,i #aafth ,,congress #b;d ,session ,h4 ,r4 #hegd ,,in ,,the ,,house ,,of ,,representatives ,october #i1 #bjbj,ms4 ,sherrill 7for herself1 ,mr4 ,pascrell1 ,mrs4 ,watson ,coleman1 ,mr4 ,sires1 ,mr4 ,beyer1 ,mr4 ,payne1 ,mr4 ,doggett1 ,ms4 ,shalala1 ,ms4 ,judy ,chu of ,california1 and ,mr4 ,kildee7 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 increase enforcement under ,medicare and ,medicaid for skilled nursing facilities and nursing facilities during the ,,covid-#ai emergency period and other infectious disease outbreak periods1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protecting ,residents with ,oversight1 ,transparency1 and ,enforcement for ,compassionate ,treatment in ,long ,term ,care ,facilities ,act or the ,,protect ,long ,term ,care ,facilities ,act4 #b4 ,increased enforcement under ,medicare and ,medicaid for skilled nursing facilities and nursing facilities during the ,,covid-#ai emergency period and other infectious disease outbreak periods 7a7 ,additional funding to ,state survey agencies 7#a7 ,appropriations ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary of ,health and ,human ,services #ajj1jjj1jjj for fiscal year #bjba to be provided1 in addition to any funds otherwise made available and in accordance with paragraph 7#b71 to ,state survey and certification agencies 7described in subsection 7f7 of section #aabh;,i of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;j77 for the following purposes3 7,a7 ,to complete surveys conducted pursuant to the amendments made by subsection 7b7 for facilities 7as defined in subsection 7a7 of such section #aabh;,i74 7,b7 ,to increase investigations and surveys performed pursuant to sections #aiai7;g77#d7 of such ,act 7#db ,u4,s4,c4 #acifr7g77#b77 and #ahai7;g77#d7 of such ,act 7#db ,u4,s4,c4 #acie;i-#c7;g77#d77 based on criteria developed pursuant to paragraph 7#g77;,b7 of section #ahai7;h7 of such ,act1 as added by subsection 7b77#a77;,c71 and paragraph 7#aj77;,b7 of section #aiai7;h7 of such ,act1 as added by subsection 7b77#b77;,c74 7,c7 ,to purchase personal protective equipment for surveyors to conduct surveys and investigations of facilities 7as defined in subsection 7a7 of such section #aabh;,i7 to ensure worker safety4 7,d7 ,to increase staffing levels at such ,state survey and certification agencies4 7#b7 ,allocation of funding ,the ,secretary shall allocate funds appropriated under paragraph 7#a7 based on the following prioritization3 7,a7 ,first to ,state survey and certification agencies 7as described in subsection 7f7 of such section #aabh;,i7 serving populations with a high burden1 as defined by the ,secretary of ,health and ,human ,services1 of ,,covid-#ai4 7,b7 ,second to such agencies preparing for1 or working to mitigate1 a ,,covid-#ai surge or any similar infectious disease outbreak4 7,c7 ,third to such agencies serving a high number1 as defined by the ,secretary1 of low-income1 uninsured1 or under-insured populations1 including medically underserved populations4 7,d7 ,fourth to such agencies1 as determined by the ,secretary1 based on the size of their nursing home population4 7,e7 ,fifth to any other such agencies4 7b7 ,special rules during ,,covid-#ai emergency period and other infectious disease outbreak periods 7#a7 ,medicare 7,a7 ,in general ,section #ahai7;g77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;g77#b77 is amended by adding at the end the following new subparagraph3 7,f7 ,,covid-#ai emergency period and other infectious disease outbreak periods 7i7 ,in general ,notwithstanding any other provision of this paragraph1 during an infectious disease outbreak period 7as defined in clause 7ii771 with respect to a ,state1 the following shall apply3 7,i7 ,each skilled nursing facility shall be subject to a standard survey under subparagraph 7,a7 not later than #d weeks after the beginning of such period and every #f months after the date of the previous standard survey conducted under such subparagraph4 7,,ii7 ,follow-up surveys under this paragraph shall be conducted based on if the skilled nursing facility is found to be-- 7aa7 a facility with substandard quality of care2 7bb7 a facility not in substantial compliance2 7cc7 a facility reporting less than three hours of direct care staff per resident per day2 7dd7 a facility that has reported no registered nurses for four or more days in a quarter2 or 7ee7 a facility with an overall score of #b or less stars on nursing home compare4 7,,iii7 ,in the case of a skilled nursing facility which is found under a standard survey or extended survey to be in substantial compliance1 ,state survey and certification agencies 7described in subsection 7f7 of section #aabh;,i7 shall have flexibility with regards to the timing of conducting such a follow-up standard survey4 7,,iv7 ,a skilled nursing facility which is found1 under a standard survey or extended survey1 to have provided substandard quality of care shall be treated as being identified by the ,secretary as having substantially failed to meet applicable requirement of this ,act for purposes of subsection 7f77#h74 7,v7 ,in the case of a skilled nursing facility that is subject to an extended survey under subparagraph 7,b71 such extended survey shall be conducted as soon as practical after the standard survey for such facility1 but not later than #d weeks after the date of completion of such standard survey4 7,,vi7 ,a skilled nursing facility which is found1 under a standard survey or extended survey to have provided substandard quality of care shall be surveyed at least once every #f months1 thereafter until the infectious disease outbreak period ends4 7,,vii7 ,surveys under this paragraph shall be conducted in a manner that prioritizes skilled nursing facilities located in towns 7or counties1 if municipal-level is not available7 with higher infection rate1 as identified by the ,secretary1 and facilities with previous violations of requirements of this ,act4 7,,viii7 ,any skilled nursing facility reporting 7as determined by the ,centers for ,medicare ,medicaid ,services7 fewer than three hours of direct care staff time per resident per day1 with hour of registered nurse time included or any skilled nursing facility that has reported no registered nurse for four or more days4 7ii7 ,infectious disease outbreak period defined ,for purposes of this subparagraph1 the term infectious disease outbreak period means any of the following periods3 7,i7 ,,covid-#ai emergency period ,the emergency period described in section #aace7;g77#a77;,b74 7,,ii7 ,other infectious disease outbreak periods 7aa7 ,the period beginning on the date a nationwide emergency related to a public health emergency is declared pursuant to the ,stafford ,act1 a ,major ,disaster ,declaration1 or the ,national ,emergencies ,act and ending on the date that is #f months after the date on which the declaration pursuant to the ,stafford ,act1 a ,major ,disaster ,declaration1 or the ,national ,emergencies ,act1 as applicable1 ends1 whichever is the latest4 7bb7 ,the period during which there exists a public health emergency related to an infectious disease outbreak declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act4 7cc7 ,with respect to a skilled nursing facility in a ,state with respect to which the ,governor has declared an emergency or major disaster 7as defined by the ,state7 with respect to an infectious disease outbreak1 the period for which such declaration is in effect with respect to such ,state4 4 7,b7 ,internet portal and hotline number ,section #ahai7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;e77 is amended by adding at the end the following new paragraph3 7#f7 ,internet portal and hotline number ,by not later than one year after the date of the enactment of this paragraph1 the ,state shall have in place and maintain an ,internet portal and hotline number 7which may be such a portal or hotline in existence before the date of the enactment of this paragraph7 for staff of nursing facilities1 residents of such facilities1 family of such residents1 the ,state long-term care ombudsman 7established under title ,,iii or ,,vii of the ,older ,americans ,act of #aife in accordance with section #gab of the ,act71 or the general public to report violations of requirements of this section by such facilities4 ,the ,secretary shall establish a process under which each violation so reported shall be preliminarily investigated by a ,state survey and certification agency 7described in subsection 7f7 of section #aabh;,i7 and based on the results of such preliminary investigation may be subject to a subsequent more comprehensive investigation by such agency1 in coordination with the ,secretary4 4 7,c7 ,increased penalties ,section #ahai7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;h77 is amended by adding at the end the following new paragraph3 7#g7 ,special rules during ,,covid-#ai emergency period and other infectious disease outbreak periods 7,a7 ,in general ,notwithstanding any other provision of this subsection1 during an infectious disease outbreak period 7as defined in subsection 7g77#b77;,f77ii771 with respect to a ,state1 the following shall apply3 7i7 ,in the cases of an outbreak specific violation1 a civil monetary penalty under paragraph 7#b77;,b77ii77,i7 may not be waived or reduced by the ,secretary4 7ii7 ,in the case of a repeat deficiency relating to any violation of a skilled nursing facility during a #ae-month period1 any civil monetary penalty under paragraph 7#b77;,b77ii77,i71 shall be doubled4 7iii7 ,in the case of a second outbreak specific violation of a skilled nursing facility during such period1 the facility shall be treated as being identified by the ,secretary 7or may be identified by the top ,state health official1 in accordance with a process specified by the ,secretary7 as having substantially failed to meet applicable requirement of this ,act for purposes of subsection 7f77#h7 for the remainder of such period4 7,b7 ,outbreak specific violation ,for purposes of this paragraph1 the ,secretary1 through the ,centers for ,medicare ,medicaid ,services1 shall develop the following3 7i7 ,in the case of an infectious disease outbreak period with respect to ,,covid-#ai1 criteria for determining an outbreak specific violation with respect to ,,covid-#ai1 including-- 7,i7 criteria specified by the ,centers for ,disease ,control and ,prevention relating to infection rates1 mortality rates1 and hospitalization rates2 and 7,,ii7 criteria for staff shortages1 overcrowding 7and ability to cohort71 and insufficient personal protective equipment4 7ii7 ,in the case of an infectious disease outbreak period other than with respect to ,,covid-#ai1 criteria for determining an outbreak specific violation specific to such outbreak period4 4 7,d7 ,reporting ,section #ahai7;d77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;d77#d77 is amended by adding at the end the following new subparagraph3 7,c7 ,,covid-#ai and ,infectious ,disease ,outbreak ,reporting and notification 7i7 ,in general ,a skilled nursing facility must1 with respect to an infectious disease outbreak period 7as defined in subsection 7g77#b77;,f77ii77-- 7,i7 electronically submit1 at a frequency specified by the ,secretary1 but no less than once weekly and in a standardized format specified by the ,secretary1 to the ,national ,healthcare ,safety ,network of the ,centers for ,disease ,control and ,prevention information on-- 7aa7 the number of suspected and confirmed cases among residents and staff of the facility1 of-- 7,,aa7 in the case of the period described in subclause 7,i7 of such section1 ,,covid-#ai 7including with respect to residents of the facility previously treated for ,,covid-#ai72 and 7,,bb7 in the case of the period described in subclause 7,,ii7 of such section1 the infectious disease that is the reason for which such period is declared 7including with respect to residents of the facility previously treated for such infectious disease72 7bb7 the number of deaths 7including residents who die outside the facility and deaths related to ,,covid-#ai or the infectious disease1 as applicable7 among residents and staff of the facility2 7cc7 the amount of personal protective equipment and hand hygiene supplies in the facility1 including how many days supply2 7dd7 ventilator capacity and related supplies in the facility2 7ee7 the number of resident beds at the facility and census2 7ff7 access to ,,covid-#ai or the infectious disease1 as applicable1 testing available in the facility for residents of the facility2 7gg7 any staffing shortages2 and 7hh7 any other information specified by the ,secretary2 and 7,,ii7 in the case of the occurrence at the facility of either a single confirmed infection of ,,covid-#ai or the infectious disease 7as applicable7 or of three or more residents or staff at the facility with new-onset of respiratory symptoms occurring within #gb hours of each other1 inform residents of the facility1 representatives of such residents1 and families of the residents of such occurrence by not later than #e p4m4 on the calendar day following such occurrence4 7ii7 ,information ,the information provided under clause 7ii77,,ii7 must-- 7,i7 not include personally identifiable information2 7,,ii7 include information on mitigating actions implemented to prevent or reduce the risk of transmission1 including if normal operations of the facility will be altered2 and 7,,iii7 include any cumulative updates for residents1 representatives1 and families at least weekly 7or1 in the case of a subsequent occurrence described in such clause 7ii77,,ii71 by not later than #e p4m4 on the calendar day following such subsequent occurrence74 7iii7 ,,cms posting ,the information submitted under clause 7ii77,i7 shall be publicly posted on a weekly basis by the ,centers for ,medicare ,medicaid ,service to support protecting the health and safety of residents1 personnel1 and the general public4 4 7#b7 ,medicaid 7,a7 ,in general ,section #aiai7;g77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7g77#b77 is amended by adding at the end the following new subparagraph3 7,f7 ,,covid-#ai emergency period and other infectious disease outbreak periods 7i7 ,in general ,notwithstanding any other provision of this paragraph1 during an infectious disease outbreak period 7as defined in clause 7ii771 with respect to a ,state1 the following shall apply3 7,i7 ,each nursing facility shall be subject to a standard survey under subparagraph 7,a7 not later than #d weeks after the beginning of such period and every #f months after the date of the previous standard survey conducted under such subparagraph4 7,,ii7 ,follow-up surveys under this paragraph shall be conducted based on if the skilled nursing facility is found to be-- 7aa7 a facility with substandard quality of care2 7bb7 a facility not in substantial compliance2 7cc7 a facility reporting less than three hours of direct care staff per resident per day2 7dd7 a facility that has reported no registered nurses for four or more days in a quarter2 or 7ee7 a facility with an overall score of #b or less stars on nursing home compare4 7,,iii7 ,in the case of a nursing facility which is found under a standard survey or extended survey to be in substantial compliance1 ,state survey and certification agencies 7described in subsection 7f7 of section #aabh;,i7 shall have flexibility with regards to the timing of conducting such a follow-up standard survey4 7,,iv7 ,a nursing facility which is found1 under a standard survey or extended survey1 to have provided substandard quality of care shall be treated as being identified by the ,secretary as having substantially failed to meet applicable requirement of this ,act for purposes of subsection 7f77#aj74 7,v7 ,in the case of a nursing facility that is subject to an extended survey under subparagraph 7,b71 such extended survey shall be conducted as soon as practical after the standard survey for such facility1 but not later than #d weeks after the date of completion of such standard survey4 7,,vi7 ,a nursing facility which is found1 under a standard survey or extended survey to have provided substandard quality of care shall be surveyed at least once every #f months1 thereafter until the infectious disease outbreak period ends4 7,,vii7 ,surveys under this paragraph shall be conducted in a manner that prioritizes nursing facilities located in towns 7or counties1 if municipal-level is not available7 with higher infection rate1 as identified by the ,secretary1 and facilities with previous violations of requirements of this ,act4 7,,viii7 ,any skilled nursing facility reporting 7as determined by the ,centers for ,medicare ,medicaid ,services7 fewer than three hours of direct care staff time per resident per day1 with hour of registered nurse time included or any skilled nursing facility that has reported no registered nurse for four or more days4 7ii7 ,infectious disease outbreak period defined ,for purposes of this subparagraph1 the term infectious disease outbreak period means any of the following periods3 7,i7 ,,covid-#ai emergency period ,the emergency period described in section #aace7;g77#a77;,b74 7,,ii7 ,other infectious disease outbreak periods 7aa7 ,the period beginning on the date a nationwide emergency related to a public health emergency is declared pursuant to the ,stafford ,act1 a ,major ,disaster ,declaration1 or the ,national ,emergencies ,act and ending on the date that is #f months after the date on which the declaration pursuant to the ,stafford ,act1 a ,major ,disaster ,declaration1 or the ,national ,emergencies ,act1 as applicable1 ends1 whichever is the latest4 7bb7 ,the period during which there exists a public health emergency related to an infectious disease outbreak declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act4 7cc7 ,with respect to a nursing facility in a ,state with respect to which the ,governor has declared an emergency or major disaster 7as defined by the ,state7 with respect to an infectious disease outbreak1 the period for which such declaration is in effect with respect to such ,state4 4 7,b7 ,internet portal and hotline number ,section #aiai7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7e77 is amended by adding at the end the following new paragraph3 7#i7 ,internet portal and hotline number ,by not later than one year after the date of the enactment of this paragraph1 the ,state shall have in place and maintain an ,internet portal and hotline number 7which may be such a portal or hotline in existence before the date of the enactment of this paragraph7 for staff of nursing facilities1 residents of such facilities1 family of such residents1 the ,state long-term care ombudsman 7established under title ,,iii or ,,vii of the ,older ,americans ,act of #aife in accordance with section #gab of the ,act71 or the general public to report violations of requirements of this section by such facilities4 ,the ,secretary shall establish a process under which each violation so reported shall be preliminarily investigated by a ,state survey and certification agency 7described in subsection 7f7 of section #aabh;,i7 and based on the results of such preliminary investigation may be subject to a subsequent more comprehensive investigation by such agency1 in coordination with the ,secretary4 4 7,c7 ,increased penalties ,section #aiai7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7h77 is amended by adding at the end the following new paragraph3 7#aj7 ,special rules during ,,covid-#ai emergency period and other infectious disease outbreak periods 7,a7 ,in general ,notwithstanding any other provision of this subsection1 during an infectious disease outbreak period 7as defined in subsection 7g77#b77;,f77ii771 with respect to a ,state1 the following shall apply3 7i7 ,in the cases of an outbreak specific violation1 a civil monetary penalty under paragraph 7#c77;,b77ii77,i7 may not be waived or reduced by the ,secretary4 7ii7 ,in the case of a repeat deficiency relating to any violation of a nursing facility during a #ae-month period1 any civil monetary penalty under paragraph 7#c77;,b77ii77,i7 shall be doubled4 7iii7 ,in the case of a second outbreak specific violation of a nursing facility during such period1 the facility shall be treated as being identified by the ,secretary 7or may be identified by the top ,state health official1 in accordance with a process specified by the ,secretary7 as having substantially failed to meet applicable requirement of this ,act for purposes of subsection 7f77#aj7 for the remainder of such period4 7,b7 ,outbreak specific violation ,for purposes of this paragraph1 the ,secretary1 through the ,centers for ,medicare ,medicaid ,services1 shall develop the following3 7i7 ,in the case of an infectious disease outbreak period with respect to ,,covid-#ai1 criteria for determining an outbreak specific violation with respect to ,,covid-#ai1 including-- 7,i7 ,criteria specified by the ,centers for ,disease ,control and ,prevention relating to infection rates1 mortality rates1 and hospitalization rates4 7,,ii7 ,criteria for staff shortages1 overcrowding 7and ability to cohort71 and insufficient personal protective equipment4 7ii7 ,in the case of an infectious disease outbreak period other than with respect to ,,covid-#ai1 criteria for determining an outbreak specific violation specific to such outbreak period4 4 7,d7 ,reporting ,section #aiai7;d77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7d77#d77 is amended by adding at the end the following new subparagraph3 7,c7 ,,covid-#ai and infectious disease outbreak reporting and notification 7i7 ,in general ,a nursing facility must1 with respect to an infectious disease outbreak period 7as defined in subsection 7g77#b77;,f77ii77-- 7,i7 electronically submit1 at a frequency specified by the ,secretary1 but no less than once weekly and in a standardized format specified by the ,secretary1 to the ,national ,healthcare ,safety ,network of the ,centers for ,disease ,control and ,prevention information on-- 7aa7 the number of suspected and confirmed cases among residents and staff of the facility1 of-- 7,,aa7 in the case of the period described in subclause 7,i7 of such section1 ,,covid-#ai 7including with respect to residents of the facility previously treated for ,,covid-#ai72 and 7,,bb7 in the case of the period described in subclause 7,,ii7 of such section1 the infectious disease that is the reason for which such period is declared 7including with respect to residents of the facility previously treated for such infectious disease72 7bb7 the number of deaths 7including residents who die outside the facility and deaths related to ,,covid-#ai or the infectious disease1 as applicable7 among residents and staff of the facility2 7cc7 the amount of personal protective equipment and hand hygiene supplies in the facility1 including how many days supply2 7dd7 ventilator capacity and related supplies in the facility2 7ee7 the number of resident beds at the facility and census2 7ff7 access to ,,covid-#ai or the infectious disease1 as applicable1 testing available in the facility for residents of the facility2 7gg7 any staffing shortages2 and 7hh7 any other information specified by the ,secretary2 and 7,,ii7 in the case of the occurrence at the facility of either a single confirmed infection of ,,covid-#ai or the infectious disease 7as applicable7 or of three or more residents or staff at the facility with new-onset of respiratory symptoms occurring within #gb hours of each other1 inform residents of the facility1 representatives of such residents1 and families of the residents of such occurrence by not later than #e p4m4 on the calendar day following such occurrence4 7ii7 ,information ,the information provided under clause 7ii77,,ii7 must-- 7,i7 not include personally identifiable information2 7,,ii7 include information on mitigating actions implemented to prevent or reduce the risk of transmission1 including if normal operations of the facility will be altered2 and 7,,iii7 include any cumulative updates for residents1 representatives1 and families at least weekly 7or1 in the case of a subsequent occurrence described in such clause 7ii77,,ii71 by not later than #e p4m4 on the calendar day following such subsequent occurrence74 7iii7 ,,cms posting ,the information submitted under clause 7ii77,i7 shall be publicly posted on a weekly basis by the ,centers for ,medicare ,medicaid ,service to support protecting the health and safety of residents1 personnel1 and the general public 4