,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #hegd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,octob] #i1 #bjbj,ms4 
,%]rill 7= h]self1 ,mr4 ,pascrell1 ,mrs4
 ,watson ,coleman1 ,mr4 ,sires1 ,mr4    
,bey]1 ,mr4 ,payne1 ,mr4 ,doggett1 ,ms4 
,%alala1 ,ms4 ,judy ,*u ( ,cali=nia1 &  
,mr4 ,kildee7 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 increase en=cem5t "u ,m$ic>e &  
,m$icaid = skill$ nurs+ facilities &    
nurs+ facilities dur+ ! ,,covid-#ai     
em]g5cy p]iod & o!r infecti\s disease   
outbreak p]iods1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,protect+ ,resid5ts ) ,ov]sight1        
,transp>5cy1 & ,en=cem5t =              
,compassionate ,treatm5t 9 ,long ,t]m   

,c>e ,facilities ,act or ! ,,protect    
,long ,t]m ,c>e ,facilities ,act4  #b4  
,increas$ en=cem5t "u ,m$ic>e & ,m$icaid
 = skill$ nurs+ facilities & nurs+      
facilities dur+ ! ,,covid-#ai em]g5cy   
p]iod & o!r infecti\s disease outbreak  
p]iods  7a7 ,additional fund+ to ,/ate  
survey ag5cies  7#a7 ,appropriations    
,out ( any funds 9 ! ,treasury n o!rwise
 appropriat$1 !re is appropriat$ to !   
,secret>y ( ,heal? & ,human ,s]vices    
#ajj1jjj1jjj = fiscal ye> #bjba to be   
provid$1 9 addition to any funds o!rwise
 made available & 9 accordance )        
p>agraph 7#b71 to ,/ate survey &        
c]tification ag5cies 7describ$ 9        
subsection 7f7 ( section #aabh;,i ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;j77 = ! foll[+ purposes3 7,a7
 ,to complete surveys conduct$ pursuant 
to ! am5dm5ts made by subsection 7b7 =  
facilities 7z def9$ 9 subsection 7a7 (  
su* section #aabh;,i74  7,b7 ,to        
increase inve/igations & surveys p]=m$  
pursuant to sections #aiai7;g77#d7 ( su*

 ,act 7#db ,u4,s4,c4 #acifr7g77#b77 &   
#ahai7;g77#d7 ( su* ,act 7#db ,u4,s4,c4 
#acie;i-#c7;g77#d77 bas$ on crit]ia     
develop$ pursuant to p>agraph 7#g77;,b7 
( section #ahai7;h7 ( su* ,act1 z add$  
by subsection 7b77#a77;,c71 & p>agraph  
7#aj77;,b7 ( section #aiai7;h7 ( su*    
,act1 z add$ by subsection 7b77#b77;,c74
  7,c7 ,to pur*ase p]sonal protective   
equipm5t = surveyors to conduct surveys 
& inve/igations ( facilities 7z def9$ 9 
subsection 7a7 ( su* section #aabh;,i7  
to ensure work] safety4  7,d7 ,to       
increase /aff+ levels at su* ,/ate      
survey & c]tification ag5cies4  7#b7    
,allocation ( fund+ ,! ,secret>y %all   
allocate funds appropriat$ "u p>agraph  
7#a7 bas$ on ! foll[+ prioritization3   
7,a7 ,fir/ to ,/ate survey &            
c]tification ag5cies 7z describ$ 9      
subsection 7f7 ( su* section #aabh;,i7  
s]v+ populations ) a high burd51 z def9$
 by ! ,secret>y ( ,heal? & ,human       
,s]vices1 ( ,,covid-#ai4  7,b7 ,second  
to su* ag5cies prep>+ =1 or work+ to    

mitigate1 a ,,covid-#ai surge or any    
simil> infecti\s disease outbreak4  7,c7
 ,?ird to su* ag5cies s]v+ a high numb]1
 z def9$ by ! ,secret>y1 ( l[-income1   
un9sur$1 or "u-insur$ populations1      
includ+ m$ically und]s]v$ populations4  
7,d7 ,f\r? to su* ag5cies1 z det]m9$ by 
! ,secret>y1 bas$ on ! size ( _! nurs+  
home population4  7,e7 ,fif? to any o!r 
su* ag5cies4  7b7 ,special rules dur+   
,,covid-#ai em]g5cy p]iod & o!r         
infecti\s disease outbreak p]iods  7#a7 
,m$ic>e  7,a7 ,9 g5]al ,section         
#ahai7;g77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#c7;g77#b77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 ,,covid-#ai em]g5cy  
p]iod & o!r infecti\s disease outbreak  
p]iods  7i7 ,9 g5]al ,not)/&+ any o!r   
provision ( ?is p>agraph1 dur+ an       
infecti\s disease outbreak p]iod 7z     
def9$ 9 clause 7ii771 ) respect to a    
,/ate1 ! foll[+ %all apply3 7,i7 ,ea*   
skill$ nurs+ facility %all be subject to
 a /&>d survey "u subp>agraph 7,a7 n    

lat] ?an #d weeks aft] ! beg9n+ ( su*   
p]iod & e #f mon?s aft] ! date ( !      
previ\s /&>d survey conduct$ "u su*     
subp>agraph4  7,,ii7 ,foll[-up surveys  
"u ?is p>agraph %all be conduct$ bas$ on
 if ! skill$ nurs+ facility is f\nd to  
be-- 7aa7 a facility ) sub/&>d quality (
 c>e2  7bb7 a facility n 9 sub/antial   
compliance2  7cc7 a facility report+    
less ?an ?ree h\rs ( direct c>e /aff p] 
resid5t p] day2  7dd7 a facility t has  
report$ no regi/]$ nurses = f\r or m    
days 9 a qu>t]2 or  7ee7 a facility ) an
 ov]all score ( #b or less />s on nurs+ 
home comp>e4  7,,iii7 ,9 ! case ( a     
skill$ nurs+ facility :i* is f\nd "u a  
/&>d survey or ext5d$ survey to be 9    
sub/antial compliance1 ,/ate survey &   
c]tification ag5cies 7describ$ 9        
subsection 7f7 ( section #aabh;,i7 %all 
h flexibility ) reg>ds to ! tim+ (      
conduct+ su* a foll[-up /&>d survey4    
7,,iv7 ,a skill$ nurs+ facility :i* is  
f\nd1 "u a /&>d survey or ext5d$ survey1
 to h provid$ sub/&>d quality ( c>e %all

 be treat$ z be+ id5tifi$ by ! ,secret>y
 z hav+ sub/antially fail$ to meet      
applicable requirem5t ( ?is ,act =      
purposes ( subsection 7f77#h74  7,v7 ,9 
! case ( a skill$ nurs+ facility t is   
subject to an ext5d$ survey "u          
subp>agraph 7,b71 su* ext5d$ survey %all
 be conduct$ z soon z practical aft] !  
/&>d survey = su* facility1 b n lat] ?an
 #d weeks aft] ! date ( completion ( su*
 /&>d survey4  7,,vi7 ,a skill$ nurs+   
facility :i* is f\nd1 "u a /&>d survey  
or ext5d$ survey to h provid$ sub/&>d   
quality ( c>e %all be survey$ at lea/   
once e #f mon?s1 !reaft] until !        
infecti\s disease outbreak p]iod ends4  
7,,vii7 ,surveys "u ?is p>agraph %all be
 conduct$ 9 a mann] t prioritizes skill$
 nurs+ facilities locat$ 9 t[ns 7or     
c\nties1 if municipal-level is n        
available7 ) high] infection rate1 z    
id5tifi$ by ! ,secret>y1 & facilities ) 
previ\s violations ( requirem5ts ( ?is  
,act4  7,,viii7 ,any skill$ nurs+       
facility report+ 7z det]m9$ by ! ,c5t]s 

= ,m$ic>e  ,m$icaid ,s]vices7 few] ?an  
?ree h\rs ( direct c>e /aff "t p]       
resid5t p] day1 )  h\r ( regi/]$ nurse  
"t includ$ or any skill$ nurs+ facility 
t has report$ no regi/]$ nurse = f\r or 
m days4  7ii7 ,infecti\s disease        
outbreak p]iod def9$ ,= purposes ( ?is  
subp>agraph1 ! t]m infecti\s disease    
outbreak p]iod means any ( ! foll[+     
p]iods3 7,i7 ,,covid-#ai em]g5cy p]iod  
,! em]g5cy p]iod describ$ 9 section     
#aace7;g77#a77;,b74  7,,ii7 ,o!r        
infecti\s disease outbreak p]iods  7aa7 
,! p]iod beg9n+ on ! date a nationwide  
em]g5cy relat$ to a public heal? em]g5cy
 is decl>$ pursuant to ! ,/af=d ,act1 a 
,major ,disa/] ,decl>ation1 or !        
,national ,em]g5cies ,act & end+ on !   
date t is #f mon?s aft] ! date on :i* ! 
decl>ation pursuant to ! ,/af=d ,act1 a 
,major ,disa/] ,decl>ation1 or !        
,national ,em]g5cies ,act1 z applicable1
 ends1 :i*ev] is ! late/4  7bb7 ,! p]iod
 dur+ :i* !re exi/s a public heal?      
em]g5cy relat$ to an infecti\s disease  

outbreak decl>$ by ! ,secret>y pursuant 
to section #cai ( ! ,public ,heal?      
,s]vice ,act4  7cc7 ,) respect to a     
skill$ nurs+ facility 9 a ,/ate )       
respect to :i* ! ,gov]nor has decl>$ an 
em]g5cy or major disa/] 7z def9$ by !   
,/ate7 ) respect to an infecti\s disease
 outbreak1 ! p]iod = :i* su* decl>ation 
is 9 effect ) respect to su* ,/ate4  4  
7,b7 ,int]net portal & hotl9e numb]     
,section #ahai7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;i-#c7;e77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#f7 ,int]net portal & hotl9e
 numb] ,by n lat] ?an "o ye> aft] ! date
 ( ! enactm5t ( ?is p>agraph1 ! ,/ate   
%all h 9 place & ma9ta9 an ,int]net     
portal & hotl9e numb] 7:i* may be su* a 
portal or hotl9e 9 exi/5ce be=e ! date (
 ! enactm5t ( ?is p>agraph7 = /aff (    
nurs+ facilities1 resid5ts ( su*        
facilities1 family ( su* resid5ts1 !    
,/ate long-t]m c>e ombudsman 7e/abli%$  
"u title ,,iii or ,,vii ( ! ,old]       
,am]icans ,act ( #aife 9 accordance )   

section #gab ( ! ,act71 or ! g5]al      
public to report violations (           
requirem5ts ( ?is section by su*        
facilities4 ,! ,secret>y %all e/abli% a 
process "u :i* ea* violation s report$  
%all be prelim9>ily inve/igat$ by a     
,/ate survey & c]tification ag5cy       
7describ$ 9 subsection 7f7 ( section    
#aabh;,i7 & bas$ on ! results ( su*     
prelim9>y inve/igation may be subject to
 a subsequ5t m compreh5sive inve/igation
 by su* ag5cy1 9 coord9ation ) !        
,secret>y4  4  7,c7 ,increas$ p5alties  
,section #ahai7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;i-#c7;h77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#g7 ,special rules dur+     
,,covid-#ai em]g5cy p]iod & o!r         
infecti\s disease outbreak p]iods  7,a7 
,9 g5]al ,not)/&+ any o!r provision (   
?is subsection1 dur+ an infecti\s       
disease outbreak p]iod 7z def9$ 9       
subsection 7g77#b77;,f77ii771 ) respect 
to a ,/ate1 ! foll[+ %all apply3 7i7 ,9 
! cases ( an outbreak specific          

violation1 a civil monet>y p5alty "u    
p>agraph 7#b77;,b77ii77,i7 may n be     
waiv$ or r$uc$ by ! ,secret>y4  7ii7 ,9 
! case ( a repeat defici5cy relat+ to   
any violation ( a skill$ nurs+ facility 
dur+ a #ae-mon? p]iod1 any civil monet>y
 p5alty "u p>agraph 7#b77;,b77ii77,i71  
%all be d\bl$4  7iii7 ,9 ! case ( a     
second outbreak specific violation ( a  
skill$ nurs+ facility dur+ su* p]iod1 ! 
facility %all be treat$ z be+ id5tifi$  
by ! ,secret>y 7or may be id5tifi$ by ! 
top ,/ate heal? (ficial1 9 accordance ) 
a process specifi$ by ! ,secret>y7 z    
hav+ sub/antially fail$ to meet         
applicable requirem5t ( ?is ,act =      
purposes ( subsection 7f77#h7 = !       
rema9d] ( su* p]iod4  7,b7 ,outbreak    
specific violation ,= purposes ( ?is    
p>agraph1 ! ,secret>y1 ?r\gh ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices1 %all develop
 ! foll[+3 7i7 ,9 ! case ( an infecti\s 
disease outbreak p]iod ) respect to     
,,covid-#ai1 crit]ia = det]m9+ an       
outbreak specific violation ) respect to

 ,,covid-#ai1 includ+-- 7,i7 crit]ia    
specifi$ by ! ,c5t]s = ,disease ,control
 & ,prev5tion relat+ to infection rates1
 mortality rates1 & hospitalization     
rates2 &  7,,ii7 crit]ia = /aff         
%ortages1 ov]cr[d+ 7& ability to        
cohort71 & insuffici5t p]sonal          
protective equipm5t4  7ii7 ,9 ! case (  
an infecti\s disease outbreak p]iod o!r 
?an ) respect to ,,covid-#ai1 crit]ia = 
det]m9+ an outbreak specific violation  
specific to su* outbreak p]iod4  4  7,d7
 ,report+ ,section #ahai7;d77#d7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;d77#d77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,c7   
,,covid-#ai & ,infecti\s ,disease       
,outbreak ,report+ & notification  7i7  
,9 g5]al ,a skill$ nurs+ facility mu/1 )
 respect to an infecti\s disease        
outbreak p]iod 7z def9$ 9 subsection    
7g77#b77;,f77ii77-- 7,i7 electronically 
submit1 at a frequ5cy specifi$ by !     
,secret>y1 b no less ?an once weekly & 9
 a /&>diz$ =mat specifi$ by ! ,secret>y1

 to ! ,national ,heal?c>e ,safety       
,network ( ! ,c5t]s = ,disease ,control 
& ,prev5tion in=mation on-- 7aa7 ! numb]
 ( suspect$ & confirm$ cases among      
resid5ts & /aff ( ! facility1 (-- 7,,aa7
 9 ! case ( ! p]iod describ$ 9 subclause
 7,i7 ( su* section1 ,,covid-#ai        
7includ+ ) respect to resid5ts ( !      
facility previ\sly treat$ =             
,,covid-#ai72 & 7,,bb7 9 ! case ( !     
p]iod describ$ 9 subclause 7,,ii7 ( su* 
section1 ! infecti\s disease t is !     
reason = :i* su* p]iod is decl>$        
7includ+ ) respect to resid5ts ( !      
facility previ\sly treat$ = su*         
infecti\s disease72  7bb7 ! numb] (     
dea?s 7includ+ resid5ts :o die outside !
 facility & dea?s relat$ to ,,covid-#ai 
or ! infecti\s disease1 z applicable7   
among resid5ts & /aff ( ! facility2     
7cc7 ! am\nt ( p]sonal protective       
equipm5t & h& hygi5e supplies 9 !       
facility1 includ+ h[ _m days supply2    
7dd7 v5tilator capacity & relat$        
supplies 9 ! facility2  7ee7 ! numb] (  

resid5t b$s at ! facility & c5sus2  7ff7
 access to ,,covid-#ai or ! infecti\s   
disease1 z applicable1 te/+ available 9 
! facility = resid5ts ( ! facility2     
7gg7 any /aff+ %ortages2 &  7hh7 any o!r
 in=mation specifi$ by ! ,secret>y2 &   
7,,ii7 9 ! case ( ! occurr5ce at !      
facility ( ei!r a s+le confirm$         
infection ( ,,covid-#ai or ! infecti\s  
disease 7z applicable7 or ( ?ree or m   
resid5ts or /aff at ! facility )        
new-onset ( respiratory symptoms occurr+
 )9 #gb h\rs ( ea* o!r1 in=m resid5ts ( 
! facility1 repres5tatives ( su*        
resid5ts1 & families ( ! resid5ts ( su* 
occurr5ce by n lat] ?an #e p4m4 on !    
cal5d> day foll[+ su* occurr5ce4  7ii7  
,in=mation ,! in=mation provid$ "u      
clause 7ii77,,ii7 mu/-- 7,i7 n include  
p]sonally id5tifiable in=mation2  7,,ii7
 include in=mation on mitigat+ actions  
implem5t$ to prev5t or r$uce ! risk (   
transmission1 includ+ if normal         
op]ations ( ! facility w be alt]$2 &    
7,,iii7 include any cumulative updates =

 resid5ts1 repres5tatives1 & families at
 lea/ weekly 7or1 9 ! case ( a subsequ5t
 occurr5ce describ$ 9 su* clause        
7ii77,,ii71 by n lat] ?an #e p4m4 on !  
cal5d> day foll[+ su* subsequ5t         
occurr5ce74  7iii7 ,,cms po/+ ,!        
in=mation submitt$ "u clause 7ii77,i7   
%all be publicly po/$ on a weekly basis 
by ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vice 
to support protect+ ! heal? & safety (  
resid5ts1 p]sonnel1 & ! g5]al public4  4
  7#b7 ,m$icaid  7,a7 ,9 g5]al ,section 
#aiai7;g77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr7g77#b77 is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,f7 ,,covid-#ai em]g5cy  
p]iod & o!r infecti\s disease outbreak  
p]iods  7i7 ,9 g5]al ,not)/&+ any o!r   
provision ( ?is p>agraph1 dur+ an       
infecti\s disease outbreak p]iod 7z     
def9$ 9 clause 7ii771 ) respect to a    
,/ate1 ! foll[+ %all apply3 7,i7 ,ea*   
nurs+ facility %all be subject to a /&>d
 survey "u subp>agraph 7,a7 n lat] ?an  
#d weeks aft] ! beg9n+ ( su* p]iod & e  

#f mon?s aft] ! date ( ! previ\s /&>d   
survey conduct$ "u su* subp>agraph4     
7,,ii7 ,foll[-up surveys "u ?is p>agraph
 %all be conduct$ bas$ on if ! skill$   
nurs+ facility is f\nd to be-- 7aa7 a   
facility ) sub/&>d quality ( c>e2  7bb7 
a facility n 9 sub/antial compliance2   
7cc7 a facility report+ less ?an ?ree   
h\rs ( direct c>e /aff p] resid5t p]    
day2  7dd7 a facility t has report$ no  
regi/]$ nurses = f\r or m days 9 a      
qu>t]2 or  7ee7 a facility ) an ov]all  
score ( #b or less />s on nurs+ home    
comp>e4  7,,iii7 ,9 ! case ( a nurs+    
facility :i* is f\nd "u a /&>d survey or
 ext5d$ survey to be 9 sub/antial       
compliance1 ,/ate survey & c]tification 
ag5cies 7describ$ 9 subsection 7f7 (    
section #aabh;,i7 %all h flexibility )  
reg>ds to ! tim+ ( conduct+ su* a       
foll[-up /&>d survey4  7,,iv7 ,a nurs+  
facility :i* is f\nd1 "u a /&>d survey  
or ext5d$ survey1 to h provid$ sub/&>d  
quality ( c>e %all be treat$ z be+      
id5tifi$ by ! ,secret>y z hav+          

sub/antially fail$ to meet applicable   
requirem5t ( ?is ,act = purposes (      
subsection 7f77#aj74  7,v7 ,9 ! case ( a
 nurs+ facility t is subject to an      
ext5d$ survey "u subp>agraph 7,b71 su*  
ext5d$ survey %all be conduct$ z soon z 
practical aft] ! /&>d survey = su*      
facility1 b n lat] ?an #d weeks aft] !  
date ( completion ( su* /&>d survey4    
7,,vi7 ,a nurs+ facility :i* is f\nd1 "u
 a /&>d survey or ext5d$ survey to h    
provid$ sub/&>d quality ( c>e %all be   
survey$ at lea/ once e #f mon?s1 !reaft]
 until ! infecti\s disease outbreak     
p]iod ends4  7,,vii7 ,surveys "u ?is    
p>agraph %all be conduct$ 9 a mann] t   
prioritizes nurs+ facilities locat$ 9   
t[ns 7or c\nties1 if municipal-level is 
n available7 ) high] infection rate1 z  
id5tifi$ by ! ,secret>y1 & facilities ) 
previ\s violations ( requirem5ts ( ?is  
,act4  7,,viii7 ,any skill$ nurs+       
facility report+ 7z det]m9$ by ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices7 few] ?an  
?ree h\rs ( direct c>e /aff "t p]       

resid5t p] day1 )  h\r ( regi/]$ nurse  
"t includ$ or any skill$ nurs+ facility 
t has report$ no regi/]$ nurse = f\r or 
m days4  7ii7 ,infecti\s disease        
outbreak p]iod def9$ ,= purposes ( ?is  
subp>agraph1 ! t]m infecti\s disease    
outbreak p]iod means any ( ! foll[+     
p]iods3 7,i7 ,,covid-#ai em]g5cy p]iod  
,! em]g5cy p]iod describ$ 9 section     
#aace7;g77#a77;,b74  7,,ii7 ,o!r        
infecti\s disease outbreak p]iods  7aa7 
,! p]iod beg9n+ on ! date a nationwide  
em]g5cy relat$ to a public heal? em]g5cy
 is decl>$ pursuant to ! ,/af=d ,act1 a 
,major ,disa/] ,decl>ation1 or !        
,national ,em]g5cies ,act & end+ on !   
date t is #f mon?s aft] ! date on :i* ! 
decl>ation pursuant to ! ,/af=d ,act1 a 
,major ,disa/] ,decl>ation1 or !        
,national ,em]g5cies ,act1 z applicable1
 ends1 :i*ev] is ! late/4  7bb7 ,! p]iod
 dur+ :i* !re exi/s a public heal?      
em]g5cy relat$ to an infecti\s disease  
outbreak decl>$ by ! ,secret>y pursuant 
to section #cai ( ! ,public ,heal?      

,s]vice ,act4  7cc7 ,) respect to a     
nurs+ facility 9 a ,/ate ) respect to   
:i* ! ,gov]nor has decl>$ an em]g5cy or 
major disa/] 7z def9$ by ! ,/ate7 )     
respect to an infecti\s disease         
outbreak1 ! p]iod = :i* su* decl>ation  
is 9 effect ) respect to su* ,/ate4  4  
7,b7 ,int]net portal & hotl9e numb]     
,section #aiai7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7e77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#i7 ,int]net portal & hotl9e numb]   
,by n lat] ?an "o ye> aft] ! date ( !   
enactm5t ( ?is p>agraph1 ! ,/ate %all h 
9 place & ma9ta9 an ,int]net portal &   
hotl9e numb] 7:i* may be su* a portal or
 hotl9e 9 exi/5ce be=e ! date ( !       
enactm5t ( ?is p>agraph7 = /aff ( nurs+ 
facilities1 resid5ts ( su* facilities1  
family ( su* resid5ts1 ! ,/ate long-t]m 
c>e ombudsman 7e/abli%$ "u title ,,iii  
or ,,vii ( ! ,old] ,am]icans ,act (     
#aife 9 accordance ) section #gab ( !   
,act71 or ! g5]al public to report      
violations ( requirem5ts ( ?is section  

by su* facilities4 ,! ,secret>y %all    
e/abli% a process "u :i* ea* violation s
 report$ %all be prelim9>ily inve/igat$ 
by a ,/ate survey & c]tification ag5cy  
7describ$ 9 subsection 7f7 ( section    
#aabh;,i7 & bas$ on ! results ( su*     
prelim9>y inve/igation may be subject to
 a subsequ5t m compreh5sive inve/igation
 by su* ag5cy1 9 coord9ation ) !        
,secret>y4  4  7,c7 ,increas$ p5alties  
,section #aiai7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7h77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#aj7 ,special rules dur+ ,,covid-#ai 
em]g5cy p]iod & o!r infecti\s disease   
outbreak p]iods  7,a7 ,9 g5]al ,not)/&+ 
any o!r provision ( ?is subsection1 dur+
 an infecti\s disease outbreak p]iod 7z 
def9$ 9 subsection 7g77#b77;,f77ii771 ) 
respect to a ,/ate1 ! foll[+ %all apply3
 7i7 ,9 ! cases ( an outbreak specific  
violation1 a civil monet>y p5alty "u    
p>agraph 7#c77;,b77ii77,i7 may n be     
waiv$ or r$uc$ by ! ,secret>y4  7ii7 ,9 
! case ( a repeat defici5cy relat+ to   

any violation ( a nurs+ facility dur+ a 
#ae-mon? p]iod1 any civil monet>y p5alty
 "u p>agraph 7#c77;,b77ii77,i7 %all be  
d\bl$4  7iii7 ,9 ! case ( a second      
outbreak specific violation ( a nurs+   
facility dur+ su* p]iod1 ! facility %all
 be treat$ z be+ id5tifi$ by ! ,secret>y
 7or may be id5tifi$ by ! top ,/ate     
heal? (ficial1 9 accordance ) a process 
specifi$ by ! ,secret>y7 z hav+         
sub/antially fail$ to meet applicable   
requirem5t ( ?is ,act = purposes (      
subsection 7f77#aj7 = ! rema9d] ( su*   
p]iod4  7,b7 ,outbreak specific         
violation ,= purposes ( ?is p>agraph1 ! 
,secret>y1 ?r\gh ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices1 %all develop !       
foll[+3 7i7 ,9 ! case ( an infecti\s    
disease outbreak p]iod ) respect to     
,,covid-#ai1 crit]ia = det]m9+ an       
outbreak specific violation ) respect to
 ,,covid-#ai1 includ+-- 7,i7 ,crit]ia   
specifi$ by ! ,c5t]s = ,disease ,control
 & ,prev5tion relat+ to infection rates1
 mortality rates1 & hospitalization     

rates4  7,,ii7 ,crit]ia = /aff %ortages1
 ov]cr[d+ 7& ability to cohort71 &      
insuffici5t p]sonal protective equipm5t4
  7ii7 ,9 ! case ( an infecti\s disease 
outbreak p]iod o!r ?an ) respect to     
,,covid-#ai1 crit]ia = det]m9+ an       
outbreak specific violation specific to 
su* outbreak p]iod4  4  7,d7 ,report+   
,section #aiai7;d77#d7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acifr7d77#d77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3  7,c7        
,,covid-#ai & infecti\s disease outbreak
 report+ & notification  7i7 ,9 g5]al ,a
 nurs+ facility mu/1 ) respect to an    
infecti\s disease outbreak p]iod 7z     
def9$ 9 subsection 7g77#b77;,f77ii77--  
7,i7 electronically submit1 at a        
frequ5cy specifi$ by ! ,secret>y1 b no  
less ?an once weekly & 9 a /&>diz$ =mat 
specifi$ by ! ,secret>y1 to ! ,national 
,heal?c>e ,safety ,network ( ! ,c5t]s = 
,disease ,control & ,prev5tion in=mation
 on-- 7aa7 ! numb] ( suspect$ & confirm$
 cases among resid5ts & /aff ( !        

facility1 (-- 7,,aa7 9 ! case ( ! p]iod 
describ$ 9 subclause 7,i7 ( su* section1
 ,,covid-#ai 7includ+ ) respect to      
resid5ts ( ! facility previ\sly treat$ =
 ,,covid-#ai72 & 7,,bb7 9 ! case ( !    
p]iod describ$ 9 subclause 7,,ii7 ( su* 
section1 ! infecti\s disease t is !     
reason = :i* su* p]iod is decl>$        
7includ+ ) respect to resid5ts ( !      
facility previ\sly treat$ = su*         
infecti\s disease72  7bb7 ! numb] (     
dea?s 7includ+ resid5ts :o die outside !
 facility & dea?s relat$ to ,,covid-#ai 
or ! infecti\s disease1 z applicable7   
among resid5ts & /aff ( ! facility2     
7cc7 ! am\nt ( p]sonal protective       
equipm5t & h& hygi5e supplies 9 !       
facility1 includ+ h[ _m days supply2    
7dd7 v5tilator capacity & relat$        
supplies 9 ! facility2  7ee7 ! numb] (  
resid5t b$s at ! facility & c5sus2  7ff7
 access to ,,covid-#ai or ! infecti\s   
disease1 z applicable1 te/+ available 9 
! facility = resid5ts ( ! facility2     
7gg7 any /aff+ %ortages2 &  7hh7 any o!r

 in=mation specifi$ by ! ,secret>y2 &   
7,,ii7 9 ! case ( ! occurr5ce at !      
facility ( ei!r a s+le confirm$         
infection ( ,,covid-#ai or ! infecti\s  
disease 7z applicable7 or ( ?ree or m   
resid5ts or /aff at ! facility )        
new-onset ( respiratory symptoms occurr+
 )9 #gb h\rs ( ea* o!r1 in=m resid5ts ( 
! facility1 repres5tatives ( su*        
resid5ts1 & families ( ! resid5ts ( su* 
occurr5ce by n lat] ?an #e p4m4 on !    
cal5d> day foll[+ su* occurr5ce4  7ii7  
,in=mation ,! in=mation provid$ "u      
clause 7ii77,,ii7 mu/-- 7,i7 n include  
p]sonally id5tifiable in=mation2  7,,ii7
 include in=mation on mitigat+ actions  
implem5t$ to prev5t or r$uce ! risk (   
transmission1 includ+ if normal         
op]ations ( ! facility w be alt]$2 &    
7,,iii7 include any cumulative updates =
 resid5ts1 repres5tatives1 & families at
 lea/ weekly 7or1 9 ! case ( a subsequ5t
 occurr5ce describ$ 9 su* clause        
7ii77,,ii71 by n lat] ?an #e p4m4 on !  
cal5d> day foll[+ su* subsequ5t         

occurr5ce74  7iii7 ,,cms po/+ ,!        
in=mation submitt$ "u clause 7ii77,i7   
%all be publicly po/$ on a weekly basis 
by ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vice 
to support protect+ ! heal? & safety (  
resid5ts1 p]sonnel1 & ! g5]al public  4