon a determination by the ,secretary of ,health and ,human ,services that the facility has corrected the issue that resulted in such prohibition4