,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #biic  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #e1 #bjai,mr4 
,w>n] 7= himself & ,mr4 ,scott ( ,s\?   
,c>ol9a7 introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,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 !   
,ensur+ ,s5iors' ,access to ,quality    
,c>e ,act4  #b4 ,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 %all1 9 consultation ) su*    
,/ate1 disapprove1 = a p]iod n to exce$ 
#b ye>s1 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 skill$ nurs+ facility 
t--  7,i7 all defici5cies = :i* ! civil 
monet>y p5alty describ$ 9 clause 7i77,i7
 0 assess$ h be5 rem$i$2  7,,ii7 !      
facility has n receiv$ defici5cies      
relat$ to direct pati5t h>m = sub/&>d   
quality ( c>e defici5cies 9 ! prior #b  
ye>s2 &  7,,iii7 ! ,secret>y c]tifies t 
! civil monet>y p5alty assess$ "u clause
 7i77,i7 did n result 9 imm$iate jeop>dy
 = direct pati5t h>m or injury relat$ to
 an abuse or neglect defici5cy4  ,=     
purposes ( resc9d+ disapproval "u ?is   
clause1 ! ,secret>y may require         
additional ov]sight ( ! skill$ nurs+    
facility = a p]iod n to exce$ ! p]iod ( 
disapproval impos$ "u clause 7i7 )      
respect to su* facility4  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 %all1 9 consultation ) su*    
,/ate1 disapprove1 = a p]iod n to exce$ 
#b ye>s1 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$4  7ii7 ,rescission (   
disapproval ,! ,secret>y %all resc9d a  
disapproval "u clause 7i7 ^u            
demon/ration by a nurs+ facility t--    
7,i7 all defici5cies = :i* ! civil      
monet>y p5alty describ$ 9 clause 7i77,i7
 0 assess$ h be5 rem$i$2  7,,ii7 !      
facility has n receiv$ defici5cies      
relat$ to direct pati5t h>m = sub/&>d   
quality ( c>e defici5cies 9 ! prior #b  
ye>s2 &  7,,iii7 ! ,secret>y c]tifies t 
! civil monet>y p5alty assess$ "u clause
 7i77,i7 did n result 9 imm$iate jeop>dy
 = direct pati5t h>m or injury relat$ to
 an abuse or neglect defici5cy4  ,=     
purposes ( resc9d+ disapproval "u ?is   
clause1 ! ,secret>y may require         
additional ov]sight ( ! nurs+ facility =
 a p]iod n to exce$ ! p]iod (           
disapproval impos$ "u clause 7i7 )      

respect to su* facility4  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 skill$
 nurs+ facility or a nurs+ 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 skill$ nurs+     
facility or a nurs+ 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 skill$ nurs+ facility or
 a nurs+ 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  #c4 ,p]mitt+ ,m$ic>e &    
,m$icaid provid]s to access ! ,national 
,practition] ,data ,bank to conduct     
employee backgr\nd *ecks ,section       
#aiba7;b77#f7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#b7;b77#f77 is   
am5d$-- 7#a7 by /rik+ & o!r heal? c>e   
entities 7z def9$ 9 section #dca ( !    
,heal? ,c>e ,quality ,improvem5t ,act ( 
#aihf7 & ins]t+ 1 o!r heal? c>e entities
 7z def9$ 9 section #dca ( ! ,heal? ,c>e
 ,quality ,improvem5t ,act ( #aihf71    
provid]s ( s]vices 7z def9$ 9 section   
#ahfa7u771 suppli]s 7z def9$ 9 section  
#ahfa7;d771 & provid]s ( items or       
s]vices "u a ,/ate plan "u ?is title 7or
 a waiv] ( su* a plan72 &  7#b7 by /rik+
 su* hospitals or o!r heal? c>e entities
 & ins]t+ su* hospitals1 heal? c>e      
entities1 provid]s1 or suppli]s4