,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #gjif  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,janu>y #ae1 #bjbf,mr4
 ,e/es 7= himself & ,mr4 ,h>d] (        
,cali=nia7 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 ensure appropriate approval =   
c]ta9 skill$ nurs+ facility & nurs+     
facility nurs+ aide tra9+ & compet5cy   
evaluation programs "u ! ,m$ic>e &      
,m$icaid program4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,ensur+ ,s5iors'   
,access to ,quality ,c>e ,act4  #b4     
,ensur+ appropriate approval = c]ta9    
skill$ nurs+ facility & nurs+ facility  
nurs+ aide tra9+ & compet5cy evaluation 
programs "u ! ,m$ic>e & ,m$icaid program
  7a7 ,m$ic>e ,section #ahai7;f77#b7 ( !

 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;i-#c7;f77#b77 is am5d$-- 7#a7 9   
subp>agraph 7,b77iii7-- 7,a7 9 ! matt]  
prec$+ subclause 7,i71 by /rik+         
subp>agraphs 7,c7 & 7,d7 & ins]t+       
subp>agraph 7,c72 &  7,b7 9 subclause   
7,i7-- 7i7 9 item 7b71 by /rik+ or at ! 
end2  7ii7 by am5d+ item 7c7 to read z  
foll[s3  7c7 has be5 assess$ a civil    
money p5alty describ$ 9 subsection      
7h77#b77;,b77ii7 or section             
#aiai7;h77#b77;,a77ii7 ( n less ?an     
#ab1ibd & has be5 cit$ = a defici5cy    
relat+ to ! quality ( c>e provid$ to    
resid5ts ( ! facility2 or  2 &  7iii7 by
 add+ at ! end ! foll[+ new item3  7d7  
has be5 subject to a rem$y describ$ 9   
clause 7i7 or 7iii7 ( subsection        
7h77#b77;,b71 subsection 7h77#d71       
section #aiai7;h77#a77;,b77i71 or 9     
clause 7i71 7iii71 or 7iv7 ( section    
#aiai7;h77#b77;,a71 or  2 &  7#b7 by    
/rik+ subp>agraph 7,d74  7b7 ,m$icaid   
,section #aiai7;f77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#acifr7f77#b77 is am5d$-- 7#a7 9        
subp>agraph 7,b77iii7-- 7,a7 9 ! matt]  
prec$+ subclause 7,i71 by /rik+         
subp>agraphs 7,c7 & 7,d7 & ins]t+       
subp>agraph 7,c72 &  7,b7 9 subclause   
7,i7-- 7i7 9 item 7b71 by /rik+ or at ! 
end2  7ii7 by am5d+ item 7c7 to read z  
foll[s3  7c7 has be5 assess$ a civil    
money p5alty describ$ 9 subsection      
7h77#b77;,a77ii7 or section             
#ahai7;h77#b77;,b77ii7 ( n less ?an     
#ab1ibd & has be5 cit$ = a defici5cy    
relat+ to ! quality ( c>e provid$ to    
resid5ts ( ! facility2 or  2 &  7iii7 by
 add+ at ! end ! foll[+ new item3  7d7  
has be5 subject to a rem$y describ$ 9   
subsection 7h77#a77;,b77i71 clauses 7i71
 7iii71 or 7iv7 ( subsection            
7h77#b77;,a71 clauses 7i7 or 7iii7 (    
section #ahai7;h77#b77;,b71 or section  
#ahai7;h77#d71 or  2 &  7#b7 by /rik+   
subp>agraph 7,d74