,,ii #aahth ,,congress #ast ,session ,s4 #agdi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ah1 #bjbc,mr4 ,warner 7for himself and ,mr4 ,scott of ,south ,carolina7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act with respect to nursing facility requirements1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,seniors' ,access to ,quality ,care ,act4 #b4 ,training and competency evaluation programs 7a7 ,medicare ,section #ahai7;f77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;f77#b77 is amended-- 7#a7 in subparagraph 7,a77iv77,i71 by striking 7unless the facility is described in subparagraph 7,b77iii77,i772 7#b7 in subparagraph 7,b7-- 7,a7 in clause 7i7-- 7i7 by striking 7subject to clause 7iii772 and 7ii7 by inserting and after the semicolon2 7,b7 in clause 7ii71 by striking 2 and and inserting a period2 and 7,c7 by striking clause 7iii72 7#c7 by striking ,a ,state may not delegate 7through subcontract or otherwise7 its responsibility under clause 7iii77,,ii7 to the skilled nursing facility42 7#d7 by striking subparagraphs 7,c7 and 7,d72 and 7#e7 by adding at the end the following3 7,c7 ,disapproval of nurse aide training and competency evaluation programs and nurse aide competency evaluation programs 7i7 ,in general ,with respect to a ,state1 the ,secretary shall1 in consultation with such ,state1 disapprove1 for a period not to exceed #b years1 a nurse aide training and competency evaluation program or a nurse aide competency evaluation program offered by or in a skilled nursing facility if such facility-- 7,i7 has been assessed a civil monetary penalty under subsection 7h77#b77;,b77ii7 or section #aiai7;h77#b77;,a77ii7 of not less than #aj1fig for providing substandard quality of care2 and 7,,ii7 has not1 in the determination of the ,secretary1 corrected the deficiencies in quality of care for which such civil monetary penalty was assessed4 7ii7 ,rescission of disapproval ,the ,secretary shall rescind a disapproval under clause 7i7 upon demonstration by a skilled nursing facility that-- 7,i7 all deficiencies for which the civil monetary penalty described in clause 7i77,i7 was assessed have been remedied2 7,,ii7 the facility has not received deficiencies related to direct patient harm for substandard quality of care deficiencies in the prior #b years2 and 7,,iii7 the ,secretary certifies that the civil monetary penalty assessed under clause 7i77,i7 did not result in immediate jeopardy for direct patient harm or injury related to an abuse or neglect deficiency4 ,for purposes of rescinding disapproval under this clause1 the ,secretary may require additional oversight of the skilled nursing facility for a period not to exceed the period of disapproval imposed under clause 7i7 with respect to such facility4 4 7b7 ,medicaid ,section #aiai7;f77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7f77#b77 is amended-- 7#a7 in subparagraph 7,a77iv77,i71 by striking 7unless the facility is described in subparagraph 7,b77iii77,i772 7#b7 in subparagraph 7,b7-- 7,a7 in clause 7i71 by inserting and after the semicolon2 7,b7 in clause 7ii71 by striking 2 and and inserting a period2 7,c7 by striking clause 7iii72 and 7,d7 by striking ,a ,state may not delegate 7through subcontract or otherwise7 its responsibility under clause 7iii77,,ii7 to the nursing facility42 7#c7 by striking subparagraphs 7,c7 and 7,d72 and 7#d7 by adding at the end the following3 7,c7 ,disapproval of nurse aide training and competency evaluation programs and nurse aide competency evaluation programs 7i7 ,in general ,with respect to a ,state1 the ,secretary shall1 in consultation with such ,state1 disapprove1 for a period not to exceed #b years1 a nurse aide training and competency evaluation program or a nurse aide competency evaluation program offered by or in a nursing facility if such facility-- 7,i7 has been assessed a civil monetary penalty under section #ahai7;h77#b77;,b77ii7 or subsection 7h77#b77;,a77ii7 of not less than #aj1fig for providing substandard quality of care2 and 7,,ii7 has not1 in the determination of the ,secretary1 corrected the deficiencies in quality of care for which such civil monetary penalty was assessed4 7ii7 ,rescission of disapproval ,the ,secretary shall rescind a disapproval under clause 7i7 upon demonstration by a nursing facility that-- 7,i7 all deficiencies for which the civil monetary penalty described in clause 7i77,i7 was assessed have been remedied2 7,,ii7 the facility has not received deficiencies related to direct patient harm for substandard quality of care deficiencies in the prior #b years2 and 7,,iii7 the ,secretary certifies that the civil monetary penalty assessed under clause 7i77,i7 did not result in immediate jeopardy for direct patient harm or injury related to an abuse or neglect deficiency4 ,for purposes of rescinding disapproval under this clause1 the ,secretary may require additional oversight of the nursing facility for a period not to exceed the period of disapproval imposed under clause 7i7 with respect to such facility4 4 7c7 ,regulations ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall promulgate regulations as necessary to implement the amendments made by this section4 7d7 ,applicability 7#a7 ,in general 7,a7 ,timing of determinations ,the amendments made by subsections 7a77#d7 and 7b77#d7 of this section shall apply only to a civil monetary penalty if the relevant covered determination was made on or after the date of enactment of this ,act4 7,b7 ,covered determination defined ,the term covered determination means1 with respect to a skilled nursing facility or a nursing facility in a ,state1 a determination by the ,state or the ,secretary of ,health and ,human ,services that the facility has provided a substandard quality of care for which a civil monetary penalty described in section #ahai7;f77#b77;,c77i77,i7 or #aiai7;f77#b77;,c77i77,i7 of the ,social ,security ,act 7as such sections have been amended by this ,act7 may be assessed4 7#b7 ,previously prohibited programs 7,a7 ,waiver ,with respect to a skilled nursing facility or a nursing facility subject1 on the day before the date of enactment of this ,act1 to a prohibition under item 7a7 of either section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 of the ,social ,security ,act 7as in effect on the day before such date of enactment71 such prohibition shall no longer apply to the facility on or after such date of enactment4 7,b7 ,survey or civil monetary penalty ,with respect to a skilled nursing facility or a nursing facility subject1 on the day before the date of enactment of this ,act1 to a prohibition under item 7b7 or 7c7 of either section #ahai7;f77#b77;,b77iii77,i7 or section #aiai7;f77#b77;,b77iii77,i7 of the ,social ,security ,act 7as in effect on the day before such date of enactment71 such prohibition shall no longer apply to the facility on or after such date of enactment upon a determination by the ,secretary of ,health and ,human ,services that the facility has corrected the issue that resulted in such prohibition4 #c4 ,permitting ,medicare and ,medicaid providers to access the ,national ,practitioner ,data ,bank to conduct employee background checks ,section #aiba7;b77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#b7;b77#f77 is amended-- 7#a7 by striking and other health care entities 7as defined in section #dca of the ,health ,care ,quality ,improvement ,act of #aihf7 and inserting 1 other health care entities 7as defined in section #dca of the ,health ,care ,quality ,improvement ,act of #aihf71 providers of services 7as defined in section #ahfa7u771 suppliers 7as defined in section #ahfa7;d771 and providers of items or services under a ,state plan under this title 7or a waiver of such a plan72 and 7#b7 by striking such hospitals or other health care entities and inserting such hospitals1 health care entities1 providers1 or suppliers4