,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #eih  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #bh1 #bjba,ms4
 ,s*ak[sky 7= h]self & ,mr4 ,takano7    
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 to improve !
 quality ( c>e 9 skill$ nurs+ facilities
 "u ! ,m$ic>e program & nurs+ facilities
 "u ! ,m$ic>e program dur+ ! ,,covid-#ai
 em]g5cy p]iod1 & = o!r purposes4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,quality ,c>e = ,nurs+ ,home ,resid5ts &
 ,work]s ,dur+ ,,covid-#ai & ,beyond    
,act4  ,i ,address+ ,,covid-#ai  #aja4  
,improv+ quality ( c>e 9 skill$ nurs+   
facilities & nurs+ facilities dur+      
,,covid-#ai em]g5cy p]iod  7a7 ,m$ic>e  
,section #ahai ( ! ,social ,security    

,act 7#db ,u4,s4,c4 #acie;i-#c7 is am5d$
 by add+ at ! end ! foll[+ new          
subsection3  7k7 ,additional requirem5ts
 dur+ c]ta9 public heal? em]g5cy  7#a7  
,skill$ nurs+ facilities  7,a7 ,9 g5]al 
,dur+ ! portion ( ! em]g5cy p]iod def9$ 
9 p>agraph 7#a77;,b7 ( section #aace7;g7
 beg9n+ on or aft] ! date ( ! enactm5t (
 ?is subsection1 a skill$ nurs+ facility
 %all comply ) ! quality ( c>e          
requirem5ts describ$ 9 subp>agraph 7,b71
 ! work] safety requirem5ts describ$ 9  
subp>agraph 7,c71 & ! transp>5cy        
requirem5ts describ$ 9 subp>agraph 7,d74
  7,b7 ,quality ( c>e requirem5ts ,!    
quality ( c>e requirem5ts describ$ 9 ?is
 subp>agraph are ea* ( ! foll[+3 7i7    
,employ1 on a full-"t basis1 an onsite  
infection prev5tioni/ :o-- 7,i7 has     
prim>y pr(essional tra9+ 9 nurs+1 m$ical
 te*nology1 microbiology1 epidemiology1 
or o!r relat$ field2  7,,ii7 is qualifi$
 by education1 tra9+1 exp]i5ce or       
c]tification2 &  7,,iii7 has complet$   
specializ$ tra9+ 9 infection prev5tion &

 control4  7ii7 ,9 ! case ( a resid5t :o
 elects to reside ) a family memb] ( su*
 resid5t = any portion ( ! em]g5cy p]iod
 describ$ 9 subp>agraph 7,a71 gu>antee !
 "r ( su* resid5t to resume resid5cy 9 !
 facility at any "t dur+ ! #ahj-;day    
p]iod imm$iately foll[+ ! end ( su*     
em]g5cy p]iod4  7iii7 ,not)/&+          
subp>agraphs 7,a7 & 7,b7 ( subsection   
7c77#b71 p]mit a resid5t to rema9 9 !   
facility & n dis*>ge or transf] !       
resid5t f ! facility unless-- 7,i7 !    
,/ate survey ag5cy approves ! dis*>ge or
 transf]2  7,,ii7 9 ! case ( a transf]1 
! transf] is to a facility d$icat$ to ! 
c>e ( resid5ts :o h be5 diagnos$ )      
,,covid-#ai if ! resid5t has be5        
diagnos$ ) ,,covid-#ai1 or a facility   
d$icat$ to ! c>e ( resid5ts :o h n be5  
diagnos$ ) ,,covid-#ai if ! resid5t has 
n be5 diagnos$ ) ,,covid-#ai2  7,,iii7  
be=e effect+ ! dis*>ge or transf]1 !    
facility records ! reasons 9 ! resid5t's
 cl9ical record2  7,,iv7 at lea/ #gb    
h\rs 9 advance ( ! dis*>ge or transf]1 !

 facility provides a notice ( ! dis*>ge 
or transf] to ! resid5t 7or legal       
repres5tative ( ! resid5t1 if           
applicable71 includ+ ! reasons !re= & ! 
items describ$ 9 clause 7iii7 (         
subsection 7c77#b77;,b72 &  7,v7 !      
resid5t 7or legal repres5tative ( !     
resid5t1 if applicable7 ackn[l$ges      
receipt ( ! notice describ$ 9 subclause 
7,,iv7 & provides writt5 cons5t to !    
dis*>ge or transf]4  7iv7 ,te/ 7on a    
weekly basis7 ea* resid5t = ,,covid-#ai1
 or1 9 ! case t ! facility does n h a   
suffici5t numb] ( te/+ kits =           
,,covid-#ai1 scre5 ea* resid5t =        
symptoms ( ,,covid-#ai & report 7on a   
daily basis until ! facility has a      
suffici5t numb] ( su* te/+ kits7 to !   
,/ate survey ag5cy t ! facility does n h
 a suffici5t numb] ( su* te/+ kits & :at
 /eps ! facility is tak+ to procure a   
suffici5t numb] ( su* te/+ kits4  7v7   
,ensure !re is an adequate numb] (      
employees to assi/ resid5ts 9           
communicat+ ) family memb]s & fri5ds    

?r\gh phone calls1 e-mail1 & virtual    
communications on at lea/ a weekly      
basis1 )\t reg>d to :e!r a resid5t has  
be5 diagnos$ ) ,,covid-#ai4  7,c7 ,work]
 safety requirem5ts ,! work] safety     
requirem5ts describ$ 9 ?is subp>agraph  
are ea* ( ! foll[+3 7i7 ,9 ! case !     
facility is n o!rwise subject to !      
,occupational ,safety & ,heal? ,act (   
#aigj 7or a ,/ate occupational safety & 
heal? plan t is approv$ "u section      
#ah7;c7 ( su* ,act71 comply ) !         
,bloodborne ,pa?og5s /&>d "u section    
#aiaj4ajcj ( title #bi1 ,code ( ,f$]al  
,regulations 7or a successor            
regulation74  7ii7 ,9 ! case ( a pr$ict$
 %ortage ( p]sonal protective equipm5t1 
report su* pr$ict$ %ortage to ! ,/ate   
heal? dep>tm5t ( ! ,/ate 9 :i* !        
facility is locat$ at lea/ #bd h\rs 9   
advance ( :5 su* pr$ict$ %ortage is     
expect$ to occur4  7iii7 ,educate ea*   
employee on ! transmission (            
,,covid-#ai4  7iv7 ,not)/&+ any o!r     
provision ( law1 provide at lea/ two    

weeks ( paid sick leave to ea* employee4
  7v7 ,be=e ea* employee's %ift1 te/ !  
employee = ,,covid-#ai1 or1 9 ! case t !
 facility does n h a suffici5t numb] (  
te/+ kits = ,,covid-#ai1 scre5 ea*      
employee = symptoms ( ,,covid-#ai &     
report 7on a daily basis until !        
facility has a suffici5t numb] ( su*    
te/+ kits7 to ! ,/ate survey ag5cy t !  
facility does n h a suffici5t numb] (   
su* te/+ kits & :at /eps ! facility is  
tak+ to procure a suffici5t numb] ( su* 
te/+ kits4  7,d7 ,transp>5cy requirem5ts
 ,! transp>5cy requirem5ts describ$ 9   
?is subp>agraph are ea* ( ! foll[+3 7i7 
,report 7on a daily basis7 to ! ,/ate   
survey ag5cy1 ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices1 & ! ,c5t]s = ,disease
 ,control & ,prev5tion ea* ( ! foll[+3  
7,i7 ,! numb] ( confirm$ & suspect$     
cases ( ,,covid-#ai among resid5ts &    
/aff1 includ+ ! age & race or e?nicity (
 su* resid5ts & /aff4  7,,ii7 ,! numb] (
 dea?s relat$ to ,,covid-#ai among      
resid5ts & /aff1 includ+ ! age & race or

 e?nicity ( su* resid5ts & /aff4        
7,,iii7 ,! total numb] ( dea?s 7)\t     
reg>d to :e!r a dea? is relat$ to       
,,covid-#ai7 among resid5ts & /aff4     
7,,iv7 ,! am\nt ( p]sonal protective    
equipm5t available & any project$ ne$   
reg>d+ su* equipm5t4  7,v7 ,in=mation on
 /aff+ levels t w\ld o!rwise be requir$ 
to be submitt$ ?r\gh ! ,payroll-,bas$   
,j\rnal ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices4  7,,vi7 ,! numb] ( resid5ts & 
/aff :o h be5 te/$ = ,,covid-#ai4  7ii7 
,9 ! case t a resid5t or employee is    
diagnos$ ) ,,covid-#ai or dies z a      
result ( ,,covid-#ai1 notify all        
resid5ts1 legal repres5tatives (        
resid5ts1 & employees n lat] ?an #ab    
h\rs aft] su* diagnosis is made or su*  
dea? occurs4  7iii7 ,at any "t ?ree or m
 resid5ts or employees h newly onset    
,,covid-#ai symptoms1 notify all        
resid5ts1 legal repres5tatives (        
resid5ts1 & employees n lat] ?an #gb    
h\rs aft] su* ?ree or m resid5ts or     
employees are kn[n to ! facility4  7iv7 

,9 ! case t a resid5t or employee is    
suspect$ to h or is diagnos$ )          
,,covid-#ai1 po/ a notice ( su*         
suspicion or diagnosis at ea* entrance (
 ! facility = ! rema9+ portion ( !      
em]g5cy p]iod describ$ 9 subp>agraph    
7,a74  7v7 ,= ea* day ( ! portion ( !   
em]g5cy p]iod describ$ 9 subp>agraph    
7,a71 po/ a notice at ea* entrance ( !  
facility ) ! in=mation requir$ "u       
subsection 7b77#h7 = su* day4  7#b7     
,/ates & ,f$]al ,gov]nm5t  7,a7 ,public 
availability ( in=mation  7i7 ,9 g5]al  
,z soon z possible1 b n lat] ?an #bd    
h\rs aft] receiv+ any in=mation requir$ 
"u p>agraph 7#a77;,d77i71 ! ,adm9i/rator
 ( ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices1 9 coord9ation ) ! ,director ( 
! ,c5t]s = ,disease ,control &          
,prev5tion1 %all make su* in=mation     
publicly available on ! ,nurs+ ,home    
,comp>e website ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices & ! ,c,o,v,i,d,view   
website ( ! ,c5t]s = ,disease ,control &
 ,prev5tion4  7ii7 ,,hipaa compliant    

in=mation only ,in=mation may only be   
made publicly available "u clause 7i7 if
 ! disclosure ( su* in=mation w\ld      
o!rwise be p]mitt$ "u ! ,f$]al          
regulations 7conc]n+ ! privacy (        
individually id5tifiable heal?          
in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif 7#db ,u4,s4,c4 #acbj;d-#b note74  
7,b7 ,designation ( ,,covid-#ai         
facilities ,= purposes ( p>agraph       
7#a77;,b77iii77,,ii7-- 7i7 !            
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all specify crit]ia  
7:i* %all include ! provision ( !       
s]vices ( a regi/]$ nurse on a #bd-;h\r 
basis7 = ea* ,/ate survey ag5cy to c>ry 
out ! designation requirem5t describ$ 9 
clause 7ii7 ) respect to skill$ nurs+   
facilities2 &  7ii7 ea* ,/ate survey    
ag5cy %all designate a skill$ nurs+     
facility 9 ! ,/ate z a facility d$icat$ 
to ! c>e ( resid5ts :o h be5 diagnos$ ) 
,,covid-#ai if su* facility meets !     

crit]ia specifi$ by ! ,adm9i/rator "u   
clause 7i74  7,c7 ,monitor+ & surveys ,a
 ,/ate survey ag5cy %all-- 7i7 provide  
onsite monitor+ 7or1 if onsite monitor+ 
is n feasible1 remote monitor+7 ( all   
skill$ nurs+ facilities ) at lea/ "o    
resid5t or employee :o has be5 diagnos$ 
) ,,covid-#ai2  7ii7 9 addition to      
surveys requir$ "u subsection 7g71      
conduct a survey ( a skill$ nurs+       
facility1 9 ! same mann] & subject to ! 
same requirem5ts applicable to /&>d     
surveys conduct$ "u subsection 7g71 if !
 facility has a ratio ( ! numb] ( dea?s 
result+ f ,,covid-#ai to ! numb] (      
,,covid-#ai diagnoses t exce$s #e p]c5t1
 or ! ,/ate survey ag5cy receives a     
,,covid-#ai or /aff+ relat$ imm$iate    
jeop>dy compla9t reg>d+ ! facility2 &   
7iii7 ensure t ea* survey team t        
conducts a survey "u clause 7ii7 has    
adequate p]sonal protective equipm5t    
:ile conduct+ su* survey4  7#c7 ,civil  
money p5alties ,! ,secret>y %all impose 
a civil money p5alty aga9/ ! op]ators ( 

a skill$ nurs+ facility 9 an am\nt equal
 to #aj1jjj p] day = ea* violation ( a  
requirem5t describ$ 9 subp>agraph 7,b71 
7,c71 or 7,d7 ( p>agraph 7#a7 or !      
report+ ( false in=mation "u clause 7i7 
( su* subp>agraph 7,d74 ,! provisions ( 
section #aabh;,a 7o!r ?an subsections   
7a7 & 7b77 %all apply to a civil money  
p5alty "u ! previ\s s5t5ce 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a7a74  4  
7b7 ,m$icaid ,section #aiai ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acifr7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7k7 ,additional requirem5ts
 dur+ c]ta9 public heal? em]g5cy  7#a7  
,nurs+ facilities  7,a7 ,9 g5]al ,dur+ !
 portion ( ! em]g5cy p]iod def9$ 9      
p>agraph 7#a77;,b7 ( section #aace7;g7  
beg9n+ on or aft] ! date ( ! enactm5t ( 
?is subsection1 a nurs+ facility %all   
comply ) ! quality ( c>e requirem5ts    
describ$ 9 subp>agraph 7,b71 ! work]    
safety requirem5ts describ$ 9           
subp>agraph 7,c71 & ! transp>5cy        

requirem5ts describ$ 9 subp>agraph 7,d74
  7,b7 ,quality ( c>e requirem5ts ,!    
quality ( c>e requirem5ts describ$ 9 ?is
 subp>agraph are ea* ( ! foll[+3 7i7    
,employ1 on a full-"t basis1 an onsite  
infection prev5tioni/ :o-- 7,i7 has     
prim>y pr(essional tra9+ 9 nurs+1 m$ical
 te*nology1 microbiology1 epidemiology1 
or o!r relat$ field2  7,,ii7 is qualifi$
 by education1 tra9+1 exp]i5ce or       
c]tification2 &  7,,iii7 has complet$   
specializ$ tra9+ 9 infection prev5tion &
 control4  7ii7 ,9 ! case ( a resid5t :o
 elects to reside ) a family memb] ( su*
 resid5t = any portion ( ! em]g5cy p]iod
 describ$ 9 subp>agraph 7,a71 gu>antee !
 "r ( su* resid5t to resume resid5cy 9 !
 facility at any "t dur+ ! #ahj-;day    
p]iod imm$iately foll[+ ! end ( su*     
em]g5cy p]iod4  7iii7 ,not)/&+          
subp>agraphs 7,a7 & 7,b7 ( subsection   
7c77#b71 p]mit a resid5t to rema9 9 !   
facility & n dis*>ge or transf] !       
resid5t f ! facility unless-- 7,i7 !    
,/ate survey ag5cy approves ! dis*>ge or

 transf]2  7,,ii7 9 ! case ( a transf]1 
! transf] is to a facility d$icat$ to ! 
c>e ( resid5ts :o h be5 diagnos$ )      
,,covid-#ai if ! resid5t has be5        
diagnos$ ) ,,covid-#ai1 or a facility   
d$icat$ to ! c>e ( resid5ts :o h n be5  
diagnos$ ) ,,covid-#ai if ! resid5t has 
n be5 diagnos$ ) ,,covid-#ai2  7,,iii7  
be=e effect+ ! dis*>ge or transf]1 !    
facility records ! reasons 9 ! resid5t's
 cl9ical record2  7,,iv7 at lea/ #gb    
h\rs 9 advance ( ! dis*>ge or transf]1 !
 facility provides a notice ( ! dis*>ge 
or transf] to ! resid5t 7or legal       
repres5tative ( ! resid5t1 if           
applicable71 includ+ ! reasons !re= & ! 
items describ$ 9 clause 7iii7 (         
subsection 7c77#b77;,b72 &  7,v7 !      
resid5t 7or legal repres5tative ( !     
resid5t1 if applicable7 ackn[l$ges      
receipt ( ! notice describ$ 9 subclause 
7,,iv7 & provides writt5 cons5t to !    
dis*>ge or transf]4  7iv7 ,te/ 7on a    
weekly basis7 ea* resid5t = ,,covid-#ai1
 or1 9 ! case t ! facility does n h a   

suffici5t numb] ( te/+ kits =           
,,covid-#ai1 scre5 ea* resid5t =        
symptoms ( ,,covid-#ai & report 7on a   
daily basis until ! facility has a      
suffici5t numb] ( su* te/+ kits7 to !   
,/ate survey ag5cy t ! facility does n h
 a suffici5t numb] ( su* te/+ kits & :at
 /eps ! facility is tak+ to procure a   
suffici5t numb] ( su* te/+ kits4  7v7   
,ensure !re is an adequate numb] (      
employees to assi/ resid5ts 9           
communicat+ ) family memb]s & fri5ds    
?r\gh phone calls1 e-mail1 & virtual    
communications on at lea/ a weekly      
basis1 )\t reg>d to :e!r a resid5t has  
be5 diagnos$ ) ,,covid-#ai4  7,c7 ,work]
 safety requirem5ts ,! work] safety     
requirem5ts describ$ 9 ?is subp>agraph  
are ea* ( ! foll[+3 7i7 ,9 ! case !     
facility is n o!rwise subject to !      
,occupational ,safety & ,heal? ,act (   
#aigj 7or a ,/ate occupational safety & 
heal? plan t is approv$ "u section      
#ah7;c7 ( su* ,act71 comply ) !         
,bloodborne ,pa?og5s /&>d "u section    

#aiaj4ajcj ( title #bi1 ,code ( ,f$]al  
,regulations 7or a successor            
regulation74  7ii7 ,9 ! case ( a pr$ict$
 %ortage ( p]sonal protective equipm5t1 
report su* pr$ict$ %ortage to ! ,/ate   
heal? dep>tm5t ( ! ,/ate 9 :i* !        
facility is locat$ at lea/ #bd h\rs 9   
advance ( :5 su* pr$ict$ %ortage is     
expect$ to occur4  7iii7 ,educate ea*   
employee on ! transmission (            
,,covid-#ai4  7iv7 ,not)/&+ any o!r     
provision ( law1 provide at lea/ two    
weeks ( paid sick leave to ea* employee4
  7v7 ,be=e ea* employee's %ift1 te/ !  
employee = ,,covid-#ai1 or1 9 ! case t !
 facility does n h a suffici5t numb] (  
te/+ kits = ,,covid-#ai1 scre5 ea*      
employee = symptoms ( ,,covid-#ai &     
report 7on a daily basis until !        
facility has a suffici5t numb] ( su*    
te/+ kits7 to ! ,/ate survey ag5cy t !  
facility does n h a suffici5t numb] (   
su* te/+ kits & :at /eps ! facility is  
tak+ to procure a suffici5t numb] ( su* 
te/+ kits4  7,d7 ,transp>5cy requirem5ts

 ,! transp>5cy requirem5ts describ$ 9   
?is subp>agraph are ea* ( ! foll[+3 7i7 
,report 7on a daily basis7 to ! ,/ate   
survey ag5cy1 ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices1 & ! ,c5t]s = ,disease
 ,control & ,prev5tion ea* ( ! foll[+3  
7,i7 ,! numb] ( confirm$ & suspect$     
cases ( ,,covid-#ai among resid5ts &    
/aff1 includ+ ! age & race or e?nicity (
 su* resid5ts & /aff4  7,,ii7 ,! numb] (
 dea?s relat$ to ,,covid-#ai among      
resid5ts & /aff1 includ+ ! age & race or
 e?nicity ( su* resid5ts & /aff4        
7,,iii7 ,! total numb] ( dea?s 7)\t     
reg>d to :e!r a dea? is relat$ to       
,,covid-#ai7 among resid5ts & /aff4     
7,,iv7 ,! am\nt ( p]sonal protective    
equipm5t available & any project$ ne$   
reg>d+ su* equipm5t4  7,v7 ,in=mation on
 /aff+ levels t w\ld o!rwise be requir$ 
to be submitt$ ?r\gh ! ,payroll-,bas$   
,j\rnal ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices4  7,,vi7 ,! numb] ( resid5ts & 
/aff :o h be5 te/$ = ,,covid-#ai4  7ii7 
,9 ! case t a resid5t or employee is    

diagnos$ ) ,,covid-#ai or dies z a      
result ( ,,covid-#ai1 notify all        
resid5ts1 legal repres5tatives (        
resid5ts1 & employees n lat] ?an #ab    
h\rs aft] su* diagnosis is made or su*  
dea? occurs4  7iii7 ,at any "t ?ree or m
 resid5ts or employees h newly onset    
,,covid-#ai symptoms1 notify all        
resid5ts1 legal repres5tatives (        
resid5ts1 & employees n lat] ?an #gb    
h\rs aft] su* ?ree or m resid5ts or     
employees are kn[n to ! facility4  7iv7 
,9 ! case t a resid5t or employee is    
suspect$ to h or is diagnos$ )          
,,covid-#ai1 po/ a notice ( su*         
suspicion or diagnosis at ea* entrance (
 ! facility = ! rema9+ portion ( !      
em]g5cy p]iod describ$ 9 subp>agraph    
7,a74  7v7 ,= ea* day ( ! portion ( !   
em]g5cy p]iod describ$ 9 subp>agraph    
7,a71 po/ a notice at ea* entrance ( !  
facility ) ! in=mation requir$ "u       
subsection 7b77#h7 = su* day4  7#b7     
,/ates & ,f$]al ,gov]nm5t  7,a7 ,public 
availability ( in=mation  7i7 ,9 g5]al  

,z soon z possible1 b n lat] ?an #bd    
h\rs aft] receiv+ any in=mation requir$ 
"u p>agraph 7#a77;,d77i71 ! ,adm9i/rator
 ( ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices1 9 coord9ation ) ! ,director ( 
! ,c5t]s = ,disease ,control &          
,prev5tion1 %all make su* in=mation     
publicly available on ! ,nurs+ ,home    
,comp>e website ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices & ! ,c,o,v,i,d,view   
website ( ! ,c5t]s = ,disease ,control &
 ,prev5tion4  7ii7 ,,hipaa compliant    
in=mation only ,in=mation may only be   
made publicly available "u clause 7i7 if
 ! disclosure ( su* in=mation w\ld      
o!rwise be p]mitt$ "u ! ,f$]al          
regulations 7conc]n+ ! privacy (        
individually id5tifiable heal?          
in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif 7#db ,u4,s4,c4 #acbj;d-#b note74  
7,b7 ,designation ( ,,covid-#ai         
facilities ,= purposes ( p>agraph       
7#a77;,b77iii77,,ii7-- 7i7 !            

,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all specify crit]ia  
7:i* %all include ! provision ( !       
s]vices ( a regi/]$ nurse on a #bd-;h\r 
basis7 = ea* ,/ate survey ag5cy to c>ry 
out ! designation requirem5t describ$ 9 
clause 7ii7 ) respect to nurs+          
facilities2 &  7ii7 ea* ,/ate survey    
ag5cy %all designate a nurs+ facility 9 
! ,/ate z a facility d$icat$ to ! c>e ( 
resid5ts :o h be5 diagnos$ ) ,,covid-#ai
 if su* facility meets ! crit]ia        
specifi$ by ! ,adm9i/rator "u clause    
7i74  7,c7 ,monitor+ & surveys ,a ,/ate 
survey ag5cy %all-- 7i7 provide onsite  
monitor+ 7or1 if onsite monitor+ is     
impractical1 remote monitor+7 ( all     
nurs+ facilities ) at lea/ "o resid5t or
 employee :o has be5 diagnos$ )         
,,covid-#ai2  7ii7 9 addition to surveys
 requir$ "u subsection 7g71 conduct a   
survey ( a nurs+ facility1 9 ! same     
mann] & subject to ! same requirem5ts   
applicable to /&>d surveys conduct$ "u  
subsection 7g71 if ! facility has a     

ratio ( ! numb] ( dea?s result+ f       
,,covid-#ai to ! numb] ( ,,covid-#ai    
diagnoses t exce$s #e p]c5t1 or ! ,/ate 
survey ag5cy receives a ,,covid-#ai or  
/aff+ relat$ imm$iate jeop>dy compla9t  
reg>d+ ! facility2 &  7iii7 ensure t ea*
 survey team t conducts a survey "u     
clause 7ii7 has adequate p]sonal        
protective equipm5t :ile conduct+ su*   
survey4  7#c7 ,civil money p5alties ,!  
,secret>y %all impose a civil money     
p5alty aga9/ ! op]ators ( a nurs+       
facility 9 an am\nt equal to #aj1jjj p] 
day = ea* violation ( a requirem5t      
describ$ 9 subp>agraph 7,b71 7,c71 or   
7,d7 ( p>agraph 7#a7 or ! report+ (     
false in=mation "u clause 7i7 ( su*     
subp>agraph 7,d74 ,! provisions (       
section #aabh;,a 7o!r ?an subsections   
7a7 & 7b77 %all apply to a civil money  
p5alty "u ! previ\s s5t5ce 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a7a74  4  
#ajb4 ,fund+ = ,/ate /rike teams =      
resid5t & employee safety 9 skill$ nurs+

 facilities & nurs+ facilities  7a7 ,9  
g5]al ,( ! am\nts made available "u     
subsection 7c71 ! ,secret>y ( ,heal? &  
,human ,s]vices 7ref]r$ to 9 ?is section
 z ! ,secret>y7 %all allocate su* am\nts
 among ! ,/ates1 9 a mann] t takes into 
acc\nt ! p]c5tage ( skill$ nurs+        
facilities & nurs+ facilities 9 ea*     
,/ate t h resid5ts or employees :o h be5
 diagnos$ ) ,,covid-#ai1 = purposes (   
e/abli%+ & implem5t+ /rike teams 9      
accordance ) subsection 7b74  7b7 ,use (
 funds ,a ,/ate t receives funds "u ?is 
section %all use su* funds to e/abli% & 
implem5t a /rike team t w be deploy$ to 
a skill$ nurs+ facility or nurs+        
facility 9 ! ,/ate1 n lat] ?an #gb h\rs 
aft] ?ree or m resid5ts or employees ( !
 facility are diagnos$ ) or suspect$ (  
hav+ ,,covid-#ai1 to assi/ ! facility 9 
sep>at+ resid5ts & employees :o h be5   
expos$ to ,,covid-#ai f ^? resid5ts &   
employees :o h n be5 s expos$1 sup]vis+ 
te/+ = ,,covid-#ai1 ensur+ any          
applicable :i/lebl[] protections are be+

 en=c$1 & su* o!r ne$s z det]m9$        
necess>y by ! /rike team4 ,su* /rike    
team %all include memb]s ( ! ,national  
,gu>d1 public heal? (ficials f ,/ate &  
local heal? dep>tm5ts1 exp]ts 9         
g]iatrics & long-t]m c>e m$ic9e1        
repres5tatives ( resid5ts or consum]s1 &
 repres5tatives ( work]s4  7c7          
,au?orization ( appropriations ,=       
purposes ( c>ry+ out ?is section1 !re is
 au?oriz$ to be appropriat$             
#ejj1jjj1jjj4  7d7 ,def9itions ,9 ?is   
section3 7#a7 ,nurs+ facility ,! t]m    
nurs+ facility means a nurs+ facility "u
 ! ,m$icaid program "u title ,,xix ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  7#b7 ,skill$ nurs+     
facility ,! t]m skill$ nurs+ facility   
means a skill$ nurs+ facility "u !      
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq474  #ajc4 ,re9/itution (   
requirem5ts waiv$ = skill$ nurs+        
facilities & nurs+ facilities dur+      
,,covid-#ai em]g5cy p]iod  7a7 ,9 g5]al 

,) respect to requirem5ts t !           
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices 7ref]r$ to 9 ?is      
section z ! ,adm9i/rator7 waiv$ = skill$
 nurs+ facilities & nurs+ facilities "u 
section #aace or #ahab7;f7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#e1 #acie;d7f77 = ! p]iod beg9n+
 on ,m>* #a1 #bjbj1 & end+ on ! la/ day 
( ! em]g5cy p]iod def9$ 9 subsection    
7g77#a77;,b7 ( su* section #aace1 !     
,adm9i/rator %all t]m9ate ! waiv] ( su* 
requirem5ts be=e ! la/ day ( su* em]g5cy
 p]iod ^u ! det]m9ation t skill$ nurs+  
facilities & nurs+ facilities h !       
capacity to comply ) su* requirem5ts & t
 su* waiv] is no long] necess>y4  7b7   
,plan = conduct+ waiv$ or po/pon$       
surveys ,) respect to any survey "u     
section #ahai7;g7 or #aiai7;g7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;g71 #acifr7g77 t is waiv$ or
 po/pon$ dur+ ! p]iod beg9n+ on ,m>* #a1
 #bjbj1 & end+ on ! la/ day ( ! em]g5cy 
p]iod describ$ 9 subsection 7a71 !      

,adm9i/rator %all develop a plan =      
conduct+ su* survey aft] su* la/ day4   
7c7 ,tra9+ & c]tification ( nurse aides 
,) respect to any nurse aide ) respect  
to :om ! ,adm9i/rator waiv$ !           
application ( ! requirem5ts "u section  
#dhc4ce7;d7 ( title #db1 ,code ( ,f$]al 
,regulations1 = ! p]iod beg9n+ on ,m>*  
#a1 #bjbj1 & end+ on ! la/ day ( !      
em]g5cy p]iod describ$ 9 subsection 7a71
 ! ,adm9i/rator %all prohibit ! skill$  
nurs+ facility or nurs+ facility employ+
 su* nurse aide f reta9+ su* nurse aide 
aft] su* la/ day unless su* nurse aide  
satisfies applicable tra9+ &            
c]tification requirem5ts "u su* section 
n lat] ?an #cj days aft] su* la/ day4 ,!
 ,adm9i/rator %all enc\rage skill$ nurs+
 facilities & nurs+ facilities to make  
available applicable tra9+s to su* aides
 to satisfy su* requirem5ts & provide   
su* res\rces z ! ,adm9i/rator det]m9es  
appropriate to su* skill$ nurs+         
facilities & nurs+ facilities 9 ord] to 
facilitate ! provision ( su* tra9+s4    

7d7 ,def9itions ,9 ?is section3 7#a7    
,nurs+ facility ,! t]m nurs+ facility   
means a nurs+ facility "u ! ,m$icaid    
program "u title ,,xix ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif et  
seq474  7#b7 ,skill$ nurs+ facility ,!  
t]m skill$ nurs+ facility means a skill$
 nurs+ facility "u ! ,m$ic>e program "u 
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq474  #ajd4  
,guidance = c]ta9 resid5tial c>e        
facilities dur+ ,,covid-#ai em]g5cy     
p]iod ,n lat] ?an #ae days aft] ! date (
 ! enactm5t ( ?is ,act1 ! ,secret>y (   
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is section z ! ,secret>y7 %all issue   
guidance = long-t]m heal? c>e           
facilities1 includ+ assi/$ liv+         
facilities1 o!r resid5tial c>e          
facilities1 & su* facilities t are      
tempor>y dur+ ! em]g5cy p]iod def9$ 9   
section #aace7;g77#a77;,b7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#e7;g77#a77;,b771 t are n       
subject to ov]sight by ! ,c5t]s =       

,m$ic>e  ,m$icaid ,s]vices on provid+   
access to virtual visitation dur+ any   
portion ( su* em]g5cy p]iod 9 :i*       
9-p]son visitation is re/rict$ & ensur+ 
appropriate infection control &         
prev5tion & employee safety dur+ su*    
em]g5cy p]iod4 ,su* guidance %all       
include-- 7#a7 /eps t heal? c>e         
facilities describ$ 9 ?is subsection    
%\ld take to provide resid5ts ) access  
to virtual visitation1 includ+ ?r\gh !  
pur*ase or in/allation ( devices pur*as$
 = ! use or b5efit ( individual or      
multiple resid5ts1 t all[s resid5ts to  
communicate ) _! families dur+ su*      
em]g5cy p]iod2  7#b7 options = su*      
facilities 9 notify+ resid5ts & resid5t 
repres5tatives ( su* access to virtual  
visitation & h[ ! facility is address+  
any op]ational issues relat$ to su*     
access to virtual visitation2 &  7#c7   
/eps t heal? c>e facilities describ$ 9  
?is subsection %\ld take to provide     
resid5ts & employees ) appropriate      
infection control & prev5tion1 bas$ on  

requirem5ts = skill$ nurs+ facilities "u
 subsection 7k7 ( section #ahai ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c71 z add$ by section #b7;a71 &
 requirem5ts = nurs+ facilities "u      
subsection 7k7 ( section #aiai ( su*    
,act 7#db ,u4,s4,c4 #acifr71 z add$ by  
section #b7;b74  ,,ii ,/aff+ & ,safety  
#bja4 ,m9imum nurse /aff+ requirem5ts = 
skill$ nurs+ facilities "u ,m$ic>e      
program & nurs+ facilities "u ,m$icaid  
program  7a7 ,m$ic>e  7#a7 ,9 g5]al     
,subp>agraph 7,c7 ( section             
#ahai7;b77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#c7;b77#d77 is  
am5d$-- 7,a7 9 clause 7i7-- 7i7 by am5d+
 ! clause head+ to read z foll[s3 ,g5]al
 requirem5ts be=e #bjbc2 &  7ii7 by     
/rik+ ,except z provid$ 9 clause 7ii71 &
 ins]t+ ,except z provid$ 9 clause      
7iii71 ) respect to skill$ nurs+        
facility s]vices provid$ be=e ,janu>y   
#a1 #bjbc12  7,b7 by r$esignat+ clause  
7ii7 z clause 7iii72 &  7,c7 by ins]t+  
aft] clause 7i7 ! foll[+ new clause3    

7ii7 ,g5]al requirem5ts aft] #bjbb  7,i7
 ,9 g5]al ,) respect to skill$ nurs+    
facility s]vices provid$ on or aft]     
,janu>y #a1 #bjbc1 a skill$ nurs+       
facility mu/-- 7aa7 provide nurs+       
s]vices t are suffici5t to meet ! nurs+ 
ne$s ( its resid5ts on a #bd-;h\r basis1
 to be divid$ into day %ifts1 ev5+      
%ifts1 & night %ifts2  7bb7 provide =   
m9imum nurse /aff+ levels ) respect to  
ea* su* %ift1 9 accordance ) ?is clause2
 &  7cc7 ensure t1 9 c>ry+ out items    
7aa7 & 7bb71 a total m9imum ( #d4a h\rs 
( c>e is provid$ p] resid5t p] day1 )   
#j4ge h\rs ( c>e ( su* total m9imum     
provid$ by a regi/]$ pr(essional nurse1 
#j4ed h\rs ( c>e ( su* total m9imum     
provid$ by a lic5s$ practical nurse1 &  
#b4ha h\rs ( c>e ( su* total m9imum     
provid$ by a nurse aide 7z def9$ 9      
p>agraph 7#e77;,f774  7,,ii7 ,day %ifts 
,) respect to a day %ift1 ! skill$ nurs+
 facility mu/ h-- 7aa7 at lea/ #a       
regi/]$ pr(essional nurse = e #bh       
resid5ts1 ) a m9imum ( #j4bi h\rs ( c>e 

provid$ p] resid5t dur+ ea* su* %ift2   
7bb7 at lea/ #a lic5s$ practical nurse =
 e #dj resid5ts1 ) a m9imum ( #j4bj h\rs
 ( c>e provid$ p] resid5t dur+ ea* su*  
%ift2 &  7cc7 at lea/ #a nurse aide 7z  
def9$ 9 p>agraph 7#e77;,f77 = e #g      
resid5ts1 ) a m9imum ( #a4ad h\rs ( c>e 
provid$ p] resid5t dur+ ea* su* %ift4   
7,,iii7 ,ev5+ %ifts ,) respect to an    
ev5+ %ift1 ! skill$ nurs+ facility mu/  
h-- 7aa7 at lea/ #a regi/]$ pr(essional 
nurse = e #cj resid5ts1 ) a m9imum (    
#j4bf h\rs ( c>e provid$ p] resid5t dur+
 ea* su* %ift2  7bb7 at lea/ #a lic5s$  
practical nurse = e #dj resid5ts1 ) a   
m9imum ( #j4bj h\rs ( c>e provid$ p]    
resid5t dur+ ea* su* %ift2 &  7cc7 at   
lea/ #a nurse aide 7z def9$ 9 p>agraph  
7#e77;,f77 = e #g resid5ts1 ) a m9imum (
 #a4ad h\rs ( c>e provid$ p] resid5t    
dur+ ea* su* %ift4  7,,iv7 ,night %ifts 
,) respect to a night %ift1 ! skill$    
nurs+ facility mu/ h-- 7aa7 at lea/ #a  
regi/]$ pr(essional nurse = e #dj       
resid5ts1 ) a m9imum ( #j4bj h\rs ( c>e 

provid$ p] resid5t dur+ su* %ift2  7bb7 
at lea/ #a lic5s$ practical nurse = e   
#ef resid5ts1 ) a m9imum ( #j4ad h\rs ( 
c>e provid$ p] resid5t dur+ su* %ift2 & 
7cc7 at lea/ #a nurse aide 7z def9$ 9   
p>agraph 7#e77;,f77 = e #ae resid5ts1 ) 
a m9imum ( #j4ec h\rs ( c>e provid$ p]  
resid5t dur+ su* %ift4  7,v7 ,secret>ial
 au?ority to e/abli% high] m9imum nurse 
/aff+ levels ,! ,secret>y may e/abli% & 
require skill$ nurs+ facilities 7or1 at 
! ,secret>y's discretion1 only skill$   
nurs+ facilities t h a high] p]c5tage ( 
resid5ts ) ext5sive c>e ne$s1 z det]m9$ 
by ! ,secret>y7 to provide = m9imum     
nurse /aff+ levels t are high] ?an !    
levels requir$ "u ?is clause4  7,,vi7   
,rule ( con/ruction reg>d+ ,/ate        
au?ority to e/abli% high] m9imum nurse  
/aff+ levels ,no?+ 9 ?is clause may be  
con/ru$ z prev5t+ a ,/ate f e/abli%+ or 
requir+ skill$ nurs+ facilities 9 !     
,/ate to provide = m9imum nurse /aff+   
levels t are high] ?an ! levels requir$ 
"u ?is clause4  7,,vii7 ,cl>ification ) 

respect to m9imum h\rs ( c>e provid$ p] 
resid5t requirem5ts ,9 comply+ ) !      
m9imum h\rs ( c>e provid$ p] resid5t    
requirem5ts "u ?is clause1 a skill$     
nurs+ facility may n c\nt any "t sp5t by
 a regi/]$ pr(essional nurse1 lic5s$    
practical nurse1 or nurse aide on       
adm9i/rative s]vices t[>ds compliance ) 
su* requirem5ts4  7,,viii7 ,def9itions  
,9 ?is clause3 7aa7 ,adm9i/rative       
s]vices ,! t]m adm9i/rative s]vices     
means food prep>ation1 h\sekeep+1       
laundry s]vices1 ma9t5ance s]vices1 &   
o!r nonc>egiv+-relat$ s]vices1 z det]m9$
 by ! ,secret>y4  7bb7 ,day %ift ,! t]m 
day %ift means1 ) respect to a day & a  
skill$ nurs+ facility1 an assign$ "w    
%ift t is a p]iod ( #h consecutive h\rs1
 beg9n+ n soon] ?an #f a4m4 9 ! "t zone 
9 :i* su* facility is locat$ & n lat]   
?an #h a4m4 9 su* "t zone4  7cc7 ,ev5+  
%ift ,! t]m ev5+ %ift means1 ) respect  
to a day & a skill$ nurs+ facility1 an  
assign$ "w %ift t is a p]iod ( #h       
consecutive h\rs1 beg9n+ n soon] ?an #b 

p4m4 9 ! "t zone 9 :i* su* facility is  
locat$ & n lat] ?an #d p4m4 9 su* "t    
zone4  7dd7 ,night %ift ,! t]m night    
%ift means1 ) respect to a day & a      
skill$ nurs+ facility1 an assign$ "w    
%ift t is a p]iod ( #h consecutive h\rs1
 beg9n+ n soon] ?an #aj p4m4 9 ! "t zone
 9 :i* su* facility is locat$ & n lat]  
?an midnight 9 su* "t zone4  4  7#b7    
,en=cem5t ,section #ahai7;h7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;i-#c7;h77 is am5d$-- 7,a7 9       
p>agraph 7#a71 by /rik+ ,if a ,/ate     
f9ds1 on ! basis ( a /&>d & ins]t+      
,subject to p>agraph 7#g71 if a ,/ate   
f9ds1 on ! basis ( a /&>d2  7,b7 9      
p>agraph 7#b71 by /rik+ ,) respect to & 
ins]t+ ,subject to p>agraph 7#g71 )     
respect to2 &  7,c7 by add+ at ! end !  
foll[+ new p>agraph3  7#g7 ,special     
en=cem5t process ) respect to m9imum    
nurse /aff+ requirem5ts  7,a7 ,9 g5]al  
,if a ,/ate f9ds1 on ! basis ( a /&>d1  
ext5d$1 or p>tial ext5d$ survey "u      
subsection 7g77#b7 or o!rwise1 t a      

skill$ nurs+ facility does n meet !     
m9imum /aff+ requirem5ts ( clause 7ii7 (
 subsection 7b77#d77;,c7 ) respect to   
skill$ nurs+ facility s]vices provid$ on
 or aft] ,janu>y #a1 #bjbc1 ! ,/ate %all
 recomm5d to ! ,secret>y t ! ,secret>y  
take su* actions z describ$ 9 subclauses
 7,i7 & 7,,ii7 ( subp>agraph 7,b77i74   
7,b7 ,secret>ial au?ority  7i7 ,9 g5]al 
,) respect to any skill$ nurs+ facility 
9 a ,/ate1 if ! ,secret>y f9ds1 or      
pursuant to a recomm5dation ( ! ,/ate "u
 subp>agraph 7,a7 f9ds1 t a skill$ nurs+
 facility does n meet ! m9imum /aff+    
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 ) respect to skill$ nurs+  
facility s]vices provid$ on or aft]     
,janu>y #a1 #bjbc1 ! ,secret>y %all--   
7,i7 d5y any fur!r paym5ts "u ?is title 
) respect to all individuals entitl$ to 
b5efits "u ?is title :o are admitt$ to !
 facility aft] ! effective date ( !     
f9d+2 &  7,,ii7 impose a civil money    
p5alty 9 an am\nt n to exce$ #aj1jjj =  
ea* day ( noncompliance4 ,! provisions (

 section #aabh;,a 7o!r ?an subsections  
7a7 & 7b77 %all apply to a civil money  
p5alty "u ! previ\s s5t5ce 9 ! same     
mann] z su* provisions apply to a p5alty
 or proce$+ "u section #aabh;,a7a74     
7ii7 ,r$uction ( civil money p5alties 9 
c]ta9 circum/ances ,subject to clause   
7iii71 9 ! case :]e a skill$ nurs+      
facility self-reports & promptly        
corrects a defici5cy = :i* a p5alty 0   
impos$ "u clause 7i77,,ii7 n lat] ?an   
#aj cal5d> days aft] ! date ( su*       
imposition1 ! ,secret>y may r$uce !     
am\nt ( ! p5alty impos$ by-- 7,i7 n m   
?an #ej p]c5t2 or  7,,ii7 9 ! case t !  
facility 0 p5aliz$ "u ?is subsection )9 
! ?ree-ye> p]iod prec$+ ! date ( su*    
imposition1 n m ?an #be p]c5t4  7iii7   
,prohibitions on r$uction = c]ta9       
defici5cies  7,i7 ,repeat defici5cies ,!
 ,secret>y may n r$uce ! am\nt ( a      
p5alty "u clause 7ii7 if ! ,secret>y _h 
r$uc$ a p5alty impos$ on ! skill$ nurs+ 
facility 9 ! prec$+ ye> "u su* clause ) 
respect to a repeat defici5cy4  7,,ii7  

,c]ta9 o!r defici5cies ,! ,secret>y may 
n r$uce ! am\nt ( a p5alty "u clause    
7ii7 if ! p5alty is impos$ on ! skill$  
nurs+ facility = a defici5cy t is f\nd  
to result 9 a patt]n ( h>m or widespread
 h>m1 imm$iately jeop>dizes ! heal? or  
safety ( a resid5t or resid5ts ( !      
facility1 or results 9 ! dea? ( a       
resid5t ( ! facility4  7iv7 ,repeat$    
noncompliance ,9 ! case ( a skill$ nurs+
 facility :i*1 on ?ree consecutive /&>d 
surveys conduct$ "u subsection 7g77#b71 
has be5 f\nd z n meet+ ! m9imum /aff+   
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 ) respect to skill$ nurs+  
facility s]vices provid$ on or aft]     
,janu>y #a1 #bjbc1 ! ,secret>y may      
7reg>dless ( ! rem$ies provid$ = "u     
clause 7i77-- 7,i7 appo9t tempor>y      
managem5t to ov]see ! op]ation ( !      
facility & to assure ! heal? & safety ( 
! facility's resid5ts 9 accordance )    
clause 7iii7 ( p>agraph 7#b77;,b71      
except t ! m9imum /aff+ requirem5ts (   
clause 7ii7 ( subsection 7b77#d77;,c7   

%all be sub/itut$ = all ! requirem5ts ( 
subsections 7b71 7c71 & 7d7 "u su*      
clause2  7,,ii7 monitor ! facility "u   
subsection 7g77#d77;,b7 ) respect to su*
 m9imum /aff+ requirem5ts until !       
facility has demon/rat$ to !            
satisfaction ( ! ,secret>y t ! facility 
is 9 compliance1 & w rema9 9 compliance1
 ) su* m9imum /aff+ requirem5ts2 or     
7,,iii7 subject to section #aabh;,i7h71 
t]m9ate ! facility's p>ticipation "u ?is
 title4  ,if ! facility's p>ticipation  
"u ?is title is t]m9at$ "u ?is clause1 !
 ,/ate %all provide = ! safe & ord]ly   
transf] ( ! resid5ts eligible "u ?is    
title1 consi/5t ) ! requirem5ts (       
subsection 7c77#b7 & section            
#aabh;,i7h74  7v7 ,public notice (      
violations  7,i7 ,int]net website ,!    
,secret>y %all publi% on ! int]net      
website ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices ! names ( skill$ nurs+         
facilities t h violat$ ! m9imum /aff+   
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 ) respect to skill$ nurs+  

facility s]vices provid$ on or aft]     
,janu>y #a1 #bjbc4  7,,ii7 ,*ange (     
own]%ip ,) respect to a skill$ nurs+    
facility ^: "n is publi%$ "u subclause  
7,i7 & has a *ange ( own]%ip1 z det]m9$ 
by ! ,secret>y1 aft] ! date ( su*       
publication1 ! ,secret>y %all remove !  
"n ( su* facility f ! website describ$  
"u su* subclause aft] ! #a-ye> p]iod    
beg9n+ on ! date ( su* *ange ( own]%ip4 
4  7#c7 ,con=m+ am5dm5t ,item 7a7 (     
section #ahai7;f77#b77;,b77iii77,i7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;f77#b77;,b77iii77,i77 is    
am5d$ by /rik+ subsection               
7b77#d77;,c77ii77,,ii7 & ins]t+         
subsection 7b77#d77;,c77iii77,,ii74  7b7
 ,m$icaid  7#a7 ,9 g5]al ,subp>agraph   
7,c7 ( section #aiai7;b77#d7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acifr7b77#d77 is am5d$-- 7,a7 9 clause 
7i7-- 7i7 9 ! clause head+1 by ins]t+   
aft] ,g5]al requirem5ts ! foll[+ be=e   
#bjbc2  7ii7 9 ! matt] prec$+ subclause 
7,i71 by ins]t+ aft] ,octob] #a1 #aiij1 

! foll[+3 & be=e ,janu>y #a1 #bjbc12    
7iii7 9 subclause 7,i71 by /rik+ clause 
7ii7 & ins]t+ clause 7iii72 &  7iv7 9   
subclause 7,,ii71 by /rik+ clause 7ii7 &
 ins]t+ clause 7iii72  7,b7 by          
r$esignat+ clauses 7ii7 & 7iii7 z       
clauses 7iii7 & 7iv71 respectively2 &   
7,c7 by ins]t+ aft] clause 7i7 ! foll[+ 
new clause3  7ii7 ,g5]al requirem5ts    
aft] #bjbb  7,i7 ,9 g5]al ,) respect to 
nurs+ facility s]vices provid$ on or    
aft] ,janu>y #a1 #bjbc1 a nurs+ facility
 mu/-- 7aa7 provide nurs+ s]vices t are 
suffici5t to meet ! nurs+ ne$s ( its    
resid5ts on a #bd-;h\r basis1 to be     
divid$ into day %ifts1 ev5+ %ifts1 &    
night %ifts2  7bb7 provide = m9imum     
nurse /aff+ levels ) respect to ea* su* 
%ift1 9 accordance ) ?is clause2 &  7cc7
 ensure t1 9 c>ry+ out items 7aa7 &     
7bb71 a total m9imum ( #d4a h\rs ( c>e  
is provid$ p] resid5t p] day1 ) #j4ge   
h\rs ( c>e ( su* total m9imum provid$ by
 a regi/]$ pr(essional nurse1 #j4ed h\rs
 ( c>e ( su* total m9imum provid$ by a  

lic5s$ practical nurse1 & #b4ha h\rs (  
c>e ( su* total m9imum provid$ by a     
nurse aide 7z def9$ 9 p>agraph          
7#e77;,f774  7,,ii7 ,day %ifts ,)       
respect to a day %ift1 ! nurs+ facility 
mu/ h-- 7aa7 at lea/ #a regi/]$         
pr(essional nurse = e #bh resid5ts1 ) a 
m9imum ( #j4bi h\rs ( c>e provid$ p]    
resid5t dur+ ea* su* %ift2  7bb7 at lea/
 #a lic5s$ practical nurse = e #dj      
resid5ts1 ) a m9imum ( #j4bj h\rs ( c>e 
provid$ p] resid5t dur+ ea* su* %ift2 & 
7cc7 at lea/ #a nurse aide 7z def9$ 9   
p>agraph 7#e77;,f77 = e #g resid5ts1 ) a
 m9imum ( #a4ad h\rs ( c>e provid$ p]   
resid5t dur+ ea* su* %ift4  7,,iii7     
,ev5+ %ifts ,) respect to an ev5+ %ift1 
! nurs+ facility mu/ h-- 7aa7 at lea/ #a
 regi/]$ pr(essional nurse = e #cj      
resid5ts1 ) a m9imum ( #j4bf h\rs ( c>e 
provid$ p] resid5t dur+ ea* su* %ift2   
7bb7 at lea/ #a lic5s$ practical nurse =
 e #dj resid5ts1 ) a m9imum ( #j4bj h\rs
 ( c>e provid$ p] resid5t dur+ ea* su*  
%ift2 &  7cc7 at lea/ #a nurse aide 7z  

def9$ 9 p>agraph 7#e77;,f77 = e #g      
resid5ts1 ) a m9imum ( #a4ad h\rs ( c>e 
provid$ p] resid5t dur+ ea* su* %ift4   
7,,iv7 ,night %ifts ,) respect to a     
night %ift1 ! nurs+ facility mu/ h--    
7aa7 at lea/ #a regi/]$ pr(essional     
nurse = e #dj resid5ts1 ) a m9imum (    
#j4bj h\rs ( c>e provid$ p] resid5t dur+
 su* %ift2  7bb7 at lea/ #a lic5s$      
practical nurse = e #ef resid5ts1 ) a   
m9imum ( #j4ad h\rs ( c>e provid$ p]    
resid5t dur+ su* %ift2 &  7cc7 at lea/  
#a nurse aide 7z def9$ 9 p>agraph       
7#e77;,f77 = e #ae resid5ts1 ) a m9imum 
( #j4ec h\rs ( c>e provid$ p] resid5t   
dur+ su* %ift4  7,v7 ,secret>ial        
au?ority to e/abli% high] m9imum nurse  
/aff+ levels ,! ,secret>y may e/abli% & 
require nurs+ facilities 7or1 at !      
,secret>y's discretion1 only nurs+      
facilities t h a high] p]c5tage (       
resid5ts ) ext5sive c>e ne$s1 z det]m9$ 
by ! ,secret>y7 to provide = m9imum     
nurse /aff+ levels t are high] ?an !    
levels requir$ "u ?is clause4  7,,vi7   

,rule ( con/ruction reg>d+ ,/ate        
au?ority to e/abli% high] m9imum nurse  
/aff+ levels ,no?+ 9 ?is clause may be  
con/ru$ z prev5t+ a ,/ate f e/abli%+ or 
requir+ nurs+ facilities 9 ! ,/ate to   
provide = m9imum nurse /aff+ levels t   
are high] ?an ! levels requir$ "u ?is   
clause4  7,,vii7 ,cl>ification ) respect
 to m9imum h\rs ( c>e provid$ p] resid5t
 requirem5ts ,9 comply+ ) ! m9imum h\rs 
( c>e provid$ p] resid5t requirem5ts "u 
?is clause1 a nurs+ facility may n c\nt 
any "t sp5t by a regi/]$ pr(essional    
nurse1 lic5s$ practical nurse1 or nurse 
aide on adm9i/rative s]vices t[>ds      
compliance ) su* requirem5ts4  7,,viii7 
,def9itions ,9 ?is clause3 7aa7         
,adm9i/rative s]vices ,! t]m            
adm9i/rative s]vices means food         
prep>ation1 h\sekeep+1 laundry s]vices1 
ma9t5ance s]vices1 & o!r                
nonc>egiv+-relat$ s]vices1 z det]m9$ by 
! ,secret>y4  7bb7 ,day %ift ,! t]m day 
%ift means1 ) respect to a day & a nurs+
 facility1 an assign$ "w %ift t is a    

p]iod ( #h consecutive h\rs1 beg9n+ n   
soon] ?an #f a4m4 9 ! "t zone 9 :i* su* 
facility is locat$ & n lat] ?an #h a4m4 
9 su* "t zone4  7cc7 ,ev5+ %ift ,! t]m  
ev5+ %ift means1 ) respect to a day & a 
nurs+ facility1 an assign$ "w %ift t is 
a p]iod ( #h consecutive h\rs1 beg9n+ n 
soon] ?an #b p4m4 9 ! "t zone 9 :i* su* 
facility is locat$ & n lat] ?an #d p4m4 
9 su* "t zone4  7dd7 ,night %ift ,! t]m 
night %ift means1 ) respect to a day & a
 nurs+ facility1 an assign$ "w %ift t is
 a p]iod ( #h consecutive h\rs1 beg9n+ n
 soon] ?an #aj p4m4 9 ! "t zone 9 :i*   
su* facility is locat$ & n lat] ?an     
midnight 9 su* "t zone4  4  7#b7        
,en=cem5t ,section #aiai7;h7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acifr7h77 is am5d$-- 7,a7 9 p>agraph   
7#a71 by /rik+ ,if a ,/ate f9ds1 on !   
basis ( a /&>d & ins]t+ ,subject to     
p>agraph 7#aj71 if a ,/ate f9ds1 on !   
basis ( a /&>d2  7,b7 9 p>agraph 7#b7-- 
7i7 9 subp>agraph 7,c71 by /rik+ ,if a  
nurs+ facility & ins]t+ ,subject to     

p>agraph 7#aj71 if a nurs+ facility2 &  
7ii7 9 subp>agraph 7,d71 by /rik+ ,9 !  
case ( & ins]t+ ,subject to p>agraph    
7#aj71 9 ! case (2  7,c7 9 p>agraph     
7#c7-- 7i7 9 subp>agraph 7,a71 by ins]t+
 be=e ! p]iod ! foll[+3 & ! rem$ies     
describ$ 9 p>agraph 7#aj77;,b72 &  7ii7 
9 subp>agraph 7,b71 by /rik+ ,) respect 
to & ins]t+ ,subject to p>agraph 7#aj71 
) respect to2 &  7,d7 by add+ at ! end !
 foll[+ new p>agraph3  7#aj7 ,special   
en=cem5t process ) respect to m9imum    
nurse /aff+ requirem5ts  7,a7 ,9 g5]al  
,if a ,/ate f9ds1 on ! basis ( a /&>d1  
ext5d$1 or p>tial ext5d$ survey "u      
subsection 7g77#b7 or o!rwise1 t a nurs+
 facility does n meet ! m9imum /aff+    
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 ) respect to nurs+ facility
 s]vices provid$ on or aft] ,janu>y #a1 
#bjbc1 ! ,/ate %all-- 7i7 d5y any fur!r 
paym5ts "u ! ,/ate plan ) respect to all
 individuals enroll$ "u su* plan :o are 
admitt$ to ! facility aft] ! effective  
date ( ! f9d+2 &  7ii7 recomm5d to !    

,secret>y t ! ,secret>y impose ! civil  
money p5alty describ$ 9 subp>agraph     
7,b74  7,b7 ,secret>ial au?ority  7i7 ,9
 g5]al ,) respect to any nurs+ facility 
9 a ,/ate o!r ?an a ,/ate nurs+         
facility1 if ! ,secret>y f9ds t su* a   
nurs+ facility does n meet ! m9imum     
/aff+ requirem5ts ( clause 7ii7 (       
subsection 7b77#d77;,c7 ) respect to    
nurs+ facility s]vices provid$ on or    
aft] ,janu>y #a1 #bjbc1 ! ,secret>y     
%all-- 7,i7 d5y any fur!r paym5ts to !  
,/ate = m$ical assi/ance furni%$ by !   
facility to all individuals enroll$ "u !
 ,/ate plan :o are admitt$ to ! facility
 aft] ! effective date ( ! f9d+2 &      
7,,ii7 impose a civil money p5alty 9 an 
am\nt n to exce$ #aj1jjj = ea* day (    
noncompliance4 ,! provisions ( section  
#aabh;,a 7o!r ?an subsections 7a7 & 7b77
 %all apply to a civil money p5alty "u !
 previ\s s5t5ce 9 ! same mann] z su*    
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a7a74  7ii7 ,r$uction 
( civil money p5alties 9 c]ta9          

circum/ances ,subject to clause 7iii71 9
 ! case :]e a nurs+ facility            
self-reports & promptly corrects a      
defici5cy = :i* a p5alty 0 impos$ "u    
clause 7i77,,ii7 n lat] ?an #aj cal5d>  
days aft] ! date ( su* imposition1 !    
,secret>y may r$uce ! am\nt ( ! p5alty  
impos$ by-- 7,i7 n m ?an #ej p]c5t2 or  
7,,ii7 9 ! case t ! facility 0 p5aliz$  
"u ?is subsection )9 ! ?ree-ye> p]iod   
prec$+ ! date ( su* imposition1 n m ?an 
#be p]c5t4  7iii7 ,prohibitions on      
r$uction = c]ta9 defici5cies  7,i7      
,repeat defici5cies ,! ,secret>y may n  
r$uce ! am\nt ( a p5alty "u clause 7ii7 
if ! ,secret>y _h r$uc$ a p5alty impos$ 
on ! nurs+ facility 9 ! prec$+ ye> "u   
su* clause ) respect to a repeat        
defici5cy4  7,,ii7 ,c]ta9 o!r           
defici5cies ,! ,secret>y may n r$uce !  
am\nt ( a p5alty "u clause 7ii7 if !    
p5alty is impos$ on ! nurs+ facility = a
 defici5cy t is f\nd to result 9 a      
patt]n ( h>m or widespread h>m1         
imm$iately jeop>dizes ! heal? or safety 

( a resid5t or resid5ts ( ! facility1 or
 results 9 ! dea? ( a resid5t ( !       
facility4  7iv7 ,repeat$ noncompliance  
,9 ! case ( a nurs+ facility :i*1 on    
?ree consecutive /&>d surveys conduct$  
"u subsection 7g77#b71 has be5 f\nd z n 
meet+ ! m9imum /aff+ requirem5ts (      
clause 7ii7 ( subsection 7b77#d77;,c7 ) 
respect to nurs+ facility s]vices       
provid$ on or aft] ,janu>y #a1 #bjbc1 ! 
,secret>y may 7reg>dless ( ! rem$ies    
provid$ = "u clause 7i77-- 7,i7 appo9t  
tempor>y managem5t to ov]see ! op]ation 
( ! facility & to assure ! heal? &      
safety ( ! facility's resid5ts 9        
accordance ) clause 7iii7 ( p>agraph    
7#c77;,c71 except t ! m9imum /aff+      
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 %all be sub/itut$ = all !  
requirem5ts ( subsections 7b71 7c71 &   
7d7 "u su* clause2  7,,ii7 monitor !    
facility "u subsection 7g77#d77;,b7 )   
respect to su* m9imum /aff+ requirem5ts 
until ! facility has demon/rat$ to !    
satisfaction ( ! ,secret>y t ! facility 

is 9 compliance1 & w rema9 9 compliance1
 ) su* m9imum /aff+ requirem5ts2 or     
7,,iii7 subject to section #aabh;,i7h71 
t]m9ate ! facility's p>ticipation "u ?is
 title4  ,if ! facility's p>ticipation  
"u ?is title is t]m9at$ "u ?is clause1 !
 ,/ate %all provide = ! safe & ord]ly   
transf] ( ! resid5ts eligible "u ?is    
title1 consi/5t ) ! requirem5ts (       
subsection 7c77#b7 & section            
#aabh;,i7h74  7v7 ,public notice (      
violations  7,i7 ,int]net website ,!    
,secret>y %all publi% on ! int]net      
website ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices ! names ( nurs+ facilities t h 
violat$ ! m9imum /aff+ requirem5ts (    
clause 7ii7 ( subsection 7b77#d77;,c7 ) 
respect to skill$ nurs+ facility s]vices
 provid$ on or aft] ,janu>y #a1 #bjbc4  
7,,ii7 ,*ange ( own]%ip ,) respect to a 
nurs+ facility ^: "n is publi%$ "u      
subclause 7,i7 & has a *ange ( own]%ip1 
z det]m9$ by ! ,secret>y1 aft] ! date ( 
su* publication1 ! ,secret>y %all remove
 ! "n ( su* facility f ! website        

describ$ "u su* subclause aft] ! #a-ye> 
p]iod beg9n+ on ! date ( su* *ange (    
own]%ip4  4  7#c7 ,con=m+ am5dm5ts  7,a7
 ,clause 7iii7 ( section                
#aiai7;b77#d77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acifr7b77#d77;,c771 z r$esignat$ by    
p>agraph 7#a77;,b71 is am5d$ by /rik+   
subject to clause 7iii7 & ins]t+ subject
 to clause 7iv74  7,b7 ,item 7a7 (      
section #aiai7;f77#b77;,b77iii77,i7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7f77#b77;,b77iii77,i77 is am5d$ by
 /rik+ subsection 7b77#d77;,c77ii7 &    
ins]t+ subsection 7b77#d77;,c77iii74    
7,c7 ,p>agraph 7#i7 ( section #aiai7;f7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acifr7f77 is am5d$ by /rik+  
subsection 7b77#d77;,c77ii7 & ins]t+    
subsection 7b77#d77;,c77iii74  7c7      
,/udies & reports reg>d+ impact ( m9imum
 nurse /aff+ requirem5ts  7#a7 ,initial 
/udy & report  7,a7 ,9 g5]al ,n lat] ?an
 ,june #a1 #bjbc1 ! ,secret>y ( ,heal? &
 ,human ,s]vices %all /udy & submit to !

 ,committee on ,en]gy & ,comm]ce & !    
,committee on ,ways & ,means ( ! ,h\se (
 ,repres5tatives & ! ,committee on      
,f9ance ( ! ,s5ate a publicly available 
report-- 7i7 on ! impact ( ! m9imum     
nurse /aff+ requirem5ts add$ by         
subsection 7a7 on ! reimbursem5t levels 
( skill$ nurs+ facilities "u ! ,m$ic>e  
program "u title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 & ! adequacy ( p]sonnel numb]s 9  
su* skill$ nurs+ facilities to meet su* 
m9imum nurse /aff+ requirem5ts2  7ii7 on
 ! impact ( ! m9imum nurse /aff+        
requirem5ts add$ by subsection 7b7 on ! 
reimbursem5t levels ( nurs+ facilities  
"u ! ,m$icaid program "u title ,,xix ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif et seq47 & ! adequacy ( p]sonnel  
numb]s 9 su* nurs+ facilities to meet   
su* m9imum nurse /aff+ requirem5ts2 &   
7iii7 includ+ recomm5dations on ! /eps t
 su* skill$ nurs+ facilities & nurs+    
facilities c take to ensure t adequate  
p]sonnel are available 9 su* skill$     

nurs+ facilities & nurs+ facilities to  
meet ! m9imum nurse /aff+ requirem5ts   
add$ by subsections 7a7 & 7b7 = su*     
skill$ nurs+ facilities & nurs+         
facilities1 respectively1 includ+ me?ods
 = attract+ & reta9+ su* p]sonnel4  7,b7
 ,consid]ations ,9 conduct+ ! /udy      
requir$ "u subp>agraph 7,a71 ! ,secret>y
 ( ,heal? & ,human ,s]vices %all take   
into consid]ation-- 7i7 ! b5efits ( any 
increase 9 nurse /aff+ levels1 includ+ )
 respect to work=ce tra9+ & ret5tion2   
7ii7 any decrease 9 ! rate ( workplace  
injuries2  7iii7 any *anges 9 m$ical c>e
 co/s = resid5ts ( skill$ nurs+         
facilities & nurs+ facilities2  7iv7 any
 decrease 9 hospitalization rates = su* 
resid5ts2  7v7 any *anges 9 p]sonnel &  
adm9i/rative co/s = skill$ nurs+        
facilities & nurs+ facilities2 &  7vi7  
any *anges 9 recruit+ & tra9+ co/s4     
7#b7 ,subsequ5t /udy & report ,n lat]   
?an ,janu>y #a1 #bjbe1 ! ,secret>y (    
,heal? & ,human ,s]vices %all conduct a 
foll[-up /udy to ! /udy conduct$ "u     

p>agraph 7#a77;,a7 & submit to !        
,committee on ,en]gy & ,comm]ce & !     
,committee on ,ways & ,means ( ! ,h\se (
 ,repres5tatives & ! ,committee on      
,f9ance ( ! ,s5ate a publicly available 
report on su* foll[-up /udy4  #bjb4     
,disclosure ( nurse /aff+ levels at     
skill$ nurs+ facilities "u ,m$ic>e      
program & nurs+ facilities "u ,m$icaid  
program  7a7 ,m$ic>e ,p>agraph 7#h7 (   
section #ahai7;b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie;i-#c7;b77 is  
am5d$ to read z foll[s3  7#h7 ,in=mation
 on nurse /aff+  7,a7 ,9 g5]al ,ea* day1
 a skill$ nurs+ facility %all po/ = ea* 
%ift notices )-- 7i7 a description ( !  
nurse /aff+ requirem5ts applicable )    
respect to ! facility & day "u p>agraph 
7#d77;,c72  7ii7 in=mation on ! numb] ( 
regi/]$ pr(essional nurses1 lic5s$      
practical nurses1 & nurse aides 7z def9$
 9 p>agraph 7#e77;,f77 assign$ to       
provide direct c>e s]vices to resid5ts 9
 ! facility dur+ ! %ift1 disaggregat$ by
 units 9 ! facility2 &  7iii7 a /atem5t 

t ! facility is requir$1 ^u reque/1 to  
provide any nurse /aff+ in=mation 7z    
describ$ 9 ?is subp>agraph7 ( ! facility
 f ! prec$+ #ab-mon? p]iod4  ,!         
in=mation 9 su* notices %all be writt5 9
 a uni=m mann]1 pr9t$ 9 an easily       
readable #ad-po9t type font1 & made     
available 9 appropriate languages1 z    
det]m9$ by ! ,secret>y4 ,! skill$ nurs+ 
facility %all make su* notices available
 at ea* nurses' /ation 9 ! facility &   
o!r areas 9 ea* unit ( ! facility1 z    
det]m9$ appropriate by ! facility1 &    
%all keep & ma9ta9 ea* su* notice = at  
lea/ ?ree ye>s aft] ! date on :i* ea*   
su* notice is po/$ 9 ! facility4  7,b7  
,public availability ( in=mation ,a     
skill$ nurs+ facility %all1 ^u reque/1  
make available to ! public any nurse    
/aff+ in=mation 7z describ$ 9           
subp>agraph 7,a77 ( ! facility f !      
prec$+ #ab-mon? p]iod4 ,9 ! case t !    
facility makes su* in=mation available z
 a pap] copy1 su* facility may n *>ge = 
su* copy an am\nt great] ?an ! co/ (    

mak+ su* copy4  4  7b7 ,m$icaid         
,p>agraph 7#h7 ( section #aiai7;b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7b77 is am5d$ to read z foll[s3   
7#h7 ,in=mation on nurse /aff+  7,a7 ,9 
g5]al ,ea* day1 a skill$ nurs+ facility 
%all po/ = ea* %ift notices )-- 7i7 a   
description ( ! nurse /aff+ requirem5ts 
applicable ) respect to ! facility & day
 "u p>agraph 7#d77;,c72  7ii7 in=mation 
on ! numb] ( regi/]$ pr(essional nurses1
 lic5s$ practical nurses1 & nurse aides 
7z def9$ 9 p>agraph 7#e77;,f77 assign$  
to provide direct c>e s]vices to        
resid5ts 9 ! facility dur+ ! %ift1      
disaggregat$ by units 9 ! facility2 &   
7iii7 a /atem5t t ! facility is requir$1
 ^u reque/1 to provide any nurse /aff+  
in=mation 7z describ$ 9 ?is subp>agraph7
 ( ! facility f ! prec$+ #ab-mon? p]iod4
  ,! in=mation 9 su* notices %all be    
writt5 9 a uni=m mann]1 pr9t$ 9 an      
easily readable #ad-po9t type font1 &   
made available 9 appropriate languages1 
z det]m9$ by ! ,secret>y4 ,! skill$     

nurs+ facility %all make su* notices    
available at ea* nurses' /ation 9 !     
facility & o!r areas 9 ea* unit ( !     
facility1 z det]m9$ appropriate by !    
facility1 & %all keep & ma9ta9 ea* su*  
notice = at lea/ ?ree ye>s aft] ! date  
on :i* ea* su* notice is po/$ 9 !       
facility4  7,b7 ,public availability (  
in=mation ,a skill$ nurs+ facility %all1
 ^u reque/1 make available to ! public  
any nurse /aff+ in=mation 7z describ$ 9 
subp>agraph 7,a77 ( ! facility f !      
prec$+ #ab-mon? p]iod4  4  7c7          
,effective date ,! am5dm5ts made by ?is 
section take effect on ! date ( enactm5t
 ( ?is ,act & apply ) respect to nurse  
/aff+ in=mation po/$ or reque/$ on or   
aft] ! date t is "o ye> aft] su* date ( 
enactm5t4  #bjc4 ,adm9i/rative /aff+    
requirem5ts = skill$ nurs+ facilities "u
 ,m$ic>e program & nurs+ facilities "u  
,m$icaid program  7a7 ,m$ic>e ,p>agraph 
7#a7 ( section #ahai7;d7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;d77 is am5d$-- 7#a7 by      

r$esignat+ ! second subp>agraph 7,c7 z  
subp>agraph 7,e72 &  7#b7 by ins]t+ aft]
 ! fir/ subp>agraph 7,c7 ! foll[+ new   
subp>agraph3  7,d7 ,nurs+ managem5t     
p]sonnel  7i7 ,9 g5]al ,a skill$ nurs+  
facility mu/ employ nurs+ managem5t     
p]sonnel 9 accordance ) ?is subp>agraph4
  7ii7 ,director ( nurs+ s]vices ,a     
skill$ nurs+ facility mu/ employ a      
regi/]$ pr(essional nurse to s]ve       
full-"t z ! director ( nurs+ s]vices ( !
 facility4 ,su* director ( nurs+ s]vices
 %all be responsible = det]m9+ ! numb] &
 types ( nurs+ p]sonnel ne$$ to         
suffici5tly meet ! nurs+ ne$s ( !       
resid5ts ( ! facility 7z requir$ "u     
subsection 7b77#d77;,c774  7iii7        
,assi/ant director ( nurs+ s]vices ,a   
skill$ nurs+ facility mu/ employ a      
regi/]$ pr(essional nurse to s]ve       
full-"t z ! assi/ant director ( nurs+   
s]vices ( ! facility1 except t 9 ! case 
( a skill$ nurs+ facility t has few] ?an
 #ajj b$s1 su* facility may employ a    
regi/]$ pr(essional nurse to s]ve "p-"t 

z ! assi/ant director ( nurs+ s]vices ( 
! facility4 ,a regi/]$ pr(essional nurse
 :o s]ves z ! assi/ant director ( nurs+ 
s]vices ( a skill$ nurs+ facility may   
also s]ve z a sup]visor = direct cl9ical
 nurs+ c>e = su* facility4  7iv7        
,director ( 9-,s]vice education ,a      
skill$ nurs+ facility mu/ employ a      
regi/]$ pr(essional nurse to s]ve       
full-"t z ! director ( 9-s]vice         
education ( ! facility1 except t 9 !    
case ( a skill$ nurs+ facility t has    
few] ?an #ajj b$s1 su* facility may     
employ a regi/]$ pr(essional nurse to   
s]ve "p-"t z ! director ( 9-s]vice      
education ( ! facility4 ,9 c>ry+ out !  
previ\s s5t5ce1 a skill$ nurs+ facility 
mu/1 to ! ext5t practicable &           
appropriate1 employ a regi/]$           
pr(essional nurse :o has receiv$ tra9+ 9
 adult education & g]ontology4  4  7b7  
,m$icaid  7#a7 ,9 g5]al ,p>agraph 7#a7 (
 section #aiai7;d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7d77 is am5d$
 by ins]t+ aft] subp>agraph 7,c7 !      

foll[+ new subp>agraph3  7,d7 ,nurs+    
managem5t p]sonnel  7i7 ,9 g5]al ,a     
nurs+ facility mu/ employ nurs+         
managem5t p]sonnel 9 accordance ) ?is   
subp>agraph4  7ii7 ,director ( nurs+    
s]vices ,a nurs+ facility mu/ employ a  
regi/]$ pr(essional nurse to s]ve       
full-"t z ! director ( nurs+ s]vices ( !
 facility4 ,su* director ( nurs+ s]vices
 %all be responsible = det]m9+ ! numb] &
 types ( nurs+ p]sonnel ne$$ to         
suffici5tly meet ! nurs+ ne$s ( !       
resid5ts ( ! facility 7z requir$ "u     
subsection 7b77#d77;,c774  7iii7        
,assi/ant director ( nurs+ s]vices ,a   
nurs+ facility mu/ employ a regi/]$     
pr(essional nurse to s]ve full-"t z !   
assi/ant director ( nurs+ s]vices ( !   
facility1 except t 9 ! case ( a nurs+   
facility t has few] ?an #ajj b$s1 su*   
facility may employ a regi/]$           
pr(essional nurse to s]ve "p-"t z !     
assi/ant director ( nurs+ s]vices ( !   
facility4 ,a regi/]$ pr(essional nurse  
:o s]ves z ! assi/ant director ( nurs+  

s]vices ( a nurs+ facility may also s]ve
 z a sup]visor = direct cl9ical nurs+   
c>e = su* facility4  7iv7 ,director (   
9-,s]vice education ,a nurs+ facility   
mu/ employ a regi/]$ pr(essional nurse  
to s]ve full-"t z ! director ( 9-s]vice 
education ( ! facility1 except t 9 !    
case ( a nurs+ facility t has few] ?an  
#ajj b$s1 su* facility may employ a     
regi/]$ pr(essional nurse to s]ve "p-"t 
z ! director ( 9-s]vice education ( !   
facility4 ,9 c>ry+ out ! previ\s s5t5ce1
 a nurs+ facility mu/1 to ! ext5t       
practicable & appropriate1 employ a     
regi/]$ pr(essional nurse :o has receiv$
 tra9+ 9 adult education & g]ontology4  
4  7#b7 ,te*nical am5dm5t ,p>agraph 7#a7
 ( section #aiai7;d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acifr7d77
 is am5d$ by r$esignat+ subp>agraph 7,v7
 z subp>agraph 7,e74  7c7 ,effective    
date ,! am5dm5ts made by ?is section    
take effect on ! date ( enactm5t ( ?is  
,act & apply ) respect to ! adm9i/ration
 ( skill$ nurs+ facilities & nurs+      

facilities on or aft] ! date t is "o ye>
 aft] su* date ( enactm5t4  #bjd4 ,nurse
 tra9+ requirem5ts ) respect to skill$  
nurs+ facilities "u ,m$ic>e program &   
nurs+ facilities "u ,m$icaid program    
7a7 ,m$ic>e  7#a7 ,ori5tation = regi/]$ 
pr(essional nurses1 lic5s$ practical    
nurses1 & nurse aides ,section #ahai7;d7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;i-#c7;d77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#e7 ,ori5tations ,a skill$ nurs+       
facility mu/ provide to regi/]$         
pr(essional nurses1 lic5s$ practical    
nurses1 & nurse aides1 be=e su* regi/]$ 
pr(essional nurses1 lic5s$ practical    
nurses1 & nurse aides are assign$ to    
provide direct c>e s]vices to resid5ts 9
 ! facility1 ori5tations provid+        
education on ! policies & em]g5cy       
proc$ures ( ! facility & on resid5ts'   
rights "u ?is section4  4  7#b7         
,requirem5ts = nurse aide tra9+ &       
compet5cy evaluation programs & = nurse 
aide compet5cy evaluation programs      

,subp>agraph 7,a7 ( section             
#ahai7;f77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#c7;f77#b77 is  
am5d$-- 7,a7 9 ! matt] prec$+ clause    
7i71 by ins]t+ aft] #aihh ! foll[+3 1 & 
update1 z det]m9$ necess>y by !         
,secret>y2  7,b7 9 clause 7i7-- 7i7 by  
ins]t+ aft] c>e ( cognitively impair$   
resid5ts1 ! foll[+3 c>e ( old] adults12 
7ii7 by /rik+ pati5t abuse prev5tion    
tra9+1 & ins]t+ pati5t abuse prev5tion  
tra9+712 &  7iii7 by /rik+ #ge h\rs &   
ins]t+ #abj h\rs2 &  7,c7 9 clause      
7ii7-- 7i7 by /rik+ requirem5t relat+ to
 & ins]t+ requirem5ts relat+ to 7,i72   
7ii7 by ins]t+ aft] c>e ( cognitively   
impair$ resid5ts1 ! foll[+3 c>e ( old]  
adults12 &  7iii7 by /rik+ & proc$ures &
 ins]t+ 7,,ii7 m9imum h\rs ( initial &  
ongo+ tra9+ & retra9+ 7includ+ n less   
?an #abj h\rs 9 ! case ( initial tra9+71
 & 7,,iii7 proc$ures4  7b7 ,m$icaid     
7#a7 ,ori5tation = regi/]$ pr(essional  
nurses1 lic5s$ practical nurses1 & nurse
 aides ,section #aiai7;d7 ( ! ,social   

,security ,act 7#db ,u4,s4,c4 #acifr7d77
 is am5d$ by add+ at ! end ! foll[+ new 
p>agraph3  7#e7 ,ori5tations ,a nurs+   
facility mu/ provide to regi/]$         
pr(essional nurses1 lic5s$ practical    
nurses1 & nurse aides1 be=e su* regi/]$ 
pr(essional nurses1 lic5s$ practical    
nurses1 & nurse aides are assign$ to    
provide direct c>e s]vices to resid5ts 9
 ! facility1 ori5tations provid+        
education on ! policies & em]g5cy       
proc$ures ( ! facility & on resid5ts'   
rights "u ?is section4  4  7#b7         
,requirem5ts = nurse aide tra9+ &       
compet5cy evaluation programs & = nurse 
aide compet5cy evaluation programs      
,subp>agraph 7,a7 ( section             
#aiai7;f77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr7f77#b77 is       
am5d$-- 7,a7 9 ! matt] prec$+ clause    
7i71 by ins]t+ aft] #aihh ! foll[+3 1 & 
update1 z det]m9$ necess>y by !         
,secret>y2  7,b7 9 clause 7i7-- 7i7 by  
ins]t+ aft] c>e ( cognitively impair$   
resid5ts1 ! foll[+3 c>e ( old] adults12 

7ii7 by /rik+ pati5t abuse prev5tion    
tra9+1 & ins]t+ pati5t abuse prev5tion  
tra9+712 &  7iii7 by /rik+ #ge h\rs &   
ins]t+ #abj h\rs2 &  7,c7 9 clause      
7ii7-- 7i7 by /rik+ requirem5t relat+ to
 & ins]t+ requirem5ts relat+ to 7,i72   
7ii7 by ins]t+ aft] c>e ( cognitively   
impair$ resid5ts1 ! foll[+3 c>e ( old]  
adults12 &  7iii7 by /rik+ & proc$ures &
 ins]t+ 7,,ii7 m9imum h\rs ( initial &  
ongo+ tra9+ & retra9+ 7includ+ n less   
?an #abj h\rs 9 ! case ( initial tra9+71
 & 7,,iii7 proc$ures4  7c7 ,effective   
date ,! am5dm5ts made by ?is section    
take effect on ! date ( enactm5t ( ?is  
,act & %all apply ) respect to nurse    
aide tra9+ & compet5cy evaluation       
programs1 nurse aide compet5cy          
evaluation programs1 & nurse ori5tations
 conduct$ on or aft] ! date t is "o ye> 
aft] su* date ( enactm5t4  #bje4        
,:i/lebl[] & resid5t protections  7a7   
,m$ic>e ,section #ahai ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7 is am5d$ by add+ at ! end ! 

foll[+ new subsection3  7l7 ,:i/lebl[] &
 resid5t protections  7#a7 ,/atem5t     
reg>d+ pr(essional obligation & rights  
,all nurses employ$ by a skill$ nurs+   
facility h a duty & "r to act bas$ on _!
 pr(essional judgm5t 9 accordance ) !   
nurs+ laws & regulations ( ! ,/ate 9 :i*
 su* facility is locat$1 to provide     
nurs+ c>e 9 ! exclusive int]e/s ( !     
resid5ts ( ! facility1 & to act z !     
resid5ts' advocate4  7#b7 ,objection to 
or refusal ( "w assignm5t ,a nurse may  
object to1 or refuse to p>ticipate 91   
any activity1 policy1 practice1         
assignm5t1 or task 7ref]r$ to 9 ?is     
subsection z a "w assignm5t7 if-- 7,a7 !
 nurse reasonably believes su* "w       
assignm5t to be 9 violation ( ! m9imum  
nurse /aff+ requirem5ts ( clause 7ii7 ( 
subsection 7b77#d77;,c72 or  7,b7 !     
nurse reasonably believes t ! nurse is n
 prep>$ by education1 tra9+1 or exp]i5ce
 to p]=m or comply ) su* "w assignm5t   
)\t compromis+ ! safety ( a resid5t or  
jeop>diz+ ! lic5se ( ! nurse4  7#c7     

,retaliation = objection to or refusal (
 "w assignm5t b>r$  7,a7 ,no dis*>ge1   
discrim9ation1 or retaliation ,no skill$
 nurs+ facility may dis*>ge1 retaliate1 
discrim9ate1 or o!rwise take adv]se     
action 9 any mann] ) respect to any     
aspect ( a nurse's employm5t ) !        
facility1 includ+ dis*>ge1 promotion1   
comp5sation1 or t]ms1 conditions1 or    
privileges ( employm5t1 bas$ on !       
nurse's objection to1 or refusal (1 a "w
 assignm5t "u p>agraph 7#b74  7,b7 ,no  
fil+ ( compla9t ,no skill$ nurs+        
facility may file a compla9t or a report
 aga9/ a nurse ) a ,/ate pr(essional    
discipl9>y ag5cy because ( ! nurse's    
objection to1 or refusal (1 a "w        
assignm5t "u p>agraph 7#b74  7#d7 ,cause
 ( action ,any nurse 7or a collective   
b>ga9+ repres5tative or legal           
repres5tative ( su* nurse7 aga9/ :om a  
skill$ nurs+ facility has tak5 an adv]se
 action 9 violation ( p>agraph          
7#c77;,a71 or aga9/ :om su* facility has
 fil$ a compla9t or report 9 violation (

 p>agraph 7#c77;,b71 may 7)\t reg>d to  
:e!r a compla9t has be5 fil$ "u p>agraph
 7#e7 or 7#aj77;,b77 br+ a cause (      
action 9 an appropriate di/rict c\rt ( !
 ,unit$ ,/ates4 ,! legal burd5s ( pro(  
specifi$ 9 section #abba7;e7 ( title #e1
 ,unit$ ,/ates ,code1 %all be controll+ 
= ! purposes ( any cause ( action br\ght
 "u ?is p>agraph4 ,a nurse :o prevails  
on ! cause ( action may be entitl$ to "o
 or m ( ! foll[+3 7,a7 ,re9/atem5t4     
7,b7 ,reimbursem5t ( lo/ wages1         
comp5sation1 & b5efits4  7,c7           
,attorneys' fees4  7,d7 ,c\rt co/s4     
7,e7 ,o!r damages4  7#e7 ,compla9t to   
,secret>y ,any individual may file a    
compla9t ) ! ,secret>y aga9/ a skill$   
nurs+ facility t violates a requirem5t  
describ$ 9 p>agraph 7#c74 ,= any        
compla9t fil$1 ! ,secret>y %all-- 7,a7  
receive & inve/igate ! compla9t2  7,b7  
det]m9e :e!r a violation ( su* p>agraph1
 z alleg$ 9 ! compla9t1 has occurr$2 &  
7,c7 9 ! case t ! ,secret>y det]m9es t  
su* a violation has occurr$1 issue an   

ord] t ! compla9+ individual may n suff]
 any adv]se action prohibit$ by p>agraph
 7#c7 or 7#g74  7#f7 ,toll-,free        
telephone numb]  7,a7 ,9 g5]al ,!       
,secret>y %all provide = ! e/abli%m5t ( 
a toll-free telephone hotl9e to provide 
in=mation reg>d+ ! m9imum nurse /aff+   
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 & to receive reports (     
violations ( su* requirem5ts4  7,b7     
,notice to resid5ts ,a skill$ nurs+     
facility %all provide ea* resid5t       
admitt$ to ! facility ) ! telephone     
numb] ( ! hotl9e describ$ 9 subp>agraph 
7,a7 & give notice to ea* su* resid5t t 
su* hotl9e may be us$ to report         
inadequate /aff+4  7#g7 ,protection =   
report+  7,a7 ,prohibition on           
retaliation or discrim9ation ,a skill$  
nurs+ facility may n retaliate or       
discrim9ate 9 any mann] aga9/ any       
resid5t1 employee1 or contract employee 
( ! facility1 or any o!r individual1 on 
! basis t su* resid5t1 employee1        
contract employee1 or individual        

7individually or 9 conjunction ) ano!r  
individual7 has1 9 good fai?-- 7i7      
pres5t$ a grievance or compla9t2  7ii7  
initiat$ or coop]at$ 9 any inve/igation 
or proce$+ ( any gov]nm5tal entity1     
regulatory ag5cy1 or private            
accr$itation body2  7iii7 made a civil  
claim or dem&2 or  7iv7 fil$ an action  
relat+ to ! c>e1 s]vices1 or conditions 
( ! facility4  7,b7 ,good fai? def9$ ,= 
purposes ( ?is p>agraph1 an individual  
%all be deem$ to be act+ 9 good fai? if 
! individual reasonably believes-- 7i7 !
 in=mation report$ or disclos$ is true2 
&  7ii7 a violation ( ! m9imum nurse    
/aff+ requirem5ts ( clause 7ii7 (       
subsection 7b77#d77;,c7 has occurr$ or  
may occur4  7#h7 ,prohibition on        
int]f]5ce ) rights  7,a7 ,ex]cise (     
rights ,a skill$ nurs+ facility may n-- 
7i7 int]f]e )1 re/ra91 or d5y ! ex]cise1
 or attempt to ex]cise1 by any          
individual ( any "r1 proc$ure1 or rem$y 
provid$ or protect$ "u ?is subsection2  
or  7ii7 co]ce or intimidate any        

individual reg>d+ ! ex]cise1 or attempt 
to ex]cise1 su* "r4  7,b7 ,opposition to
 unlawful policies or practices ,a      
skill$ nurs+ facility may n retaliate or
 discrim9ate aga9/ any individual =     
oppos+ any policy1 practice1 or action (
 ! facility :i* is alleg$ to violate1   
brea*1 or fail to comply ) any provision
 ( ! m9imum nurse /aff+ requirem5ts (   
clause 7ii7 ( subsection 7b77#d77;,c74  
7,c7 ,prohibition on int]f]5ce )        
protect$ communications ,a skill$ nurs+ 
facility may n make1 adopt1 or en=ce any
 rule1 regulation1 policy1 or practice  
:i* 9 any mann] directly or indirectly  
prohibits1 imp$es1 or disc\rages a nurse
 f1 or intimidates1 co]ces1 or induces a
 nurse reg>d+1 engag+ 9 free spee*      
activities or disclos+ in=mation z      
provid$ "u ?is subsection4  7,d7        
,prohibition on int]f]5ce ) collective  
action ,a skill$ nurs+ facility may n 9 
any way int]f]e ) ! rights ( nurses to  
organize1 b>ga9 collectively1 & engage 9
 conc]t$ activity "u section #g ( !     

,national ,labor ,relations ,act 7#bi   
,u4,s4,c4 #aeg74  7#i7 ,notice ,a skill$
 nurs+ facility %all po/ 9 an           
appropriate location 9 ea* unit a       
conspicu\s notice1 9 a =m specifi$ by ! 
,secret>y1 t-- 7,a7 expla9s ! rights (  
nurses1 resid5ts1 & o!r individuals "u  
?is subsection2  7,b7 includes a /atem5t
 t a nurse1 resid5t1 or o!r individual  
may file a compla9t ) ! ,secret>y aga9/ 
! facility = a violation ( a requirem5t 
or a prohibition ( ?is subsection2 &    
7,c7 provides in/ructions on h[ to file 
su* a compla9t4  7#aj7 ,en=cem5t  7,a7  
,9 g5]al ,! ,secret>y %all en=ce !      
requirem5ts & prohibitions ( ?is        
subsection 9 accordance ) ?is p>agraph4 
7,b7 ,proc$ures = receiv+ & inve/igat+  
compla9ts ,! ,secret>y %all e/abli%     
proc$ures "u :i*-- 7i7 any individual   
may file a compla9t alleg+ t a skill$   
nurs+ facility has violat$ a requirem5t 
or a prohibition ( ?is subsection2 &    
7ii7 any su* compla9t %all be inve/igat$
 by ! ,secret>y4  7,c7 ,rem$ies ,if !   

,secret>y det]m9es t a skill$ nurs+     
facility has violat$ a requirem5t or    
prohibition ( ?is subsection1 !         
,secret>y-- 7i7 %all require ! facility 
to e/abli% a corrective action plan to  
prev5t ! recurr5ce ( su* violation2 &   
7ii7 may impose civil money p5alties z  
describ$ 9 subp>agraph 7,d74  7,d7      
,civil p5alties  7i7 ,9 g5]al ,9        
addition to any o!r p5alties prescrib$  
by law1 ! ,secret>y may impose civil    
p5alties z foll[s3 7,i7 ,skill$ nurs+   
facility liability ,! ,secret>y may     
impose on a skill$ nurs+ facility f\nd  
to be 9 violation ( ?is subsection a    
civil money p5alty (-- 7aa7 n m ?an     
#be1jjj = ! fir/ kn[+ violation ( ?is   
subsection by su* facility2 &  7bb7 n m 
?an #ej1jjj = any subsequ5t kn[+        
violation ( ?is subsection by su*       
facility4  7,,ii7 ,individual liability 
,! ,secret>y may impose on an individual
 :o-- 7aa7 is employ$ by a skill$ nurs+ 
facility2 &  7bb7 is f\nd by ! ,secret>y
 to h kn[+ly violat$ ?is subsection on  

behalf ( ! facility1  a civil money     
p5alty ( n m ?an #bj1jjj = ea* su*      
violation by ! individual4  7ii7        
,proc$ures ,! provisions ( section      
#aabh;,a ( ! ,social ,security ,act 7o!r
 ?an subsections 7a7 & 7b77 %all apply )
 respect to a civil money p5alty or     
proce$+ "u ?is subp>agraph 9 ! same     
mann] z su* provisions apply ) respect  
to a civil money p5alty or proce$+ "u   
su* section #aabh;,a4  7,e7 ,public     
notice ( violations  7i7 ,int]net       
website ,! ,secret>y %all publi% on !   
int]net website ( ! ,dep>tm5t ( ,heal? &
 ,human ,s]vices ! names ( skill$ nurs+ 
facilities on :i* a civil money p5alty  
has be5 impos$ "u ?is subsection1 !     
violation = :i* su* p5alty 0 impos$1 &  
su* additional in=mation z ! ,secret>y  
det]m9es appropriate4  7ii7 ,*ange (    
own]%ip ,) respect to a skill$ nurs+    
facility t _h a *ange ( own]%ip1 z      
det]m9$ by ! ,secret>y1 p5alties impos$ 
on ! facility :ile "u previ\s own]%ip   
%all no long] be publi%$ by ! ,secret>y 

pursuant to clause 7i7 aft] ! #a-ye>    
p]iod beg9n+ on ! date ( su* *ange (    
own]%ip4  7,f7 ,use ( funds ,funds      
collect$ by ! ,secret>y pursuant to ?is 
subsection are au?oriz$ to be           
appropriat$ to implem5t ! m9imum nurse  
/aff+ requirem5ts ( clause 7ii7 (       
subsection 7b77#d77;,c74  7#aa7 ,nurse  
def9$ ,9 ?is subsection1 ! t]m nurse    
means a regi/]$ pr(essional nurse1 a    
lic5s$ practical nurse1 & a nurse aide4 
4  7b7 ,m$icaid ,section #aiai ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7l7 ,:i/lebl[] &
 resid5t protections  7#a7 ,/atem5t     
reg>d+ pr(essional obligation & rights  
,all nurses employ$ by a nurs+ facility 
h a duty & "r to act bas$ on _!         
pr(essional judgm5t 9 accordance ) !    
nurs+ laws & regulations ( ! ,/ate 9 :i*
 su* facility is locat$1 to provide     
nurs+ c>e 9 ! exclusive int]e/s ( !     
resid5ts ( ! facility1 & to act z !     
resid5ts' advocate4  7#b7 ,objection to 

or refusal ( "w assignm5t ,a nurse may  
object to1 or refuse to p>ticipate 91   
any activity1 policy1 practice1         
assignm5t1 or task 7ref]r$ to 9 ?is     
subsection z a "w assignm5t7 if-- 7,a7 !
 nurse reasonably believes su* "w       
assignm5t to be 9 violation ( ! m9imum  
nurse /aff+ requirem5ts ( clause 7ii7 ( 
subsection 7b77#d77;,c72 or  7,b7 !     
nurse reasonably believes t ! nurse is n
 prep>$ by education1 tra9+1 or exp]i5ce
 to p]=m or comply ) su* "w assignm5t   
)\t compromis+ ! safety ( a resid5t or  
jeop>diz+ ! lic5se ( ! nurse4  7#c7     
,retaliation = objection to or refusal (
 "w assignm5t b>r$  7,a7 ,no dis*>ge1   
discrim9ation1 or retaliation ,no nurs+ 
facility may dis*>ge1 retaliate1        
discrim9ate1 or o!rwise take adv]se     
action 9 any mann] ) respect to any     
aspect ( a nurse's employm5t ) !        
facility1 includ+ dis*>ge1 promotion1   
comp5sation1 or t]ms1 conditions1 or    
privileges ( employm5t1 bas$ on !       
nurse's objection to1 or refusal (1 a "w

 assignm5t "u p>agraph 7#b74  7,b7 ,no  
fil+ ( compla9t ,no nurs+ facility may  
file a compla9t or a report aga9/ a     
nurse ) a ,/ate pr(essional discipl9>y  
ag5cy because ( ! nurse's objection to1 
or refusal (1 a "w assignm5t "u p>agraph
 7#b74  7#d7 ,cause ( action ,any nurse 
7or a collective b>ga9+ repres5tative or
 legal repres5tative ( su* nurse7 aga9/ 
:om a nurs+ facility has tak5 an adv]se 
action 9 violation ( p>agraph 7#c77;,a71
 or aga9/ :om su* facility has fil$ a   
compla9t or report 9 violation (        
p>agraph 7#c77;,b71 may 7)\t reg>d to   
:e!r a compla9t has be5 fil$ "u p>agraph
 7#e7 or 7#aj77;,b77 br+ a cause (      
action 9 an appropriate di/rict c\rt ( !
 ,unit$ ,/ates4 ,! legal burd5s ( pro(  
specifi$ 9 section #abba7;e7 ( title #e1
 ,unit$ ,/ates ,code1 %all be controll+ 
= ! purposes ( any cause ( action br\ght
 "u ?is p>agraph4 ,a nurse :o prevails  
on ! cause ( action may be entitl$ to "o
 or m ( ! foll[+3 7,a7 ,re9/atem5t4     
7,b7 ,reimbursem5t ( lo/ wages1         

comp5sation1 & b5efits4  7,c7           
,attorneys' fees4  7,d7 ,c\rt co/s4     
7,e7 ,o!r damages4  7#e7 ,compla9t to   
,secret>y ,any individual may file a    
compla9t ) ! ,secret>y aga9/ a nurs+    
facility t violates a requirem5t        
describ$ 9 p>agraph 7#c74 ,= any        
compla9t fil$1 ! ,secret>y %all-- 7,a7  
receive & inve/igate ! compla9t2  7,b7  
det]m9e :e!r a violation ( su* p>agraph1
 z alleg$ 9 ! compla9t1 has occurr$2 &  
7,c7 9 ! case t ! ,secret>y det]m9es t  
su* a violation has occurr$1 issue an   
ord] t ! compla9+ individual may n suff]
 any adv]se action prohibit$ by p>agraph
 7#c7 or 7#g74  7#f7 ,toll-,free        
telephone numb]  7,a7 ,9 g5]al ,!       
,secret>y %all provide = ! e/abli%m5t ( 
a toll-free telephone hotl9e to provide 
in=mation reg>d+ ! m9imum nurse /aff+   
requirem5ts ( clause 7ii7 ( subsection  
7b77#d77;,c7 & to receive reports (     
violations ( su* requirem5ts4  7,b7     
,notice to resid5ts ,a nurs+ facility   
%all provide ea* resid5t admitt$ to !   

facility ) ! telephone numb] ( ! hotl9e 
describ$ 9 subp>agraph 7,a7 & give      
notice to ea* su* resid5t t su* hotl9e  
may be us$ to report inadequate /aff+ or
 c>e4  7#g7 ,protection = report+  7,a7 
,prohibition on retaliation or          
discrim9ation ,a nurs+ facility may n   
retaliate or discrim9ate 9 any mann]    
aga9/ any resid5t1 employee1 or contract
 employee ( ! facility1 or any o!r      
individual1 on ! basis t su* resid5t1   
employee1 contract employee1 or         
individual 7individually or 9           
conjunction ) ano!r individual7 has1 9  
good fai?-- 7i7 pres5t$ a grievance or  
compla9t2  7ii7 initiat$ or coop]at$ 9  
any inve/igation or proce$+ ( any       
gov]nm5tal entity1 regulatory ag5cy1 or 
private accr$itation body2  7iii7 made a
 civil claim or dem&2 or  7iv7 fil$ an  
action relat+ to ! c>e1 s]vices1 or     
conditions ( ! facility4  7,b7 ,good    
fai? def9$ ,= purposes ( ?is p>agraph1  
an individual %all be deem$ to be act+ 9
 good fai? if ! individual reasonably   

believes-- 7i7 ! in=mation report$ or   
disclos$ is true2 &  7ii7 a violation ( 
! m9imum nurse /aff+ requirem5ts (      
clause 7ii7 ( subsection 7b77#d77;,c7   
has occurr$ or may occur4  7#h7         
,prohibition on int]f]5ce ) rights  7,a7
 ,ex]cise ( rights ,a nurs+ facility may
 n-- 7i7 int]f]e )1 re/ra91 or d5y !    
ex]cise1 or attempt to ex]cise1 by any  
individual ( any "r1 proc$ure1 or rem$y 
provid$ or protect$ "u ?is subsection2  
or  7ii7 co]ce or intimidate any        
individual reg>d+ ! ex]cise1 or attempt 
to ex]cise1 su* "r4  7,b7 ,opposition to
 unlawful policies or practices ,a nurs+
 facility may n retaliate or discrim9ate
 aga9/ any individual = oppos+ any      
policy1 practice1 or action ( ! facility
 :i* is alleg$ to violate1 brea*1 or    
fail to comply ) any provision ( !      
m9imum nurse /aff+ requirem5ts ( clause 
7ii7 ( subsection 7b77#d77;,c74  7,c7   
,prohibition on int]f]5ce ) protect$    
communications ,a nurs+ facility may n  
make1 adopt1 or en=ce any rule1         

regulation1 policy1 or practice :i* 9   
any mann] directly or indirectly        
prohibits1 imp$es1 or disc\rages a nurse
 f1 or intimidates1 co]ces1 or induces a
 nurse reg>d+1 engag+ 9 free spee*      
activities or disclos+ in=mation z      
provid$ "u ?is subsection4  7,d7        
,prohibition on int]f]5ce ) collective  
action ,a nurs+ facility may n 9 any way
 int]f]e ) ! rights ( nurses to         
organize1 b>ga9 collectively1 & engage 9
 conc]t$ activity "u section #g ( !     
,national ,labor ,relations ,act 7#bi   
,u4,s4,c4 #aeg74  7#i7 ,notice ,a nurs+ 
facility %all po/ 9 an appropriate      
location 9 ea* unit a conspicu\s notice1
 9 a =m specifi$ by ! ,secret>y1 t--    
7,a7 expla9s ! rights ( nurses1         
resid5ts1 & o!r individuals "u ?is      
subsection2  7,b7 includes a /atem5t t a
 nurse1 resid5t1 or o!r individual may  
file a compla9t ) ! ,secret>y aga9/ !   
facility = a violation ( a requirem5t or
 a prohibition ( ?is subsection2 &  7,c7
 provides in/ructions on h[ to file su* 

a compla9t4  7#aj7 ,en=cem5t  7,a7 ,9   
g5]al ,! ,secret>y %all en=ce !         
requirem5ts & prohibitions ( ?is        
subsection 9 accordance ) ?is p>agraph4 
7,b7 ,proc$ures = receiv+ & inve/igat+  
compla9ts ,! ,secret>y %all e/abli%     
proc$ures "u :i*-- 7i7 any individual   
may file a compla9t alleg+ t a nurs+    
facility has violat$ a requirem5t or a  
prohibition ( ?is subsection2 &  7ii7   
any su* compla9t %all be inve/igat$ by !
 ,secret>y4  7,c7 ,rem$ies ,if !        
,secret>y det]m9es t a nurs+ facility   
has violat$ a requirem5t or prohibition 
( ?is subsection1 ! ,secret>y-- 7i7 %all
 require ! facility to e/abli% a        
corrective action plan to prev5t !      
recurr5ce ( su* violation2 &  7ii7 may  
impose civil money p5alties z describ$ 9
 subp>agraph 7,d74  7,d7 ,civil p5alties
  7i7 ,9 g5]al ,9 addition to any o!r   
p5alties prescrib$ by law1 ! ,secret>y  
may impose civil p5alties z foll[s3 7,i7
 ,nurs+ facility liability ,! ,secret>y 
may impose on a nurs+ facility f\nd to  

be 9 violation ( ?is subsection a civil 
money p5alty (-- 7aa7 n m ?an #be1jjj = 
! fir/ kn[+ violation ( ?is subsection  
by su* facility2 &  7bb7 n m ?an #ej1jjj
 = any subsequ5t kn[+ violation ( ?is   
subsection by su* facility4  7,,ii7     
,individual liability ,! ,secret>y may  
impose on an individual :o-- 7aa7 is    
employ$ by a nurs+ facility2 &  7bb7 is 
f\nd by ! ,secret>y to h kn[+ly violat$ 
?is subsection on behalf ( ! facility1  
a civil money p5alty ( n m ?an #bj1jjj =
 ea* su* violation by ! individual4     
7ii7 ,proc$ures ,! provisions ( section 
#aabh;,a ( ! ,social ,security ,act 7o!r
 ?an subsections 7a7 & 7b77 %all apply )
 respect to a civil money p5alty or     
proce$+ "u ?is subp>agraph 9 ! same     
mann] z su* provisions apply ) respect  
to a civil money p5alty or proce$+ "u   
su* section #aabh;,a4  7,e7 ,public     
notice ( violations  7i7 ,int]net       
website ,! ,secret>y %all publi% on !   
int]net website ( ! ,dep>tm5t ( ,heal? &
 ,human ,s]vices ! names ( nurs+        

facilities on :i* a civil money p5alty  
has be5 impos$ "u ?is subsection1 !     
violation = :i* su* p5alty 0 impos$1 &  
su* additional in=mation z ! ,secret>y  
det]m9es appropriate4  7ii7 ,*ange (    
own]%ip ,) respect to a nurs+ facility t
 _h a *ange ( own]%ip1 z det]m9$ by !   
,secret>y1 p5alties impos$ on ! facility
 :ile "u previ\s own]%ip %all no long]  
be publi%$ by ! ,secret>y pursuant to   
clause 7i7 aft] ! #a-ye> p]iod beg9n+ on
 ! date ( su* *ange ( own]%ip4  7,f7    
,use ( funds ,funds collect$ by !       
,secret>y pursuant to ?is subsection are
 au?oriz$ to be appropriat$ to implem5t 
! m9imum nurse /aff+ requirem5ts (      
clause 7ii7 ( subsection 7b77#d77;,c74  
7#aa7 ,nurse def9$ ,9 ?is subsection1 ! 
t]m nurse means a regi/]$ pr(essional   
nurse1 a lic5s$ practical nurse1 & a    
nurse aide4  4  7c7 ,effective date ,!  
am5dm5ts made by ?is section take effect
 on ! date ( enactm5t ( ?is ,act & %all 
apply ) respect to objections to or     
refusals ( "w assignm5ts1 compla9ts1    

retaliations & o!r adv]se actions1 &    
int]f]5ces ) rights t occur on or aft] !
 date t is "o ye> aft] su* date (       
enactm5t & ) respect to notices provid$ 
on or aft] ! date t is "o ye> aft] su*  
date ( enactm5t4  #bjf4 ,prohibit+      
pre-dispute arbitration agreem5ts  7a7  
,m$ic>e ,section #ahai7;c7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;c77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#g7        
,prohibition on use ( pre-dispute       
arbitration agreem5ts  7,a7 ,9 g5]al ,a 
skill$ nurs+ facility may n require1    
solicit1 accept1 or move to en=ce a     
pre-dispute arbitration agreem5t f or on
 behalf ( any resid5t1 :e!r ! agreem5t  
is made be=e1 dur+1 or aft] ! resid5t's 
admission to ! facility1 or f or on     
behalf ( any employee1 or contract      
employee ( ! facility1 or any o!r       
individual if su* individual is alleg$  
to be engag$ 9 conduct protect$ "u      
subsection 7l74  7,b7 ,application ,?is 
p>agraph %all apply to ! skill$ nurs+   

facility & to any o!r bus9ess or p]son  
provid+ or responsible = provid+ skill$ 
nurs+ s]vices to ! resid5t4  7,c7 ,no   
validity or en=cem5t ,a pre-dispute     
arbitration agreem5t %all n be valid or 
specifically en=ceable aga9/ a resid5t  
or =m] resid5t ( a skill$ nurs+         
facility1 )\t reg>d to :e!r ! agreem5t 0
 made prior to or aft] ! effective date 
( ?is p>agraph4  7,d7 ,def9ition (      
pre-dispute arbitration agreem5t ,9 ?is 
p>agraph1 ! t]m pre-dispute arbitration 
agreem5t means any agreem5t to arbitrate
 a dispute :5 ! dispute has aris5 aft]  
su* agreem5t has be5 made4  7,e7        
,judicial review ,a det]m9ation z to    
:e!r & h[ ?is p>agraph applies to an    
arbitration agreem5t %all be det]m9$ "u 
,f$]al law by a c\rt ( compet5t         
jurisdiction1 r ?an an arbitrator1 )\t  
reg>d to :e!r ! p>ty oppos+ arbitration 
*all5ges su* agreem5t specifically or 9 
conjunction ) any o!r t]m ( ! contract  
conta9+ su* agreem5t4  4  7b7 ,m$icaid  
7#a7 ,home & community-bas$ s]vices &   

home heal? c>e s]vices ,section #aiae ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acifn7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7m7 ,prohibit+  
pre-,dispute arbitration agreem5ts  7#a7
 ,9 g5]al ,= home & community-bas$      
s]vices or home heal? c>e s]vices       
provid$ "u a waiv] "u ?is section1      
section #aijb7;a77#aj77;,d71 or any o!r 
provision au?oriz+ ! provision ( home & 
community-bas$ s]vices or home heal? c>e
 s]vices "u ?is title1 ! provid] ( su*  
s]vices 7& any employee1 ag5t1 relat$   
entity1 or affiliate ( su* provid]7 %all
 n require1 solicit1 or accept a        
pre-dispute arbitration agreem5t f or on
 behalf ( any individual receiv+ su*    
s]vices1 :e!r ! agreem5t is made be=e1  
dur+1 or aft] ! fir/ date on :i* s]vices
 are receiv$1 or f or on behalf ( any   
employee1 or contract employee ( !      
provid]1 or any o!r individual if su*   
individual is alleg$ to be engag$ 9     
conduct protect$ "u section #aiai7l74 ,a
 pre-dispute arbitration agreem5t betwe5

 su* a provid] 7or entity or p]son7 & an
 individual receiv+ s]vices 7or :o =m]ly
 receiv$ s]vices7 %all n be valid or    
en=ceable1 )\t reg>d to :e!r su*        
agreem5t 0 made prior to ! effective    
date ( ?is subsection4  7#b7 ,def9ition 
( pre-dispute arbitration agreem5t ,!   
t]m pre-dispute arbitration agreem5t    
means any agreem5t to arbitrate a       
dispute :5 ! dispute has aris5 aft] su* 
agreem5t has be5 made4  7#c7 ,judicial  
review ,a det]m9ation z to :e!r & h[ ?is
 subsection applies to an arbitration   
agreem5t %all be det]m9$ "u ,f$]al law  
by a c\rt ( compet5t jurisdiction1 r ?an
 an arbitrator1 )\t reg>d to :e!r ! p>ty
 oppos+ arbitration *all5ges su*        
agreem5t specifically or 9 conjunction )
 any o!r t]m ( ! contract conta9+ su*   
agreem5t4  4  7#b7 ,nurs+ facilities    
,section #aiai7;c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7c77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#i7 ,prohibition on use ( pre-dispute
 arbitration agreem5ts  7,a7 ,9 g5]al ,a

 nurs+ facility may n require1 solicit1 
accept1 or move to en=ce a pre-dispute  
arbitration agreem5t f or on behalf (   
any resid5t1 :e!r ! agreem5t is made    
be=e1 dur+1 or aft] ! resid5t's         
admission to ! facility1 or f or on     
behalf ( any employee1 or contract      
employee ( ! facility1 or any o!r       
individual if su* individual is alleg$  
to be engag$ 9 conduct protect$ "u      
subsection 7l74  7,b7 ,application ,?is 
p>agraph %all apply to ! nurs+ facility 
& to any o!r bus9ess or p]son provid+ or
 responsible = provid+ nurs+ s]vices to 
! resid5t4  7,c7 ,no validity or        
en=cem5t ,a pre-dispute arbitration     
agreem5t %all n be valid or specifically
 en=ceable aga9/ a resid5t or =m]       
resid5t ( a nurs+ facility1 )\t reg>d to
 :e!r ! agreem5t 0 made prior to or aft]
 ! effective date ( ?is p>agraph4  7,d7 
,def9ition ( pre-dispute arbitration    
agreem5t ,9 ?is p>agraph1 ! t]m         
pre-dispute arbitration agreem5t means  
any agreem5t to arbitrate a dispute :5 !

 dispute has aris5 aft] su* agreem5t has
 be5 made4  7,e7 ,judicial review ,a    
det]m9ation z to :e!r & h[ ?is p>agraph 
applies to an arbitration agreem5t %all 
be det]m9$ "u ,f$]al law by a c\rt (    
compet5t jurisdiction1 r ?an an         
arbitrator1 )\t reg>d to :e!r ! p>ty    
oppos+ arbitration *all5ges su* agreem5t
 specifically or 9 conjunction ) any o!r
 t]m ( ! contract conta9+ su* agreem5t4 
4  #bjg4 ,/&>diz$ protocol = obta9+     
in=m$ cons5t f resid5ts prior to        
prescrib+ psy*otropic drugs  7a7        
,/&>diz$ protocol  7#a7 ,skill$ nurs+   
facilities ,section #ahai7;b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;b77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#i7        
,/&>diz$ protocol = obta9+ in=m$ cons5t 
f a resid5t prior to prescrib+          
psy*otropic drugs = a use n approv$ by !
 ,food & ,drug ,adm9i/ration  7,a7      
,protocol ,n lat] ?an ! date t is "o ye>
 aft] ! date ( ! enactm5t ( ?is         
p>agraph1 ! ,secret>y1 tak+ into acc\nt 

! results ( ! /udy conduct$ by !        
,comptroll] ,g5]al ( ! ,unit$ ,/ates "u 
section #h7;a77#c7 ( ! ,quality ,c>e =  
,nurs+ ,home ,resid5ts & ,work]s ,dur+  
,,covid-#ai & ,beyond ,act & 9          
consultation ) /akehold] gr\ps 7includ+ 
resid5ts ( skill$ nurs+ facilities1     
family memb]s ( su* resid5ts1 advocates 
= su* resid5ts1 long-t]m c>e ombudsm51 &
 provid]s71 %all develop a /&>diz$      
protocol = skill$ nurs+ facilities to   
obta9 writt5 in=m$ cons5t1 9 accordance 
) ?is p>agraph1 f a resid5t 7or1 if     
applicable1 ! resid5t's designat$ heal? 
c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 prior to prescrib+ a     
psy*otropic drug to ! resid5t = a use n 
approv$ by ! ,food & ,drug              
,adm9i/ration4  7,b7 ,requirem5ts ,!    
/&>diz$ protocol develop$ "u subp>agraph
 7,a7 %all include ! foll[+3 7i7 ,a     
requirem5t1 ) respect to a resid5t1 t-- 
7,i7 ! facility1 ) ! involvem5t ( !     
prescrib]1 in=m ! resid5t 7or1 if       
applicable1 ! resid5t's designat$ heal? 

c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 (-- 7aa7 possible side   
effects & risks associat$ ) !           
psy*otropic drug1 includ+ ! m5tion ( any
 black box w>n+2  7bb7 treatm5t         
modalities t 7 attempt$ prior to ! use (
 ! psy*otropic drug2 &  7cc7 any o!r    
in=mation ! ,secret>y det]m9es          
appropriate2  7,,ii7 ! resid5t 7or1 if  
applicable1 ! resid5t's designat$ heal? 
c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 provide writt5 in=m$     
cons5t to ! adm9i/ration ( ! psy*otropic
 drug2 &  7,,iii7 ! adm9i/ration ( !    
psy*otropic drug is 9 accordance ) any  
plan ( c>e t ! resid5t has 9 place1     
includ+ non-ph>macological int]v5tions z
 appropriate t c effectively address    
und]ly+ m$ical & environm5tal causes (  
behavioral disord]s4  7ii7 ,an          
alt]native protocol = obta9+ su* writt5 
in=m$ cons5t-- 7,i7 9 ! case (          
em]g5cies2 &  7,,ii7 9 ! abs5ce ( a     
cle>ly id5tifi$ designat$ heal? c>e ag5t
 or o!r surrogate "u ,/ate law or       

regulation4  7iii7 ,o!r items det]m9$   
appropriate by ! ,secret>y4  7,c7 ,tim+ 
( in=m$ cons5t ,"u ! /&>diz$ protocol1 a
 skill$ nurs+ facility %all obta9 !     
writt5 in=m$ cons5t describ$ 9          
subp>agraph 7,a71 ) respect to a        
psy*otropic drug & a resid5t ( !        
facility-- 7i7 prior to ! initial       
prescrib+ ( su* psy*otropic drug to su* 
resid5t if su* resid5t does n h a curr5t
 prescription = su* psy*otropic drug at 
! "t su* resid5t is admitt$ to !        
facility2 &  7ii7 at lea/ once a mon? to
 ! ext5t t ! adm9i/ration ( su*         
psy*otropic drug to su* resid5t is 9    
accordance ) ! plan ( c>e t ! resid5t   
has 9 place4  7,d7 ,compliance          
,effective beg9n+ on ! date t is "o ye> 
& #ahj days aft] ! date ( ! enactm5t (  
?is p>agraph1 a skill$ nurs+ facility   
%all comply ) ! /&>diz$ protocol        
develop$ "u subp>agraph 7,a74  7,e7 ,no 
preemption ,no?+ 9 ?is p>agraph %all    
preempt any provision ( ,/ate or ,f$]al 
law t provides broad] rights ) respect  

to writt5 in=m$ cons5t = resid5ts (     
facilities4  4  7#b7 ,nurs+ facilities  
,section #aiai7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7b77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#i7 ,/&>diz$ protocol = obta9+ in=m$ 
cons5t f a resid5t prior to prescrib+   
psy*otropic drugs = a use n approv$ by !
 ,food & ,drug ,adm9i/ration  7,a7      
,protocol ,n lat] ?an ! date t is "o ye>
 aft] ! date ( ! enactm5t ( ?is         
p>agraph1 ! ,secret>y1 tak+ into acc\nt 
! results ( ! /udy conduct$ by !        
,comptroll] ,g5]al ( ! ,unit$ ,/ates "u 
section #h7;a77#c7 ( ! ,quality ,c>e =  
,nurs+ ,home ,resid5ts & ,work]s ,dur+  
,,covid-#ai & ,beyond ,act & 9          
consultation ) /akehold] gr\ps 7includ+ 
resid5ts ( skill$ nurs+ facilities1     
family memb]s ( su* resid5ts1 advocates 
= su* resid5ts1 long-t]m c>e ombudsm51 &
 provid]s71 %all develop a /&>diz$      
protocol = nurs+ facilities to obta9    
writt5 in=m$ cons5t1 9 accordance ) ?is 
p>agraph1 f a resid5t 7or1 if           

applicable1 ! resid5t's designat$ heal? 
c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 prior to prescrib+ a     
psy*otropic drug to ! resid5t = a use n 
approv$ by ! ,food & ,drug              
,adm9i/ration4  7,b7 ,requirem5ts ,!    
/&>diz$ protocol develop$ "u subp>agraph
 7,a7 %all include ! foll[+3 7i7 ,a     
requirem5t1 ) respect to a resid5t1 t-- 
7,i7 ! facility1 ) ! involvem5t ( !     
prescrib]1 in=m ! resid5t 7or1 if       
applicable1 ! resid5t's designat$ heal? 
c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 (-- 7aa7 possible side   
effects & risks associat$ ) !           
psy*otropic drug1 includ+ ! m5tion ( any
 black box w>n+2  7bb7 treatm5t         
modalities t 7 attempt$ prior to ! use (
 ! psy*otropic drug2 &  7cc7 any o!r    
in=mation ! ,secret>y det]m9es          
appropriate2  7,,ii7 ! resid5t 7or1 if  
applicable1 ! resid5t's designat$ heal? 
c>e ag5t or o!r surrogate "u ,/ate law  
or regulation7 provide writt5 in=m$     
cons5t to ! adm9i/ration ( ! psy*otropic

 drug2 &  7,,iii7 ! adm9i/ration ( !    
psy*otropic drug is 9 accordance ) any  
plan ( c>e t ! resid5t has 9 place1     
includ+ non-ph>macological int]v5tions z
 appropriate t c effectively address    
und]ly+ m$ical & environm5tal causes (  
behavioral disord]s4  7ii7 ,an          
alt]native protocol = obta9+ su* writt5 
in=m$ cons5t-- 7,i7 9 ! case (          
em]g5cies2 &  7,,ii7 9 ! abs5ce ( a     
cle>ly id5tifi$ designat$ heal? c>e ag5t
 or o!r surrogate "u ,/ate law or       
regulation4  7iii7 ,o!r items det]m9$   
appropriate by ! ,secret>y4  7,c7 ,tim+ 
( in=m$ cons5t ,"u ! /&>diz$ protocol1 a
 nurs+ facility %all obta9 ! writt5     
in=m$ cons5t describ$ 9 subp>agraph     
7,a71 ) respect to a psy*otropic drug & 
a resid5t ( ! facility-- 7i7 prior to ! 
initial prescrib+ ( su* psy*otropic drug
 to su* resid5t if su* resid5t does n h 
a curr5t prescription = su* psy*otropic 
drug at ! "t su* resid5t is admitt$ to !
 facility2 &  7ii7 at lea/ once a mon?  
to ! ext5t t ! adm9i/ration ( su*       

psy*otropic drug to su* resid5t is 9    
accordance ) ! plan ( c>e t ! resid5t   
has 9 place4  7,d7 ,compliance          
,effective beg9n+ on ! date t is "o ye> 
& #ahj days aft] ! date ( ! enactm5t (  
?is p>agraph1 a nurs+ facility %all     
comply ) ! /&>diz$ protocol develop$ "u 
subp>agraph 7,a74  7,e7 ,no preemption  
,no?+ 9 ?is p>agraph %all preempt any   
provision ( ,/ate or ,f$]al law t       
provides broad] rights ) respect to     
writt5 in=m$ cons5t = resid5ts (        
facilities4  4  7#c7 ,,gao /udy & report
 on in=m$ cons5t laws ) respect to      
prescrib+ ( psy*otropic drugs  7,a7     
,/udy ,! ,comptroll] ,g5]al ( ! ,unit$  
,/ates 79 ?is p>agraph ref]r$ to z !    
,comptroll] ,g5]al7 %all conduct a /udy 
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