,i #aaf? ,,congress #a/ ,session ,h4 ,r4 #abfe ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #ad1 #bjai,mr4 ,duffy 7= himself1 ,mr4 ,pet]son1 & ,mr4 ,gian=te7 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 ) respect to nurs+ facility requirem5ts1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,nurs+ ,home ,work=ce ,quality ,act4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,nurs+ facilities are an integral compon5t ( ! cont9uum ( c>e = ,m$ic>e & ,m$icaid pati5ts4 7#b7 ,_m nurs+ facilities h 9-h\se educational programs approv$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices to tra9 individuals z c]tifi$ nurs+ aides to provide ext5sive1 direct c>e4 7#c7 ,! ability to provide ?is tra9+ is critical = nurs+ facilities to ensure t-- 7,a7 resid5ts receive ! highe/ quality c>e2 7,b7 c>egiv]s are tra9$ on ! mo/ timely be/ practices & cl9ical /&>ds2 & 7,c7 facilities c-- 7i7 su/a9 appropriate /aff+ levels2 & 7ii7 recruit & reta9 qualifi$ /aff4 #c4 ,tra9+ & compet5cy evaluation programs 7a7 ,m$ic>e ,section #ahai ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7 is am5d$-- 7#a7 9 subsection 7f77#b7-- 7,a7 9 subp>agraph 7,a77iv77,i71 by /rik+ 7unless ! facility is describ$ 9 subp>agraph 7,b77iii77,i772 7,b7 9 subp>agraph 7,b7-- 7i7 9 clause 7i7-- 7,i7 by /rik+ 7subject to clause 7iii772 & 7,,ii7 by ins]t+ & aft] ! semicolon2 7ii7 9 clause 7ii71 by /rik+ 2 & & ins]t+ a p]iod2 7iii7 by /rik+ clause 7iii72 & 7iv7 by /rik+ ,a ,/ate may n delegate 7?r\gh subcontract or o!rwise7 its responsibility "u clause 7iii77,,ii7 to ! skill$ nurs+ facility42 7,c7 by /rik+ subp>agraphs 7,c7 & 7,d72 & 7,d7 by add+ at ! end ! foll[+3 7,c7 ,disapproval ( nurse aide tra9+ & compet5cy evaluation programs & nurse aide compet5cy evaluation programs 7i7 ,9 g5]al ,) respect to a ,/ate1 ! ,secret>y may1 9 consultation ) su* ,/ate1 disapprove a nurse aide tra9+ & compet5cy evaluation program or a nurse aide compet5cy evaluation program (f]$ by or 9 a skill$ nurs+ facility if su* facility-- 7,i7 has be5 assess$ a civil monet>y p5alty "u subsection 7h77#b77;,b77ii7 or section #aiai7;h77#b77;,a77ii7 ( n less ?an #aj1fig = provid+ sub/&>d quality ( c>e2 & 7,,ii7 has n1 9 ! det]m9ation ( ! ,secret>y1 correct$ ! defici5cies 9 quality ( c>e = :i* su* civil monet>y p5alty 0 assess$4 7ii7 ,rescission ( disapproval ,! ,secret>y %all resc9d a disapproval "u clause 7i7 ^u demon/ration by a facility t all defici5cies = :i* ! civil monet>y p5alty describ$ 9 clause 7i77,i7 0 assess$ h be5 rem$i$4 2 & 7#b7 9 subsection 7h77#b77;,b77ii77,i71 by /rik+ #aj1jjj & ins]t+ #ba1cic4 7b7 ,m$icaid ,section #aiai ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr7 is am5d$-- 7#a7 9 subsection 7f77#b7-- 7,a7 9 subp>agraph 7,a77iv77,i71 by /rik+ 7unless ! facility is describ$ 9 subp>agraph 7,b77iii77,i772 7,b7 9 subp>agraph 7,b7-- 7i7 9 clause 7i71 by ins]t+ & aft] ! semicolon2 7ii7 9 clause 7ii71 by /rik+ 2 & & ins]t+ a p]iod2 7iii7 by /rik+ clause 7iii72 & 7iv7 by /rik+ ,a ,/ate may n delegate 7?r\gh subcontract or o!rwise7 its responsibility "u clause 7iii77,,ii7 to ! nurs+ facility42 7,c7 by /rik+ subp>agraphs 7,c7 & 7,d72 & 7,d7 by add+ at ! end ! foll[+3 7,c7 ,disapproval ( nurse aide tra9+ & compet5cy evaluation programs & nurse aide compet5cy evaluation programs 7i7 ,9 g5]al ,) respect to a ,/ate1 ! ,secret>y may1 9 consultation ) su* ,/ate1 disapprove a nurse aide tra9+ & compet5cy evaluation program or a nurse aide compet5cy evaluation program (f]$ by or 9 a nurs+ facility if su* facility-- 7,i7 has be5 assess$ a civil monet>y p5alty "u section #ahai7;h77#b77;,b77ii7 or subsection 7h77#b77;,a77ii7 ( n less ?an #aj1fig = provid+ sub/&>d quality ( c>e2 & 7,,ii7 has n1 9 ! det]m9ation ( ! ,secret>y1 correct$ ! defici5cies 9 quality ( c>e = :i* su* civil monet>y p5alty 0 assess$4 7ii7 ,rescission ( disapproval ,! ,secret>y %all resc9d a disapproval "u clause 7i7 ^u demon/ration by a facility t all defici5cies = :i* ! civil monet>y p5alty describ$ 9 clause 7i77,i7 0 assess$ h be5 rem$i$4 2 & 7#b7 9 subsection 7h77#c77;,c77ii77,i71 by /rik+ #aj1jjj & ins]t+ #ba1cic4 7c7 ,regulations ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all promulgate regulations z necess>y to implem5t ! am5dm5ts made by ?is section4 7d7 ,applicability 7#a7 ,9 g5]al 7,a7 ,tim+ ( det]m9ations ,! am5dm5ts made by subsections 7a77#a77;,d7 & 7b77#a77;,d7 ( ?is section %all apply only to a civil monet>y p5alty if ! relevant cov]$ det]m9ation 0 made on or aft] ! date ( enactm5t ( ?is ,act4 7,b7 ,cov]$ det]m9ation def9$ ,! t]m cov]$ det]m9ation means1 ) respect to a facility 9 a ,/ate1 a det]m9ation by ! ,/ate or ! ,secret>y ( ,heal? & ,human ,s]vices t ! facility has provid$ a sub/&>d quality ( c>e = :i* a civil monet>y p5alty describ$ 9 section #ahai7;f77#b77;,c77i77,i7 or #aiai7;f77#b77;,c77i77,i7 ( ! ,social ,security ,act 7z su* sections h be5 am5d$ by ?is ,act7 may be assess$4 7#b7 ,previ\sly prohibit$ programs 7,a7 ,waiv] ,) respect to a facility subject1 on ! day be=e ! date ( enactm5t ( ?is ,act1 to a prohibition "u item 7a7 ( ei!r section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 ( ! ,social ,security ,act 7z 9 effect on ! day be=e su* date ( enactm5t71 su* prohibition %all no long] apply to ! facility on or aft] su* date ( enactm5t4 7,b7 ,survey or civil monet>y p5alty ,) respect to a facility subject1 on ! day be=e ! date ( enactm5t ( ?is ,act1 to a prohibition "u item 7b7 or 7c7 ( ei!r section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 ( ! ,social ,security ,act 7z 9 effect on ! day be=e su* date ( enactm5t71 su* prohibition %all no long] apply to ! facility on or aft] su* date ( enactm5t ^u a det]m9ation by ! ,secret>y ( ,heal? & ,human ,s]vices t ! facility has correct$ ! issue t result$ 9 su* prohibition4