,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #hfbd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #bi1 #bjbb,ms4  
,s*ak[sky 7= h]self & ,mr4 ,takano7     
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xi ( ! ,social
 ,security ,act to provide = additional 
requirem5ts = disclos+ entities relat+  
to ! quality ( c>e furni%$ at skill$    
nurs+ facilties & nurs+ facilites1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,l9k+ ,inve/ors &      
,nurs+ ,home ,quality ,act or ! ,,l9hq  
,act4  #b4 ,regulat+ own]%ip ( skill$   
nurs+ facilities & nurs+ facilities  7a7
 ,requirem5t ,to submit timely          
disclosures ,to admit new resid5ts (    
skill$ nurs+ facilities & nurs+         
facilities ,section #aabd ( ! ,social   

,security ,act 7#db ,u4,s4,c4           
#acbj;a-#c7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7d7 ,susp5sion (
 c]ta9 paym5ts = c]ta9 entities t fail  
,to submit timely own]%ip disclosures   
7#a7 ,9 g5]al ,9 ! case ( a cov]$ nurs+ 
facility t fails to submit specifi$     
in=mation to ! ,secret>y by ! date t is 
#cj days aft] ! date t su* in=mation is 
requir$ to be submitt$ pursuant to      
regulations or contract provisions      
describ$ 9 subsection 7a77#a7 7or1 9 !  
case ( a p>ty ) an own]%ip int]e/ 9 su* 
facility t fails to submit in=mation to 
! ,secret>y 9 accordance ) p>agraph     
7#c77-- 7,a7 ! ,secret>y %all susp5d    
paym5t "u title ,,xviii ) respect to    
items & s]vices furni%$ to a specifi$   
resid5t dur+ ! applicable paym5t        
susp5sion p]iod2 &  7,b7 ! ,secret>y    
%all susp5d paym5t "u title ,,xix =     
m$ical assi/ance consi/+ ( items &      
s]vices furni%$ by su* facility to su* a
 resid5t dur+ su* p]iod4  7#b7 ,quality 
review  7,a7 ,9 g5]al ,! ,secret>y %all1

 ) respect to ea* cov]$ nurs+ facility1 
on a p]iodic basis1 conduct a review ( !
 quality ( c>e furni%$ by ea* su*       
facility us+ in=mation report$ by su* a 
facility z "p ( a survey conduct$ "u    
section #ahai7;g7 or #aiai7;g7 or z "p (
 ! m9imum data set describ$ 9 section   
#ahai7;f77#f7 or #aiai7;f77#f74 ,=      
purposes ( conduct+ su* reviews1 !      
,secret>y %all e/abli% quality metrics  
relat+ to su* in=mation to evaluate ea* 
su* facility4  7,b7 ,quality metrics    
7i7 ,9 g5]al ,= purposes ( subp>agraph  
7,a71 ! quality metrics describ$ 9 ?is  
subp>agraph are quality metrics specifi$
 by ! ,secret>y1 tak+ into acc\nt input 
f ! ,data ,liaison ,team e/abli%$ "u    
section #b7;c7 ( ! ,,l9hq ,act1 t may be
 us$ to evaluate ! in=mation describ$ 9 
subp>agraph 7,a74 ,su* metrics %all     
include a metric ) respect to ! av]age  
numb] ( direct c>e h\rs furni%$ to      
resid5ts4  7ii7 ,specification ,!       
,secret>y %all publi% on a public       
website ea* quality measure specifi$ "u 

?is subp>agraph at lea/ #ahj days prior 
to su* quality metric be+ us$ 9 a       
quality review "u ?is p>agraph1 except  
t1 ) respect to su* reviews beg9n+ dur+ 
! #a-ye> p]iod beg9n+ on ! date ( !     
enactm5t ( ?is subsection1 ! ,secret>y  
may use any su* metric t ! ,secret>y    
publi%es on su* a website at lea/ #ad   
days prior to ! beg9n+ ( su* review4    
7,c7 ,e/abli%m5t ( /&>ds ,! ,secret>y   
%all specify /&>ds ) respect to quality 
measures describ$ 9 subp>agraph 7,b71   
tak+ into acc\nt input f ! ,data        
,liaison ,team s describ$4 ,su* /&>ds   
%all include1 ) respect to ! metric     
relat+ to ! av]age numb] ( direct c>e   
h\rs furni%$ to resid5ts1 a /&>d ( at   
lea/ #d4a direct c>e h\rs furni%$ p]    
resid5t p] day4  7,d7 ,notification &   
publication ( facilities fall+ bel[     
/&>ds ,if ! ,secret>y det]m9es t a cov]$
 nurs+ facility has fail$ to meet a /&>d
 e/abli%$ "u subp>agraph 7,c7 ) respect 
to a quality measure describ$ 9         
subp>agraph 7,b7 pursuant to a review   

conduct$ "u ?is p>agraph1 ! ,secret>y   
%all-- 7i7 notify su* facility ( su*    
det]m9ation2  7ii7 publi% ! "n ( su*    
facility on ! ,c>e ,comp>e website 7or a
 successor website7 describ$ 9 section  
#ahai7;i7 ) an explanation t su*        
facility has fail$ to meet su* /&>d2 &  
7iii7 susp5d paym5t "u title ,,xviii to 
su* facility1 & paym5t "u title ,,xix = 
m$ical assi/ance furni%$ by su*         
facility1 until su* facility demon/rates
 t su* facility has met su* /&>d4  7#c7 
,submission ( ?ird-p>ty in=mation ,!    
,secret>y %all e/abli% a process "u :i*1
 ) respect to a cov]$ nurs+ facility1   
any p>ty t has an own]%ip int]e/ 9 su*  
facility & t also has an own]%ip int]e/ 
9 an entity t contracts ) su* facility  
to provide any s]vice to su* facility   
submits to ! ,secret>y ! foll[+         
in=mation3 7,a7 ,a balance %eet detail+ 
! assets1 liabilities1 & net wor? ( !   
entity4  7,b7 ,a /atem5t ( income1      
exp5ses1 & op]at+ surplus or deficit4   
7,c7 ,a /atem5t ( ca%fl[s1 includ+ ongo+

 & new capital exp5ditures &            
depreciation4  7#d7 ,submission (       
additional info by facilities ,!        
,secret>y %all require a cov]$ nurs+    
facility1 z "p ( ! in=mation submitt$ "u
 subsection 7a77#a71 to provide to !    
,secret>y a detail$ docum5t outl9+ a    
visual repres5tation ( ! facility's     
/ructure t includes bo? ( ! foll[+3 7,a7
 ,any entity 9 :i* any p>ty t has an    
own]%ip or control int]e/ 9 ! cov]$     
nurs+ facility & t also has an own]%ip  
int]e/ or control int]e/ ( #e p]c5t or m
 9 su* entity t provides any s]vice1    
facility1 or supply to su* cov]$ nurs+  
facility4  7,b7 ,unrelat$ p>ties t      
provide s]vices to su* facility or to   
facilities t are op]at$1 conduct$1 own$1
 manag$1 or ma9ta9$ by ! organization1  
includ+ managem5t companies & prop]ty   
companies1 & t are paid m ?an #bjj1jjj  
by su* facility4  7#e7 ,def9itions ,9   
?is subsection3 7,a7 ,applicable paym5t 
susp5sion p]iod ,! t]m applicable paym5t
 susp5sion p]iod means1 ) respect to    

specifi$ in=mation requir$ to be        
submitt$ by a cov]$ nurs+ facility      
pursuant to regulations or contract     
provisions describ$ 9 subsection 7a77#a7
 7or ) respect to ?ird-p>ty in=mation   
requir$ to be submitt$ by a p>ty ) an   
own]%ip int]e/ 9 su* facility71 ! p]iod 
beg9n+ on ! day t is #cj days aft] !    
date t su* in=mation is requir$ to be s 
submitt$ by su* facility 7or p>ty7 &    
end+ on ! date t is #e days aft] su*    
facility 7or p>ty7 submits su*          
in=mation4  7,b7 ,cov]$ nurs+ facility  
,! t]m cov]$ nurs+ facility means a     
skill$ nurs+ facility 7z def9$ 9 section
 #ahai7;a77#a77 or a nurs+ facility 7z  
def9$ 9 section #aiai7;a77#a774  7,c7   
,specifi$ in=mation ,! t]m specifi$     
in=mation means any in=mation requir$ to
 be submitt$ "u subsection 7a77#a74     
7,d7 ,specifi$ resid5t ,! t]m specifi$  
resid5t means a resid5t ( a cov]$ nurs+ 
facility :o is admitt$ to su* facility  
dur+ an applicable paym5t susp5sion     
p]iod ) respect to su* facility4  7,e7  

,own]%ip int]e/ ,! t]m own]%ip int]e/   
means a direct or indirect int]e/ ( at  
lea/ #e p]c5t4  4  7b7 ,requir+ annual  
report+ = disclos+ entities ,section    
#aabd7;c77#c77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acbj;a-#c7;c77#c77;,a77 is am5d$ by    
add+ at ! end ! foll[+ new s5t5ce3 ,!   
,secret>y %all1 n lat] ?an #ij days aft]
 ! date ( ! enactm5t ( ?is s5t5ce1 am5d 
su* regulations to provide t su*        
in=mation is report$ n less frequ5tly   
?an annually44  7c7 ,increas+ ov]sight (
 facilities  7#a7 ,data ,liaison ,team  
7,a7 ,9 g5]al ,n lat] ?an #ahj days aft]
 ! date ( ! enactm5t ( ?is ,act1 !      
,secret>y ( ,heal? & ,human ,s]vices 79 
?is subsection ref]r$ to z ! ,secret>y7 
%all e/abli% a task =ce 79 ?is p>agraph1
 ref]r$ to z ! ,data ,liaison ,team7 to 
c>ry out ! activities describ$ 9        
subp>agraph 7,b74  7,b7 ,activities     
describ$ ,= purposes ( subp>agraph 7,a71
 ! activities describ$ 9 ?is subp>agraph
 are-- 7i7 review+ in=mation submitt$ "u

 section #aabd ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;a-#c7 to      
id5tify any common own]%ip patt]ns )    
respect to skill$ nurs+ facilities' 7z  
def9$ 9 section #ahai7;a77#a7 ( su* ,act
 7#db ,u4,s4,c4 #acie;i-#c7;a77#a777 &  
nurs+ facilities' 7z def9$ 9 section    
#aiai7;a77#a7 ( su* ,act 7#db ,u4,s4,c4 
#acifr7a77#a777 t-- 7,i7 are at lea/ #cj
 days del9qu5t 9 supply+ ! own]%ip      
in=mation requir$ pursuant to section   
#aabd7;a77#a7 ( su* ,act 7#db ,u4,s4,c4 
#acbj;a-#c7;a77#a772  7,,ii7 9 ! prec$+ 
qu>t]ly report+ p]iod1 fail$ to meet a  
payroll bas$ j\rnal level ( #d4a h\rs ( 
direct resid5t c>e h\rs 7includ+ regi/]$
 nurse1 lic5s$ practical nurse1 & nurs+ 
assi/ant or c]tifi$ nurs+ assi/ant c>e7 
p] resid5t p] day2 or  7,,iii7 9 !      
prec$+ ye> ( report+1 fail$ to meet any 
quality /&>d e/abli%$ by ! ,secret>y "u 
subsection 7d7 ( su* section or e/abli%$
 by ! ,secret>y or a ,/ate ) respect to 
surveys conduct$ "u section #ahai7;g7 or
 #aiai7;g7 ( su* ,act 7#db ,u4,s4,c4    

#acie;i-#c7;g72 #db ,u4,s4,c4           
#acifr7g772  7ii7 assess+ pot5tial      
misuse ( paym5ts "u titles ,,xviii &    
,,xix ( su* ,act 7#db ,u4,s4,c4 #acie et
 seq42 #acif et seq47 ?r\gh review (    
data collect$ by ! ,treasury ,dep>tm5t1 
facility organization *>ts1 & co/       
reports submitt$ "u su* title ,,xviii2  
7iii7 on a mon?ly basis1 report+ any    
disclos+ entities 7z def9$ = purposes ( 
section #aabd ( su* ,act 7#db ,u4,s4,c4 
#acbj;a-#c77 ) common own]%ip id5tifi$  
pursuant to clause 7i71 or ) respect to 
:i* ! ,team has f\nd a pot5tial misuse (
 paym5ts pursuant to clause 7ii71 to !  
,int]ag5cy ,bo>d1 ! ,(fice ( ,inspector 
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 & ! ,dep>tm5t ( ,ju/ice2  7iv7
 regul>ly review+ skill$ nurs+          
facilities & nurs+ facilities ) a "o-/> 
rat+ 9 heal? inspections or /aff+ on !  
,c>e ,comp>e website 7or a successor    
website7 describ$ 9 section #ahai7;i7 ( 
su* ,act 7#db ,u4,s4,c4 #acie;i-#c7;i771
 z well z su* facilities t are rank$    

among ! l[e/ #bj p]c5t ( facilities on  
su* website ) respect to quality2 &  7v7
 at ! discretion ( ! ,data ,liaison     
,team1 requir+ skill$ nurs+ facilities &
 nurs+ facilities to submit to ! ,team  
in=mation on :e!r su* facilities-- 7,i7 
d bus9ess 7includ+ bus9ess relat+ to    
laundry s]vices1 /aff+ ag5cies1 food &  
bev]age s]vices1 m$ical supplies1 or    
consult+7 ) any o!r entity 7includ+ a   
specification ( su* o!r entity72  7,,ii7
 lease _! build+ or prop]ty f ano!r     
entity 7includ+ a specification ( su*   
o!r entity72 or  7,,iii7 %>e an         
individual :o has directly or indirectly
 7z det]m9$ by ! ,secret>y pursuant to a
 notice & comm5t rulemak+7 any own]%ip  
int]e/ ( #e p]c5t or m 9 an entity      
describ$ 9 subclause 7,,ii7 & ! skill$  
nurs+ facility or nurs+ facility4  7,c7 
,provision ( in=mation  7i7 ,treasury   
in=mation ,= purposes ( subp>agraph     
7,b77ii71 ! ,secret>y ( ! ,treasury %all
 furni% to ! ,data ,liaison ,team su*   
in=mation z su* ,team may reque/4  7ii7 

,facility in=mation ,= purposes (       
subp>agraph 7,b77v71 a skill$ nurs+     
facility or nurs+ facility %all submit  
to ! ,data ,liaison ,team su* in=mation 
z may be reque/$ by ! ,team4 ,any       
failure to submit su* in=mation %all be 
deem$ to con/itute a violation ( section
 #aabd7;a77#a7 ( su* ,act 7#db ,u4,s4,c4
 #acbj;a-#c7;a77#a774  7,d7 ,composition
  7i7 ,9 g5]al ,! ,data ,liaison ,team  
%all consi/ (-- 7,i7 ! ,adm9i/rator ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices ( ! 
,dep>tm5t ( ,heal? & ,human ,s]vices 7or
 designee72 &  7,,ii7 any o!r employees 
( ! ag5cy specifi$ 9 subclause 7,i7 7z  
det]m9$ appropriate by ! ,secret>y74    
7ii7 ,manag] ,an employee ( ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices ( ! ,dep>tm5t
 ( ,heal? & ,human ,s]vices %all manage 
! ,data ,liaison ,team4  7#b7 ,int]ag5cy
 ,bo>d  7,a7 ,9 g5]al ,n lat] ?an #ahj  
days aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all e/abli% a task =ce 79 ?is 
p>agraph1 ref]r$ to z ! ,int]ag5cy      

,bo>d7 to c>ry out ! activities describ$
 9 subp>agraph 7,b74  7,b7 ,activities  
describ$ ,= purposes ( subp>agraph 7,a71
 ! activities describ$ 9 ?is subp>agraph
 are-- 7i7 review+ ! li/ ( disclos+     
entities report$ pursuant to p>agraph   
7#a77;,b77iii7 to det]m9e :i* entities  
to ref] to ! ,(fice ( ,inspector ,g5]al 
( ! ,dep>tm5t ( ,heal? & ,human ,s]vices
 & ! ,dep>tm5t ( ,ju/ice = fur!r        
inve/igation2  7ii7 report+ any su*     
ref]rals to ! ,data ,liaison ,team1 & ! 
reason+ = any su* ref]rals1 n lat] ?an  
#g days aft] su* a ref]ral is made2 &   
7iii7 on an biannual basis1 submitt+ to 
,congress a report on ! f9d+s made by & 
results f any ref]rals made by !        
,int]ag5cy ,bo>d1 includ+ any reason = n
 pursu+ action on ref]rals 9 ! ev5t t   
action 0 n tak5 7if ! ,int]ag5cy ,bo>d  
has be5 in=m$ ( su* reason74  7,c7      
,composition  7i7 ,9 g5]al ,! ,int]ag5cy
 ,bo>d %all consi/ (-- 7,i7 !           
,adm9i/rator ( ,c5t]s = ,m$ic>e         
,m$icaid ,s]vices ( ! ,dep>tm5t ( ,heal?

 & ,human ,s]vices 7or designee72       
7,,ii7 ! ,inspector ,g5]al ( ! ,(fice ( 
! ,inspector ,g5]al ( ! ,dep>tm5t (     
,heal? & ,human ,s]vices 7or designee72 
7,,iii7 ! ,attorney ,g5]al ( ! ,dep>tm5t
 ( ,ju/ice 7or designee72 &  7,,iv7 any 
o!r employees ( ! ag5cies specifi$ 9    
subclauses 7,i7 ?r\gh 7,,iii7 7z det]m9$
 appropriate by ! ,secret>y ( ,heal? &  
,human ,s]vices74  7ii7 ,*air ,an       
employee ( ! ,(fice ( ,inspector ,g5]al 
( ! ,dep>tm5t ( ,heal? & ,human ,s]vices
 %all *air ! ,int]ag5cy ,bo>d4  #c4     
,fund+ = national demon/ration projects 
on culture *ange & use ( in=mation      
te*nology 9 nurs+ homes ,section #faad (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act 7#db ,u4,s4,c4 #acie;i-#c note7 is 
am5d$-- 7#a7 9 subsection 7a71 by add+  
at ! end ! foll[+ new s5t5ce3 ,beg9n+ 9 
fiscal ye> #bjbc1 ! ,secret>y %all      
implem5t #b additional demon/ration     
projects1 split 9 accordance ) ! previ\s
 s5t5ce42  7#b7 9 subsection 7b7-- 7,a7 
9 p>agraph 7#a71 by add+ at ! end !     

foll[+ new s5t5ce3 ,= ! c>ry+ out ( !   
implem5tation ( demon/ration projects   
beg9n+ 9 fiscal ye> #bjbc1 ! ,secret>y  
%all aw>d grants 79 a numb] det]m9$     
appropriate7 9 accordance ) ! provisions
 ( ?is subsection42 &  7,b7 by add+ at !
 end ! foll[+ new p>agraph3  7#c7       
,requirem5t = "o ( ! r5ew$ demon/ration 
projects ,) respect to ! grants :i* are 
aw>d$ "u #a ( ! #b demon/ration projects
 :i* is implem5t$ pursuant to ! second  
s5t5ce ( subsection 7a71 all ( ! grants 
:i* are s aw>d$ %all be aw>d$ to skill$ 
nurs+ facilities & nurs+ facilities :i* 
h a high proportion ( resid5ts receiv+  
m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act = nurs+ facility 
s]vices4  2  7#c7 9 subsection 7c7--    
7,a7 9 p>agraph 7#a71 by /rik+ ,!       
demon/ration projects & ins]t+ ,subject 
to p>agraph 7#c71 ! demon/ration        
projects2 &  7,b7 by add+ at ! end !    
foll[+ new p>agraph3  7#c7              
,implem5tation ( demon/ration projects  
,! demon/ration projects describ$ 9 !   

second s5t5ce ( subsection 7a7 %all be  
implem5t$ = a p]iod n to exce$ #e ye>s4 
2  7#d7 9 subsection 7d71 by add+ at !  
end ! foll[+ new p>agraph3  7#d7        
,culture *ange ,! t]m culture *ange     
means1 ) respect to a skill$ nurs+      
facility or a nurs+ facility c>ry+ out a
 demon/ration project "u ?is section1 ! 
process ( promot+ p]son-c5t]$ c>e &     
p]son-c5t]$ "w culture at su* facility4 
2 &  7#e7 9 subsection 7e71 by add+ at !
 end ! foll[+ new s5t5ce3 ,) respect to 
! implem5tation ( ! demon/ration        
projects pursuant to ! second s5t5ce (  
subsection 7a71 !re are au?oriz$ to be  
appropriat$ #ej1jjj1jjj to c>ry out !   
demon/ration project relat+ to culture  
*ange & #cj1jjj1jjj to c>ry out !       
demon/ration project relat+ to in=mation
 te*nology = ! p]iod ( fiscal ye>s #bjbc
 ?r\gh #bjbg44