Bill Summary
This legislation, titled the "Improving Quality of Care in Skilled Nursing Facilities and Nursing Facilities During COVID-19 Emergency Period," outlines requirements and guidelines for skilled nursing facilities and nursing facilities during the pandemic. It includes measures for infection prevention, employee safety, reporting COVID-19 cases and deaths, funding for state strike teams, and reinstatement of waived requirements. It also requires the Secretary of Health and Human Services to issue guidance for long-term health care facilities, including virtual visitation and infection control measures.
Possible Impacts
1. Residents of skilled nursing facilities and nursing facilities will have the right to return to their facility after staying with family during the COVID-19 emergency period, ensuring they are not left without proper care.
2. Employees at these facilities will have increased safety requirements and access to personal protective equipment, protecting their health while caring for residents during the pandemic.
3. Long-term health care facilities will be required to implement infection control and prevention measures, such as virtual visitation and notifying residents of this option, to protect the health of both residents and employees during the COVID-19 emergency period.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3644 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 3644
To amend titles XVIII and XIX of the Social Security Act to improve the
quality of care in skilled nursing facilities under the Medicare
program and nursing facilities under the Medicare program during the
COVID-19 emergency period, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 7, 2020
Mr. Booker (for himself and Mr. Blumenthal) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to improve the
quality of care in skilled nursing facilities under the Medicare
program and nursing facilities under the Medicare program during the
COVID-19 emergency period, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Quality Care for Nursing Home
Residents and Workers During COVID-19 Act of 2020''.
SEC. 2. IMPROVING QUALITY OF CARE IN SKILLED NURSING FACILITIES AND
NURSING FACILITIES DURING COVID-19 EMERGENCY PERIOD.
(a) Medicare.--Section 1819 of the Social Security Act (42 U.S.C.
1395i-3) is amended by adding at the end the following new subsection:
``(k) Additional Requirements During Certain Public Health
Emergency.--
``(1) Skilled nursing facilities.--
``(A) In general.--During the portion of the
emergency period defined in paragraph (1)(B) of section
1135(g) beginning on or after the date of the enactment
of this subsection, a skilled nursing facility shall
comply with the quality of care requirements described
in subparagraph (B), the worker safety requirements
described in subparagraph (C), and the transparency
requirements described in subparagraph (D).
``(B) Quality of care requirements.--The quality of
care requirements described in this subparagraph are
each of the following:
``(i) Employ, on a full-time basis, an
infection preventionist who--
``(I) has primary professional
training in nursing, medical
technology, microbiology, epidemiology,
or other related field;
``(II) is qualified by education,
training, experience or certification;
and
``(III) has completed specialized
training in infection prevention and
control.
``(ii) In the case of a resident who elects
to reside with a family member of such resident
for any portion of the emergency period
described in subparagraph (A), guarantee the
right of such resident to resume residency in
the facility at any time during the 180-day
period immediately following the end of such
emergency period.
``(iii) Notwithstanding subparagraphs (A)
and (B) of subsection (c)(2), permit a resident
to remain in the facility and not discharge or
transfer the resident from the facility
unless--
``(I) the State survey agency
approves the discharge or transfer;
``(II) in the case of a transfer,
the transfer is to a facility dedicated
to the care of residents who have been
diagnosed with COVID-19 if the resident
has been diagnosed with COVID-19, or a
facility dedicated to the care of
residents who have not been diagnosed
with COVID-19 if the resident has not
been diagnosed with COVID-19;
``(III) before effecting the
discharge or transfer, the facility
records the reasons in the resident's
clinical record;
``(IV) at least 72 hours in advance
of the discharge or transfer, the
facility provides a notice of the
discharge or transfer to the resident
(or legal representative of the
resident, if applicable), including the
reasons therefor and the items
described in clause (iii) of subsection
(c)(2)(B); and
``(V) the resident (or legal
representative of the resident, if
applicable) acknowledges receipt of the
notice described in subclause (IV) and
provides written consent to the
discharge or transfer.
``(iv) Test (on a weekly basis) each
resident for COVID-19, or, in the case that the
facility does not have a sufficient number of
testing kits for COVID-19, screen each resident
for symptoms of COVID-19 and report (on a daily
basis until the facility has a sufficient
number of such testing kits) to the State
survey agency that the facility does not have a
sufficient number of such testing kits and what
steps the facility is taking to procure a
sufficient number of such testing kits.
``(v) Ensure there is an adequate number of
employees to assist residents in communicating
with family members and friends through phone
calls, email, and virtual communications on at
least a weekly basis, without regard to whether
a resident has been diagnosed with COVID-19.
``(C) Worker safety requirements.--The worker
safety requirements described in this subparagraph are
each of the following:
``(i) In the case the facility is not
otherwise subject to the Occupational Safety
and Health Act of 1970 (or a State occupational
safety and health plan that is approved under
section 18(c) of such Act), comply with the
Bloodborne Pathogens standard under section
1910.1030 of title 29, Code of Federal
Regulations (or a successor regulation).
``(ii) In the case of a predicted shortage
of personal protective equipment, report such
predicted shortage to the State health
department of the State in which the facility
is located at least 24 hours in advance of when
such predicted shortage is expected to occur.
``(iii) Educate each employee on the
transmission of COVID-19.
``(iv) Notwithstanding any other provision
of law, provide at least two weeks of paid sick
leave to each employee.
``(v) Before each employee's shift, test
the employee for COVID-19, or, in the case that
the facility does not have a sufficient number
of testing kits for COVID-19, screen each
employee for symptoms of COVID-19 and report
(on a daily basis until the facility has a
sufficient number of such testing kits) to the
State survey agency that the facility does not
have a sufficient number of such testing kits
and what steps the facility is taking to
procure a sufficient number of such testing
kits.
``(D) Transparency requirements.--The transparency
requirements described in this subparagraph are each of
the following:
``(i) Report (on a daily basis) to the
State survey agency, the Centers for Medicare &
Medicaid Services, and the Centers for Disease
Control and Prevention each of the following:
``(I) The number of confirmed and
suspected cases COVID-19 among
residents and staff, including the age
and race or ethnicity of such residents
and staff.
``(II) The number of deaths related
to COVID-19 among residents and staff,
including the age and race or ethnicity
of such residents and staff.
``(III) The total number of deaths
(without regard to whether a death is
related to COVID-19) among residents
and staff.
``(IV) The amount of personal
protective equipment available and any
projected need regarding such
equipment.
``(V) Information on staffing
levels that would otherwise be required
to be submitted through the Payroll-
Based Journal of the Centers for
Medicare & Medicaid Services.
``(VI) The number of residents and
staff who have been tested for COVID-
19.
``(ii) In the case that a resident or
employee is diagnosed with COVID-19 or dies as
a result of COVID-19, notify all residents,
legal representatives of residents, and
employees not later than 12 hours after such
diagnosis is made or such death occurs.
``(iii) At any time three or more residents
or employees have newly onset COVID-19
symptoms, notify all residents, legal
representatives of residents, and employees not
later than 72 hours after such three or more
residents or employees are known to the
facility.
``(iv) In the case that a resident or
employee is suspected to have or is diagnosed
with COVID-19, post a notice of such suspicion
or diagnosis at each entrance of the facility
for the remaining portion of the emergency
period described in subparagraph (A).
``(v) For each day of the portion of the
emergency period described in subparagraph (A),
post a notice at each entrance of the facility
with the information required under subsection
(b)(8) for such day.
``(2) States and federal government.--
``(A) Public availability of information.--
``(i) In general.--As soon as possible, but
not later than 24 hours after receiving any
information required under paragraph (1)(D)(i),
the Administrator of the Centers for Medicare &
Medicaid Services, in coordination with the
Director of the Centers for Disease Control and
Prevention, shall make such information
publicly available on the Nursing Home Compare
website of the Centers for Medicare & Medicaid
Services and the COVIDView website of the
Centers for Disease Control and Prevention.
``(ii) HIPAA compliant information only.--
Information may only be made publicly available
under clause (i) if the disclosure of such
information would otherwise be permitted under
the Federal regulations (concerning the privacy
of individually identifiable health
information) promulgated under section 264(c)
of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2
note).
``(B) Designation of covid-19 facilities.--For
purposes of paragraph (1)(B)(iii)(II)--
``(i) the Administrator of the Centers for
Medicare & Medicaid Services shall specify
criteria (which shall include the provision of
the services of a registered nurse on a 24-
hours basis) for each State survey agency to
carry out the designation requirement described
in clause (ii) with respect to skilled nursing
facilities; and
``(ii) each State survey agency shall
designate a skilled nursing facility in the
State as a facility dedicated to the care of
residents who have been diagnosed with COVID-19
if such facility meets the criteria specified
by the Administrator under clause (i).
``(C) Remote monitoring and surveys.--A State
survey agency shall--
``(i) remotely monitor all skilled nursing
facilities with at least one resident or
employee who has been diagnosed with COVID-19;
``(ii) in addition to surveys required
under subsection (g), conduct a survey of a
skilled nursing facility, in the same manner
and subject to the same requirements applicable
to standard surveys conducted under subsection
(g), if the facility has a ratio of the number
of deaths resulting from COVID-19 to the number
of COVID-19 diagnoses that exceeds 5 percent,
or the State survey agency receives a COVID-19
or staffing related immediate jeopardy
complaint regarding the facility; and
``(iii) ensure that each survey team that
conducts a survey under clause (ii) has
adequate personal protective equipment while
conducting such survey.
``(3) Civil money penalties.--The Secretary shall impose a
civil money penalty against the operators of a skilled nursing
facility in an amount equal to $10,000 per day for each
violation of a requirement described in subparagraph (B), (C),
or (D) of paragraph (1) or the reporting of false information
under clause (i) of such subparagraph (D). 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).''.
(b) Medicaid.--Section 1919 of the Social Security Act (42 U.S.C.
1396r) is amended by adding at the end the following new subsection:
``(k) Additional Requirements During Certain Public Health
Emergency.--
``(1) Nursing facilities.--
``(A) In general.--During the portion of the
emergency period defined in paragraph (1)(B) of section
1135(g) beginning on or after the date of the enactment
of this subsection, a nursing facility shall comply
with the quality of care requirements described in
subparagraph (B), the worker safety requirements
described in subparagraph (C), and the transparency
requirements described in subparagraph (D).
``(B) Quality of care requirements.--The quality of
care requirements described in this subparagraph are
each of the following:
``(i) Employ, on a full-time basis, an
infection preventionist who--
``(I) has primary professional
training in nursing, medical
technology, microbiology, epidemiology,
or other related field;
``(II) is qualified by education,
training, experience or certification;
and
``(III) has completed specialized
training in infection prevention and
control.
``(ii) In the case of a resident who elects
to reside with a family member of such resident
for any portion of the emergency period
described in subparagraph (A), guarantee the
right of such resident to resume residency in
the facility at any time during the 180-day
period immediately following the end of such
emergency period.
``(iii) Notwithstanding subparagraphs (A)
and (B) of subsection (c)(2), permit a resident
to remain in the facility and not discharge or
transfer the resident from the facility
unless--
``(I) the State survey agency
approves the discharge or transfer;
``(II) in the case of a transfer,
the transfer is to a facility dedicated
to the care of residents who have been
diagnosed with COVID-19 if the resident
has been diagnosed with COVID-19, or a
facility dedicated to the care of
residents who have not been diagnosed
with COVID-19 if the resident has not
been diagnosed with COVID-19;
``(III) before effecting the
discharge or transfer, the facility
records the reasons in the resident's
clinical record;
``(IV) at least 72 hours in advance
of the discharge or transfer, the
facility provides a notice of the
discharge or transfer to the resident
(or legal representative of the
resident, if applicable), including the
reasons therefor and the items
described in clause (iii) of subsection
(c)(2)(B); and
``(V) the resident (or legal
representative of the resident, if
applicable) acknowledges receipt of the
notice described in subclause (IV) and
provides written consent to the
discharge or transfer.
``(iv) Test (on a weekly basis) each
resident for COVID-19, or, in the case that the
facility does not have a sufficient number of
testing kits for COVID-19, screen each resident
for symptoms of COVID-19 and report (on a daily
basis until the facility has a sufficient
number of such testing kits) to the State
survey agency that the facility does not have a
sufficient number of such testing kits and what
steps the facility is taking to procure a
sufficient number of such testing kits.
``(v) Ensure there is an adequate number of
employees to assist residents in communicating
with family members and friends through phone
calls, email, and virtual communications on at
least a weekly basis, without regard to whether
a resident has been diagnosed with COVID-19.
``(C) Worker safety requirements.--The worker
safety requirements described in this subparagraph are
each of the following:
``(i) In the case the facility is not
otherwise subject to the Occupational Safety
and Health Act of 1970 (or a State occupational
safety and health plan that is approved under
section 18(c) of such Act), comply with the
Bloodborne Pathogens standard under section
1910.1030 of title 29, Code of Federal
Regulations (or a successor regulation).
``(ii) In the case of a predicted shortage
of personal protective equipment, report such
predicted shortage to the State health
department of the State in which the facility
is located at least 24 hours in advance of when
such predicted shortage is expected to occur.
``(iii) Educate each employee on the
transmission of COVID-19.
``(iv) Notwithstanding any other provision
of law, provide at least two weeks of paid sick
leave to each employee.
``(v) Before each employee's shift, test
the employee for COVID-19, or, in the case that
the facility does not have a sufficient number
of testing kits for COVID-19, screen each
employee for symptoms of COVID-19 and report
(on a daily basis until the facility has a
sufficient number of such testing kits) to the
State survey agency that the facility does not
have a sufficient number of such testing kits
and what steps the facility is taking to
procure a sufficient number of such testing
kits.
``(D) Transparency requirements.--The transparency
requirements described in this subparagraph are each of
the following:
``(i) Report (on a daily basis) to the
State survey agency, the Centers for Medicare &
Medicaid Services, and the Centers for Disease
Control and Prevention each of the following:
``(I) The number of confirmed and
suspected cases COVID-19 among
residents and staff, including the age
and race or ethnicity of such residents
and staff.
``(II) The number of deaths related
to COVID-19 among residents and staff,
including the age and race or ethnicity
of such residents and staff.
``(III) The total number of deaths
(without regard to whether a death is
related to COVID-19) among residents
and staff.
``(IV) The amount of personal
protective equipment available and any
projected need regarding such
equipment.
``(V) Information on staffing
levels that would otherwise be required
to be submitted through the Payroll-
Based Journal of the Centers for
Medicare & Medicaid Services.
``(VI) The number of residents and
staff who have been tested for COVID-
19.
``(ii) In the case that a resident or
employee is diagnosed with COVID-19 or dies as
a result of COVID-19, notify all residents,
legal representatives of residents, and
employees not later than 12 hours after such
diagnosis is made or such death occurs.
``(iii) At any time three or more residents
or employees have newly onset COVID-19
symptoms, notify all residents, legal
representatives of residents, and employees not
later than 72 hours after such three or more
residents or employees are known to the
facility.
``(iv) In the case that a resident or
employee is suspected to have or is diagnosed
with COVID-19, post a notice of such suspicion
or diagnosis at each entrance of the facility
for the remaining portion of the emergency
period described in subparagraph (A).
``(v) For each day of the portion of the
emergency period described in subparagraph (A),
post a notice at each entrance of the facility
with the information required under subsection
(b)(8) for such day.
``(2) States and federal government.--
``(A) Public availability of information.--
``(i) In general.--As soon as possible, but
not later than 24 hours after receiving any
information required under paragraph (1)(D)(i),
the Administrator of the Centers for Medicare &
Medicaid Services, in coordination with the
Director of the Centers for Disease Control and
Prevention, shall make such information
publicly available on the Nursing Home Compare
website of the Centers for Medicare & Medicaid
Services and the COVIDView website of the
Centers for Disease Control and Prevention.
``(ii) HIPAA compliant information only.--
Information may only be made publicly available
under clause (i) if the disclosure of such
information would otherwise be permitted under
the Federal regulations (concerning the privacy
of individually identifiable health
information) promulgated under section 264(c)
of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2
note).
``(B) Designation of covid-19 facilities.--For
purposes of paragraph (1)(B)(iii)(II)--
``(i) the Administrator of the Centers for
Medicare & Medicaid Services shall specify
criteria (which shall include the provision of
the services of a registered nurse on a 24-
hours basis) for each State survey agency to
carry out the designation requirement described
in clause (ii) with respect to nursing
facilities; and
``(ii) each State survey agency shall
designate a nursing facility in the State as a
facility dedicated to the care of residents who
have been diagnosed with COVID-19 if such
facility meets the criteria specified by the
Administrator under clause (i).
``(C) Remote monitoring and surveys.--A State
survey agency shall--
``(i) remotely monitor all nursing
facilities with at least one resident or
employee who has been diagnosed with COVID-19;
``(ii) in addition to surveys required
under subsection (g), conduct a survey of a
nursing facility, in the same manner and
subject to the same requirements applicable to
standard surveys conducted under subsection
(g), if the facility has a ratio of the number
of deaths resulting from COVID-19 to the number
of COVID-19 diagnoses that exceeds 5 percent,
or the State survey agency receives a COVID-19
or staffing related immediate jeopardy
complaint regarding the facility; and
``(iii) ensure that each survey team that
conducts a survey under clause (ii) has
adequate personal protective equipment while
conducting such survey.
``(3) Civil money penalties.--The Secretary shall impose a
civil money penalty against the operators of a nursing facility
in an amount equal to $10,000 per day for each violation of a
requirement described in subparagraph (B), (C), or (D) of
paragraph (1) or the reporting of false information under
clause (i) of such subparagraph (D). 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).''.
SEC. 3. FUNDING FOR STATE STRIKE TEAMS FOR RESIDENT AND EMPLOYEE SAFETY
IN SKILLED NURSING FACILITIES AND NURSING FACILITIES.
(a) In General.--Of the amounts made available under subsection
(c), the Secretary of Health and Human Services (referred to in this
section as the ``Secretary'') shall allocate such amounts among the
States, in a manner that takes into account the percentage of skilled
nursing facilities and nursing facilities in each State that have
residents or employees who have been diagnosed with COVID-19, for
purposes of establishing and implementing strike teams in accordance
with subsection (b).
(b) Use of Funds.--A State that receives funds under this section
shall use such funds to establish and implement a strike team that will
be deployed to a skilled nursing facility or nursing facility in the
State, not later than 72 hours after three or more residents or
employees of the facility are diagnosed with or suspected of having
COVID-19, to assist the facility in separating residents and employees
who have been exposed to COVID-19 from those residents and employees
who have not been so exposed, supervising testing for COVID-19,
ensuring any applicable whistleblower protections are being enforced,
and such other needs as determined necessary by the strike team. Such
strike team shall include members of the National Guard, public health
officials from State and local health departments, experts in
geriatrics and long-term care medicine, representatives of residents or
consumers, and representatives of workers.
(c) Authorization of Appropriations.--For purposes of carrying out
this section, there is authorized to be appropriated $500,000,000.
(d) Definitions.--In this section:
(1) Nursing facility.--The term ``nursing facility'' means
a nursing facility under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) Skilled nursing facility.--The term ``skilled nursing
facility'' means a skilled nursing facility under the Medicare
program under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
SEC. 4. REINSTITUTION OF REQUIREMENTS WAIVED FOR SKILLED NURSING
FACILITIES AND NURSING FACILITIES DURING COVID-19
EMERGENCY PERIOD.
(a) In General.--With respect to requirements that the
Administrator of the Centers for Medicare & Medicaid Services (referred
to in this section as the ``Administrator'') waived for skilled nursing
facilities and nursing facilities under section 1135 or 1812(f) of the
Social Security Act (42 U.S.C. 1320b-5, 1395d(f)) for the period
beginning on March 1, 2020, and ending on the last day of the emergency
period defined in subsection (g)(1)(B) of such section 1135, the
Administrator shall terminate the waiver of such requirements before
the last day of such emergency period upon the determination that
skilled nursing facilities and nursing facilities have the capacity to
comply with such requirements and that such waiver is no longer
necessary.
(b) Plan for Conducting Waived or Postponed Surveys.--With respect
to any survey under section 1819(g) or 1919(g) of the Social Security
Act (42 U.S.C. 1395i-3(g), 1396r(g)) that is waived or postponed during
the period beginning on March 1, 2020, and ending on the last day of
the emergency period described in subsection (a), the Administrator
shall develop a plan for conducting such survey after such last day.
(c) Training and Certification of Nurse Aides.--With respect to any
nurse aide with respect to whom the Administrator waived the
application of the requirements under section 483.35(d) of title 42,
Code of Federal Regulations, for the period beginning on March 1, 2020,
and ending on the last day of the emergency period described in
subsection (a), the Administrator shall prohibit the skilled nursing
facility or nursing facility employing such nurse aide from retaining
such nurse aide after such last day unless such nurse aide satisfies
applicable training and certification requirements under such section
not later than 15 days after such last day.
(d) Definitions.--In this section:
(1) Nursing facility.--The term ``nursing facility'' means
a nursing facility under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) Skilled nursing facility.--The term ``skilled nursing
facility'' means a skilled nursing facility under the Medicare
program under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
SEC. 5. GUIDANCE FOR CERTAIN RESIDENTIAL CARE FACILITIES DURING COVID-
19 EMERGENCY PERIOD.
Not later than 15 days after the date of the enactment of this Act,
the Secretary of Health and Human Services (referred to in this section
as the ``Secretary'') shall issue guidance for long-term health care
facilities, including assisted living facilities, other residential
care facilities, and such facilities that are temporary during the
emergency period defined in section 1135(g)(1)(B) of the Social
Security Act (42 U.S.C. 1320b-5(g)(1)(B)), that are not subject to
oversight by the Centers for Medicare & Medicaid Services on providing
access to virtual visitation during any portion of such emergency
period in which in-person visitation is restricted and ensuring
appropriate infection control and prevention and employee safety during
such emergency period. Such guidance shall include--
(1) steps that health care facilities described in this
subsection should take to provide residents with access to
virtual visitation, including through the purchase or
installation of devices purchased for the use or benefit of
individual or multiple residents, that allows residents to
communicate with their families during such emergency period;
(2) options for such facilities in notifying residents and
resident representatives of such access to virtual visitation
and how the facility is addressing any operational issues
related to such access to virtual visitation; and
(3) steps that health care facilities described in this
subsection should take to provide residents and employees with
appropriate infection control and prevention, based on
requirements for skilled nursing facilities under subsection
(k) of section 1819 of the Social Security Act (42 U.S.C.
1395i-3), as added by section 2(a), and requirements for
nursing facilities under subsection (k) of section 1919 of such
Act (42 U.S.C. 1396r), as added by section 2(b).
<all>