Sec. 2. Minimum nurse staffing requirements for skilled nursing facilities under Medicare program and nursing facilities under Medicaid program
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Subparagraph
(C)of section 1819(b)(4) of the Social Security Act ( 42 U.S.C. 1395i–3(b)(4) ) is amended— in clause (i)— by amending the clause heading to read as follows: ; and General requirements before 2022 by striking Except as provided in clause (ii), and inserting Except as provided in clause (iii), with respect to skilled nursing facility services provided before January 1, 2022, ; by redesignating clause
(ii)as clause (iii); and by inserting after clause
(i)the following new clause: With respect to skilled nursing facility services provided on or after January 1, 2022, a skilled nursing facility must— provide nursing services that are sufficient to meet the nursing needs of its residents on a 24-hour basis, to be divided into day shifts, evening shifts, and night shifts; provide for minimum nurse staffing levels with respect to each such shift, in accordance with this clause; and ensure that, in carrying out items
(aa)and (bb), a total minimum of 4.1 hours of care is provided per resident per day, with 0.75 hours of care of such total minimum provided by a registered professional nurse, 0.54 hours of care of such total minimum provided by a licensed practical nurse, and 2.81 hours of care of such total minimum provided by a nurse aide (as defined in paragraph (5)(F)). With respect to a day shift, the skilled nursing facility must have— at least 1 registered professional nurse for every 28 residents, with a minimum of 0.29 hours of care provided per resident during each such shift; at least 1 licensed practical nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during each such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 7 residents, with a minimum of 1.14 hours of care provided per resident during each such shift. With respect to an evening shift, the skilled nursing facility must have— at least 1 registered professional nurse for every 30 residents, with a minimum of 0.26 hours of care provided per resident during each such shift; at least 1 licensed practical nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during each such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 7 residents, with a minimum of 1.14 hours of care provided per resident during each such shift. With respect to a night shift, the skilled nursing facility must have— at least 1 registered professional nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during such shift; at least 1 licensed practical nurse for every 56 residents, with a minimum of 0.14 hours of care provided per resident during such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 15 residents, with a minimum of 0.53 hours of care provided per resident during such shift. The Secretary may establish and require skilled nursing facilities (or, at the Secretary’s discretion, only skilled nursing facilities that have a higher percentage of residents with extensive care needs, as determined by the Secretary) to provide for minimum nurse staffing levels that are higher than the levels required under this clause. Nothing in this clause may be construed as preventing a State from establishing or requiring skilled nursing facilities in the State to provide for minimum nurse staffing levels that are higher than the levels required under this clause. In complying with the minimum hours of care provided per resident requirements under this clause, a skilled nursing facility may not count any time spent by a registered professional nurse, licensed practical nurse, or nurse aide on administrative services towards compliance with such requirements. In this clause: The term administrative services means food preparation, housekeeping, laundry services, maintenance services, and other noncaregiving-related services, as determined by the Secretary. The term day shift means, with respect to a day and a skilled nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 6 a.m. in the time zone in which such facility is located and not later than 8 a.m. in such time zone. The term evening shift means, with respect to a day and a skilled nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 2 p.m. in the time zone in which such facility is located and not later than 4 p.m. in such time zone. The term night shift means, with respect to a day and a skilled nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 10 p.m. in the time zone in which such facility is located and not later than midnight in such time zone. . Section 1819(h) of the Social Security Act ( 42 U.S.C. 1395i–3(h) ) is amended— in paragraph (1), by striking If a State finds, on the basis of a standard and inserting Subject to paragraph (7), if a State finds, on the basis of a standard ; in paragraph (2), by striking With respect to and inserting Subject to paragraph (7), with respect to ; and by adding at the end the following new paragraph: If a State finds, on the basis of a standard, extended, or partial extended survey under subsection (g)(2) or otherwise, that a skilled nursing facility does not meet the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to skilled nursing facility services provided on or after January 1, 2022, the State shall recommend to the Secretary that the Secretary take such actions as described in subclauses
(I)and
(II)of subparagraph (B)(i). With respect to any skilled nursing facility in a State, if the Secretary finds, or pursuant to a recommendation of the State under subparagraph
(A)finds, that a skilled nursing facility does not meet the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to skilled nursing facility services provided on or after January 1, 2022, the Secretary shall— deny any further payments under this title with respect to all individuals entitled to benefits under this title who are admitted to the facility after the effective date of the finding; and impose a civil money penalty in an amount not to exceed $10,000 for each day of noncompliance. The provisions of section 1128A (other than subsections
(a)and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). Subject to clause (iii), in the case where a skilled nursing facility self-reports and promptly corrects a deficiency for which a penalty was imposed under clause (i)(II) not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by— not more than 50 percent; or in the case that the facility was penalized under this subsection within the three-year period preceding the date of such imposition, not more than 25 percent. The Secretary may not reduce the amount of a penalty under clause
(ii)if the Secretary had reduced a penalty imposed on the skilled nursing facility in the preceding year under such clause with respect to a repeat deficiency. The Secretary may not reduce the amount of a penalty under clause
(ii)if the penalty is imposed on the skilled nursing facility for a deficiency that is found to result in a pattern of harm or widespread harm, immediately jeopardizes the health or safety of a resident or residents of the facility, or results in the death of a resident of the facility. In the case of a skilled nursing facility which, on three consecutive standard surveys conducted under subsection (g)(2), has been found as not meeting the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to skilled nursing facility services provided on or after January 1, 2022, the Secretary may (regardless of the remedies provided for under clause (i))— appoint temporary management to oversee the operation of the facility and to assure the health and safety of the facility’s residents in accordance with clause
(iii)of paragraph (2)(B), except that the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) shall be substituted for all the requirements of subsections (b), (c), and
(d)under such clause; monitor the facility under subsection (g)(4)(B) with respect to such minimum staffing requirements until the facility has demonstrated to the satisfaction of the Secretary that the facility is in compliance, and will remain in compliance, with such minimum staffing requirements; or subject to section 1128I(h), terminate the facility’s participation under this title. If the facility’s participation under this title is terminated under this clause, the State shall provide for the safe and orderly transfer of the residents eligible under this title, consistent with the requirements of subsection (c)(2) and section 1128I(h). The Secretary shall publish on the internet website of the Department of Health and Human Services the names of skilled nursing facilities that have violated the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to skilled nursing facility services provided on or after January 1, 2022. With respect to a skilled nursing facility whose name is published under subclause
(I)and has a change of ownership, as determined by the Secretary, after the date of such publication, the Secretary shall remove the name of such facility from the website described under such subclause after the 1-year period beginning on the date of such change of ownership. . Item
(a)of section 1819(f)(2)(B)(iii)(I) of the Social Security Act ( 42 U.S.C. 1395i–3(f)(2)(B)(iii)(I) ) is amended by striking subsection (b)(4)(C)(ii)(II) and inserting subsection (b)(4)(C)(iii)(II) . Subparagraph
(C)of section 1919(b)(4) of the Social Security Act ( 42 U.S.C. 1396r(b)(4) ) is amended— in clause (i)— in the clause heading, by inserting after the following General requirements ; before 2022 in the matter preceding subclause (I), by inserting after October 1, 1990, the following: and before January 1, 2022, ; in subclause (I), by striking clause
(ii)and inserting clause
(iii); and in subclause (II), by striking clause
(ii)and inserting clause
(iii); by redesignating clauses
(ii)and
(iii)as clauses
(iii)and (iv), respectively; and by inserting after clause
(i)the following new clause: With respect to nursing facility services provided on or after January 1, 2022, a nursing facility must— provide nursing services that are sufficient to meet the nursing needs of its residents on a 24-hour basis, to be divided into day shifts, evening shifts, and night shifts; provide for minimum nurse staffing levels with respect to each such shift, in accordance with this clause; and ensure that, in carrying out items
(aa)and (bb), a total minimum of 4.1 hours of care is provided per resident per day, with 0.75 hours of care of such total minimum provided by a registered professional nurse, 0.54 hours of care of such total minimum provided by a licensed practical nurse, and 2.81 hours of care of such total minimum provided by a nurse aide (as defined in paragraph (5)(F)). With respect to a day shift, the nursing facility must have— at least 1 registered professional nurse for every 28 residents, with a minimum of 0.29 hours of care provided per resident during each such shift; at least 1 licensed practical nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during each such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 7 residents, with a minimum of 1.14 hours of care provided per resident during each such shift. With respect to an evening shift, the nursing facility must have— at least 1 registered professional nurse for every 30 residents, with a minimum of 0.26 hours of care provided per resident during each such shift; at least 1 licensed practical nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during each such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 7 residents, with a minimum of 1.14 hours of care provided per resident during each such shift. With respect to a night shift, the nursing facility must have— at least 1 registered professional nurse for every 40 residents, with a minimum of 0.20 hours of care provided per resident during such shift; at least 1 licensed practical nurse for every 56 residents, with a minimum of 0.14 hours of care provided per resident during such shift; and at least 1 nurse aide (as defined in paragraph (5)(F)) for every 15 residents, with a minimum of 0.53 hours of care provided per resident during such shift. The Secretary may establish and require nursing facilities (or, at the Secretary’s discretion, only nursing facilities that have a higher percentage of residents with extensive care needs, as determined by the Secretary) to provide for minimum nurse staffing levels that are higher than the levels required under this clause. Nothing in this clause may be construed as preventing a State from establishing or requiring nursing facilities in the State to provide for minimum nurse staffing levels that are higher than the levels required under this clause. In complying with the minimum hours of care provided per resident requirements under this clause, a nursing facility may not count any time spent by a registered professional nurse, licensed practical nurse, or nurse aide on administrative services towards compliance with such requirements. In this clause: The term administrative services means food preparation, housekeeping, laundry services, maintenance services, and other noncaregiving-related services, as determined by the Secretary. The term day shift means, with respect to a day and a nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 6 a.m. in the time zone in which such facility is located and not later than 8 a.m. in such time zone. The term evening shift means, with respect to a day and a nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 2 p.m. in the time zone in which such facility is located and not later than 4 p.m. in such time zone. The term night shift means, with respect to a day and a nursing facility, an assigned work shift that is a period of 8 consecutive hours, beginning not sooner than 10 p.m. in the time zone in which such facility is located and not later than midnight in such time zone. . Section 1919(h) of the Social Security Act ( 42 U.S.C. 1396r(h) ) is amended— in paragraph (1), by striking If a State finds, on the basis of a standard and inserting Subject to paragraph (10), if a State finds, on the basis of a standard ; in paragraph (2)— in subparagraph (C), by striking If a nursing facility and inserting Subject to paragraph (10), if a nursing facility ; and in subparagraph (D), by striking In the case of and inserting Subject to paragraph (10), in the case of ; in paragraph (3)— in subparagraph (A), by inserting before the period the following: and the remedies described in paragraph (10)(B) ; and in subparagraph (B), by striking With respect to and inserting Subject to paragraph (10), with respect to ; and by adding at the end the following new paragraph: If a State finds, on the basis of a standard, extended, or partial extended survey under subsection (g)(2) or otherwise, that a nursing facility does not meet the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to nursing facility services provided on or after January 1, 2022, the State shall— deny any further payments under the State plan with respect to all individuals enrolled under such plan who are admitted to the facility after the effective date of the finding; and recommend to the Secretary that the Secretary impose the civil money penalty described in subparagraph (B). With respect to any nursing facility in a State other than a State nursing facility, if the Secretary finds that such a nursing facility does not meet the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to nursing facility services provided on or after January 1, 2022, the Secretary shall— deny any further payments to the State for medical assistance furnished by the facility to all individuals enrolled under the State plan who are admitted to the facility after the effective date of the finding; and impose a civil money penalty in an amount not to exceed $10,000 for each day of noncompliance. The provisions of section 1128A (other than subsections
(a)and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). Subject to clause (iii), in the case where a nursing facility self-reports and promptly corrects a deficiency for which a penalty was imposed under clause (i)(II) not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by— not more than 50 percent; or in the case that the facility was penalized under this subsection within the three-year period preceding the date of such imposition, not more than 25 percent. The Secretary may not reduce the amount of a penalty under clause
(ii)if the Secretary had reduced a penalty imposed on the nursing facility in the preceding year under such clause with respect to a repeat deficiency. The Secretary may not reduce the amount of a penalty under clause
(ii)if the penalty is imposed on the nursing facility for a deficiency that is found to result in a pattern of harm or widespread harm, immediately jeopardizes the health or safety of a resident or residents of the facility, or results in the death of a resident of the facility. In the case of a nursing facility which, on three consecutive standard surveys conducted under subsection (g)(2), has been found as not meeting the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to nursing facility services provided on or after January 1, 2022, the Secretary may (regardless of the remedies provided for under clause (i))— appoint temporary management to oversee the operation of the facility and to assure the health and safety of the facility’s residents in accordance with clause
(iii)of paragraph (3)(C), except that the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) shall be substituted for all the requirements of subsections (b), (c), and
(d)under such clause; monitor the facility under subsection (g)(4)(B) with respect to such minimum staffing requirements until the facility has demonstrated to the satisfaction of the Secretary that the facility is in compliance, and will remain in compliance, with such minimum staffing requirements; or subject to section 1128I(h), terminate the facility’s participation under this title. If the facility’s participation under this title is terminated under this clause, the State shall provide for the safe and orderly transfer of the residents eligible under this title, consistent with the requirements of subsection (c)(2) and section 1128I(h). The Secretary shall publish on the internet website of the Department of Health and Human Services the names of nursing facilities that have violated the minimum staffing requirements of clause
(ii)of subsection (b)(4)(C) with respect to skilled nursing facility services provided on or after January 1, 2022. With respect to a nursing facility whose name is published under subclause
(I)and has a change of ownership, as determined by the Secretary, after the date of such publication, the Secretary shall remove the name of such facility from the website described under such subclause after the 1-year period beginning on the date of such change of ownership. . Clause
(iii)of section 1919(b)(4)(C) of the Social Security Act ( 42 U.S.C. 1396r(b)(4)(C) ), as redesignated by paragraph (1)(B), is amended by striking subject to clause
(iii)and inserting subject to clause
(iv). Item
(a)of section 1919(f)(2)(B)(iii)(I) of the Social Security Act ( 42 U.S.C. 1396r(f)(2)(B)(iii)(I) ) is amended by striking subsection (b)(4)(C)(ii) and inserting subsection (b)(4)(C)(iii) . Paragraph
(9)of section 1919(f) of the Social Security Act ( 42 U.S.C. 1396r(f) ) is amended by striking subsection (b)(4)(C)(ii) and inserting subsection (b)(4)(C)(iii) . Not later than June 1, 2023, the Secretary of Health and Human Services shall study and submit to the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a publicly available report— on the impact of the minimum nurse staffing requirements added by subsection
(a)on the reimbursement levels of skilled nursing facilities under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) and the adequacy of personnel numbers in such skilled nursing facilities to meet such minimum nurse staffing requirements; on the impact of the minimum nurse staffing requirements added by subsection
(b)on the reimbursement levels of nursing facilities under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.) and the adequacy of personnel numbers in such nursing facilities to meet such minimum nurse staffing requirements; and including recommendations on the steps that such skilled nursing facilities and nursing facilities can take to ensure that adequate personnel are available in such skilled nursing facilities and nursing facilities to meet the minimum nurse staffing requirements added by subsections
(a)and
(b)for such skilled nursing facilities and nursing facilities, respectively, including methods for attracting and retaining such personnel. In conducting the study required under subparagraph (A), the Secretary of Health and Human Services shall take into consideration— the benefits of any increase in nurse staffing levels, including with respect to workforce training and retention; any decrease in the rate of workplace injuries; any changes in medical care costs for residents of skilled nursing facilities and nursing facilities; any decrease in hospitalization rates for such residents; any changes in personnel and administrative costs for skilled nursing facilities and nursing facilities; and any changes in recruiting and training costs. Not later than January 1, 2025, the Secretary of Health and Human Services shall conduct a follow-up study to the study conducted under paragraph (1)(A) and submit to the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a publicly available report on such follow-up study.
Connectionstraces to 3
3 references not yet in our index
- 42 USC 1395i–3(b)(4)
- 42 USC 1395i–3(h)
- 42 USC 1395i–3(f)(2)(B)(iii)(I)
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cites case law
Sec. 2
Minimum nurse staffing requirements for skilled nursing facilities under Medicare program and nursing facilities under Medicaid program
Cite42 USC 1395i–3(b)(4)
Cite42 USC 1395i–3(h)
Cite42 USC 1395i–3(f)(2)(B)(iii)(I)
Cites 6Cited by 0 across 0 sources