108th CONGRESS
1st Session
H. R. 3355
To amend titles XVIII and XIX of the Social Security Act to establish
minimum requirements for nurse staffing in nursing facilities receiving payments
under the Medicare or Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
October 21, 2003
Mr. WAXMAN (for himself, Mr. DINGELL, Mr. STARK, Mr. BROWN of Ohio, Mr. FROST,
Mr. GEORGE MILLER of California, Ms. SCHAKOWSKY, Mr. CARSON of Oklahoma, Mr.
RODRIGUEZ, Mr. MARKEY, Ms. NORTON, Ms. KAPTUR, Mr. SANDERS, Mr. HOEFFEL, Mrs.
MALONEY, Mr. GRIJALVA, Mr. HINCHEY, Mr. UDALL of New Mexico, Mr. ACEVEDO-VILA,
Mr. KUCINICH, Mr. MOORE, Mr. LANTOS, Ms. CORRINE BROWN of Florida, Mr. THOMPSON
of Mississippi, Mr. BERMAN, Mr. WEXLER, Mr. EVANS, Ms. ROYBAL-ALLARD, Mr.
KILDEE, Ms. BALDWIN, Mrs. CAPPS, Ms. SOLIS, Mr. STUPAK, Mr. KLECZKA, Mr. BACA,
Mr. MCGOVERN, Mr. HOLT, Mr. PALLONE, Ms. ESHOO, Mr. BRADY of Pennsylvania,
Mr. CLAY, and Mr. MCDERMOTT) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the Committee
on Ways and Means, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the jurisdiction
of the committee concerned
A BILL
To amend titles XVIII and XIX of the Social Security Act to establish
minimum requirements for nurse staffing in nursing facilities receiving payments
under the Medicare or Medicaid Program.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSE.
(a) SHORT TITLE- This Act may be cited as the `Nursing Home Staffing Act of
2003'.
(b) PURPOSE- The purpose of this Act is to improve the quality of care received
by residents of nursing facilities through the implementation of the minimum
nurse staffing levels identified by the Secretary of Health and Human Services
in a report to Congress submitted on March 21, 2002.
SEC. 2. IMPLEMENTATION OF NURSE STAFFING STANDARDS.
(a) IN GENERAL- Sections 1819(b)(4) and 1919(b)(4) of the Social Security
Act (42 U.S.C. 1395i-3(b)(4); 1396r(b)(4)) are each amended by adding at the
end the following new subparagraph:
`(D) MINIMUM STAFFING REQUIREMENTS-
`(i) DEADLINE FOR COMPLIANCE WITH MINIMUM STANDARDS- With respect to
facility services provided after the date that is the end of the 2-year
period beginning on the date of the enactment of this subparagraph,
a facility shall comply with the minimum staffing levels promulgated
by the Secretary under clause (ii).
`(I) IN GENERAL- Not later than 1 year after the date of the enactment
of this subparagraph, and consistent with the provisions of this clause,
the Secretary shall promulgate standards for minimum staffing levels
for facilities. Such standards shall provide for sufficient staffing
levels during day, evening, and night shifts to ensure that residents
of nursing facilities receive the level of care necessary to meet
the objectives of subsection (b)(2), and shall provide for appropriate
adjustments to account for resident case mix.
`(II) MINIMUM STANDARDS- Subject to subclause (III), standards promulgated
under subclause (I) shall be, at a minimum, the HHS minimum nurse
staffing ratios (as defined in clause (iii)).
`(III) AUTHORITY TO PHASE IN FACILITY COMPLIANCE WITH STANDARDS- If
the Secretary determines that compliance with the HHS minimum nurse
staffing ratios is not feasible for nursing facilities by the end
of the 2-year period applicable under clause (i), the Secretary may
delay the implementation of the HHS minimum nurse staffing ratios
until the date that is the end of the 5-year period that begins on
the date of the enactment of this subparagraph. If the Secretary delays
implementation of the HHS minimum nurse staffing ratios under the
previous sentence, the Secretary shall phase in over such 5-year period
alternative minimum staffing standards that gradually increase in
each of the years of the phase-in until the such standards meet the
HHS minimum nurse staffing ratios.
`(IV) COUNTING- In determining compliance with the staffing levels
under this subparagraph, an individual may not be counted while performing
services that are not direct nursing care, such as administrative
services, food preparation, housekeeping, laundry, maintenance services,
or other activities that are not direct nursing care.
`(iii) HHS MINIMUM NURSE STAFFING RATIOS- The term `HHS minimum nurse
staffing ratios' means the minimum staffing levels identified in the
report to Congress entitled `Appropriateness of Minimum Nurse Staffing
Ratios in Nursing Homes, Report to Congress: Phase II Final' submitted
by the Secretary on March 21, 2002, which require--
`(I) from 2.4 to 2.8 hours of care per resident per day by a certified
nurse aide, and
`(II) from 1.15 to 1.3 hours of care per resident per day by a licensed
practical nurse, a licensed vocational nurse, or a registered nurse,
of which from 0.55 to 0.75 hours of care per resident per day shall
be provided by a registered nurse.
`(I) NONPREEMPTION- Nothing in this subparagraph shall be construed
as prohibiting the Secretary or a State (in the case of title XIX)
from imposing higher minimum staffing levels on facilities than those
imposed under this subparagraph.
`(II) MINIMUM STANDARDS ONLY- Compliance with the staffing requirements
imposed under this subparagraph alone shall not be construed as complying
with the requirement under paragraph (2) to provide services to attain
or maintain the highest practicable physical, mental, and psychosocial
well-being of each resident.
`(III) SUPPLEMENTARY REQUIREMENTS- The staffing requirements of this
subparagraph are in addition to the requirements of subparagraph (C).'.
(b) POSTING OF STAFFING INFORMATION-
(1) IN GENERAL- The first sentence of subparagraph (A) of sections 1819(b)(8)
and 1919(b)(8) of the Social Security Act (42 U.S.C. 1395i-3(b)(8); 1396r(b)(8))
are each amended by inserting before the period the following: `, a description
of the minimum staffing requirements under paragraph (4)(D), and the average
number of hours of nursing care that residents of the facility have received
for each of the four previous calendar quarters'.
(2) REPORTS- Such sections are each amended by adding at the end the following
new subparagraph:
`(C) REPORTS OF STAFFING DATA- A facility shall maintain records on nurse
staffing, and shall submit such reports of such records to the Secretary
as the Secretary may require for the administration and enforcement of
this section. Such records shall be reviewed for accuracy as part of a
standard survey required under subsection (g)(2)(A).'.
SEC. 3. INCREASED RESOURCES.
(a) REINSTITUTION OF BOREN AMENDMENT PAYMENT METHODOLOGY-
(1) IN GENERAL- Section 1902(a)(13) of the Social Security Act (42 U.S.C.
1396a(a)(13)) is amended to read as follows:
`(13) provide for payment of services through the use of rates determined
pursuant to the criteria under this paragraph as in effect on August 1,
1997;'.
(2) ESTABLISHMENT OF SAFE HARBOR RATES- Section 1902 of such Act (42 U.S.C.
1396a) is amended by adding at the end the following: `The Secretary may,
by regulation, promulgate standards or methodologies for determining rates
that comply with paragraph (13), and a State that pays rates that meet such
standards or methodologies is deemed to be in compliance with paragraph
(13).'.
(3) EFFECTIVE DATE- The amendment made by this subsection shall apply to
services furnished on or after the date that is one year after the date
of the enactment of this Act.
(b) Permanent 1.5 Percent Increase of Medicaid FMAP Beginning With Fiscal
Year 2004- Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b))
is amended by adding at the end the following: `With respect to calendar quarters
beginning after October 1, 2003, the Federal medical assistance percentage
for a State determined under the first sentence shall be increased by 1.50
percentage points.'.
(c) FINANCIAL ACCOUNTABILITY-
(1) IN GENERAL- Sections 1819(g)(2) and 1919(g)(2) of the Social Security
Act (42 U.S.C. 1395i-3(g)(2); 1396r(g)(2)) are each amended--
(A) by redesignating subparagraphs (C), (D), and (E) as subparagraphs
(D), (E), and (F); and
(B) by inserting after subparagraph (B) the following new subparagraph:
`(C) FINANCIAL ACCOUNTABILITY- A standard or an extended survey may include
an examination of the financial records of a facility to determine whether
payments made to the facility under this section for services furnished
to residents are being used in a manner consistent with this section.'.
(2) COMPOSITION OF MULTIDISCIPLINARY TEAM- Sections 1819(g)(2)(E)(i) and
1919(g)(2)(E)(i) of the Social Security Act (42 U.S.C. 1395i-3(g)(2)(E)(i);
1396r(g)(2)(E)(i)) are each amended by inserting after the period the following:
`This multidisciplinary team may include professionals trained in financial
accounting and auditing.'
(3) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to
surveys conducted on or after the date of the enactment of this Act.
END
