article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Nursing Home Staff Improvement Act of 2000''. SEC. 2. FINDINGS. Congress makes the following findings: (1) Part I of the Health Care Financing Administration's Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes was completed in August of 2000 and showed the following: (A) Quality of care may be significantly impaired when staffing thresholds fall below 2.0 nurse aide hours per resident day, 1.0 registered nurse and licensed practical nurse hours per resident day and 0.45 registered nurse hours per resident day. (B) Below this threshold, residents are more likely to suffer life threatening illnesses secondary to pressure sores, weight loss and preventable infections, and rates of avoidable hospitalization increase significantly. (C) Fifty-four percent of nursing home facilities do not provide 2.0 nurse aide hours per resident day and approximately \1/2\ of nursing home facilities would require greater than a 10 percent change in staffing to meet this minimal standard. (D) The 2.0 nurse aide hours per resident day is a threshold below which residents lives are at risk, not a standard for the provision of appropriate care. (2)(A) A minimum of 2.9 nurse aide hours per resident day are necessary to deliver 5 necessary daily care services. (B) Over 92 percent of nursing home facilities fall below the 2.9 nurse aide hours per resident day standard and would require a 50 percent increase in staffing to meet this standard. (C) The 2.9 nurse aide hours per resident day standard is based on a conservative assumption and understates the real staffing levels necessary for a nurse aide to complete all tasks that constitute adequate care. (3)(A) Facilities that serve residents with more complex medical conditions will require higher staffing levels. (B) Minimum staffing levels that take into account case mix have not yet been established. (C) Part II of the Health Care Financing Administration report, which has not yet been completed, will report to Congress on minimum staffing levels according to the facility's resident acuity level. SEC. 3. COMPLETION OF REPORT TO CONGRESS ON ADEQUATE NURSING FACILITY STAFFING REQUIREMENTS. (a) In General.--Section 4801(e)(17)(B) of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1396r note) is amended-- (1) by striking ``January 1, 1999'' and inserting ``July 1, 2001''; (2) by inserting ``and optimal minimum'' after ``minimum'' each place it appears; (3) by striking the period and inserting a semicolon; (4) by striking ``such study recommendations'' and inserting ``such study-- ``(i) recommendations''; and (5) by adding at the end the following: ``(ii) an examination of the cost and benefits associated with establishing staffing minimum and optimal minimum ratios; ``(iii) a description of the data used in Phase II of the study to expand the multivariate analysis from 3 States to a more representative national sample; ``(iv) an analysis of proposed refined case mix classification methods considered in Phase II of the study; ``(v) a description of the case studies used to validate the Phase I findings of the study; and ``(vi) an examination of other issues that impact the recruitment and retention of certified nursing assistants.''. (b) Effective Date.--The amendments made by subsection (a) take effect as if included in the enactment of section 4801 of the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508; 104 Stat. 1388- 211). SEC. 4. ESTABLISHMENT OF APPROPRIATE MINIMUM STAFFING REQUIREMENTS. (a) Notice of Proposed Rulemaking.--Not later than 6 months after the date that the Secretary of Health and Human Services (in this section referred to as the ``Secretary'') submits the report to Congress required under section 4801(e)(17)(B) of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1396r note) regarding the study of establishing appropriate minimum caregiver to resident levels and appropriate minimum supervisor to caregiver levels for skilled nursing facilities participating as providers of services under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and nursing facilities receiving payments under the medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.) that includes recommendations regarding appropriate minimums for such levels, the Secretary shall issue a notice of proposed rule-making with respect to the promulgation of a final regulation requiring compliance with appropriate minimum caregiver to resident levels and appropriate minimum supervisor to caregiver levels as a condition for such facilities to receive payments under such programs. (b) Final Regulation.--Not later than 6 months after the issuance of the notice required under subsection (a), the Secretary shall issue the final regulation (to be effective upon publication) that was the subject of such notice. (c) Definition of Appropriate.--In this section, the term ``appropriate'' means the staffing threshold level required to attain a good or optimal quality outcome with respect to a resident of a skilled nursing facility participating as a provider of services under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or of a nursing facility receiving payments under the medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), as opposed to avoiding a bad outcome with respect to such a resident. SEC. 5. GRANTS TO IMPROVE STAFFING LEVELS AND THE QUALITY OF CARE IN NURSING FACILITIES. (a) Authority To Award Grants.--The Secretary of Health and Human Services shall award grants to States on a competitive basis for the purpose of improving staffing levels in nursing facilities in order to improve the quality of care to residents of such facilities. (b) Applications.--Each State that wishes to receive a grant under this section shall submit an application at such time, in such form, and complete with such information as the Secretary may require, except that any such application shall include at least a certification that the application was developed through an open, public process. (c) Requirements for Use of Funds.-- (1) Permissible uses.-- (A) In general.--A State awarded a grant under this section shall use funds provided under the grant to provide financial support or technical assistance for projects operated by nursing facilities, labor organizations, nonprofit organizations, community colleges, or other organizations, or through joint efforts of such entities and organizations, that are designed to do any or all of the following: (i) Enhance staff recruitment and retention efforts. (ii) Establish centers of expertise and training. (iii) Establish career ladders for certified nurse assistants, including additional or advanced training opportunities. (iv) Provide additional training for nursing facility direct care staff. (v) Improve workplace safety. (vi) Improve nursing facility management. (vii) Conduct other staffing initiatives to improve patient outcomes, as approved by the Secretary. (B) Applicability of nursing home reform provisions.--Funds made available under a grant awarded to a State under this section may only be used to provide financial support or technical assistance for any project described in subparagraph (A) to the extent that the activities conducted under the project are consistent with the requirements of sections 1818 and 1919 of the Social Security Act (42 U.S.C. 1395i-3, 1396r). (C) Prohibition.--No funds made available under a grant awarded to a State under this section may be used to provide financial support or technical assistance for any project described in subparagraph (A) that is conducted at, or for the benefit of, a nursing facility that is owned or operated by a State, county, or local government. (2) No supplantation of funds.--Funds made available under a grant awarded to a State under this section may only be used to supplement, not supplant, other funds that the State expends to carry out activities described in paragraph (1)(A). (d) Authorization of Appropriations.--There are authorized to be appropriated to the Secretary for purposes of carrying out this section $500,000,000 for each of fiscal years 2001 and 2002. Funds appropriated in accordance with this subsection for a fiscal year shall remain available through the end of the succeeding fiscal year. (e) Reports and Secretarial Evaluation.-- (1) State final reports.--Each State that is awarded a grant under this section shall submit a final report to the Secretary on the use of funds awarded under the grant not later than 3 months after the earlier of-- (A) the completion of the project or projects provided financial support or technical assistance with funds received under the grant; or (B) the conclusion of the 2-year period that begins on the date that the State receives such grant funds. (2) Secretarial evaluation and report.--Not later than 6 months after the final State report is submitted to the Secretary under paragraph (1), the Secretary shall submit to Congress a report evaluating the extent to which the grant program established under this section assists States in improving staffing levels in nursing facilities. (f) Definitions.--In this section: (1) Nursing facility.--The term ``nursing facility'' means a skilled nursing facility participating in the medicare program established under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or a nursing facility receiving payments under the medicaid program established under title XIX of such Act (42 U.S.C. 1396 et seq.). (2) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. SEC. 6. PROVIDING ACCURATE INFORMATION ON STAFFING. (a) Medicare.-- (1) Data on staffing levels.--Section 1819(b) of the Social Security Act (42 U.S.C. 1395i-3(b)) is amended by adding at the end the following new paragraph: ``(8) Submission of data on staffing levels.-- ``(A) In general.--A skilled nursing facility shall submit to the Secretary, at such time as the Secretary shall specify and on a standard reporting format developed by the Secretary, data with respect to nursing staff that-- ``(i) includes the total number of nursing staff hours and coverage levels per shift furnished by the facility to residents for which payment is made under section 1888(e), broken down by total certified nurse aide hours, total licensed practical or vocational nurse hours, and total registered nurse hours; and ``(ii) is attested to in writing by the facility as accurate. ``(B) Publication of data.--The Secretary shall provide for the publication on the Internet Site of the Department of Health and Human Services known as Nursing Home Compare the facility-specific nursing staff information described in subparagraph (A). The Secretary shall update such information periodically.''. (2) Information concerning patient classification.--Section 1819(b)(4) of the Social Security Act (42 U.S.C. 1395i-3(b)(4)) is amended by adding at the end the following new subparagraph: ``(D) Information concerning residents.--The skilled nursing facility shall provide the Secretary, in such form and manner and at such intervals as the Secretary may require, a classification of all residents of the skilled nursing facility that accords with the resident classification system described in section 1888(e)(4)(G)(i), or such successor system as the Secretary may identify.''. (b) Medicaid.-- (1) Data on staffing levels.--Section 1919(b) of the Social Security Act (42 U.S.C. 1396r(b)) is amended by adding at the end the following new paragraph: ``(8) Submission of data on staffing levels.-- ``(A) In general.--A nursing facility shall submit to the Secretary, at such time as the Secretary shall specify and on a standard reporting format developed by the Secretary, data with respect to nursing staff that-- ``(i) includes the total number of nursing staff hours and coverage levels per shift furnished by the facility to residents for which payment is made under the State plan, broken down by total certified nurse aide hours, total licensed practical or vocational nurse hours, and total registered nurse hours; and ``(ii) is attested to in writing by the facility as accurate. ``(B) Publication of data.--The Secretary shall provide for the publication on the Internet Site of the Department of Health and Human Services known as Nursing Home Compare the facility-specific nursing staff information described in subparagraph (A). The Secretary shall update such information periodically.''. (2) Information concerning patient classification.--Section 1919(b)(4) of the Social Security Act (42 U.S.C. 1395r(b)(4)) is amended by adding at the end the following new subparagraph: ``(D) Information concerning residents.--The nursing facility shall provide the Secretary, in such form and manner and at such intervals as the Secretary may require, a classification of all residents of the nursing facility that accords with the resident classification system described in section 1888(e)(4)(G)(i), or such successor system as the Secretary may identify.''. SEC. 7. INFORMATION ON NURSING FACILITY STAFFING. (a) Medicare Amendments.--Section 1819(b) of the Social Security Act (42 U.S.C. 1395i-3(b)), as amended by section 6(a), is further amended by adding at the end the following new paragraph: ``(9) Information on nurse staffing.--A skilled nursing facility shall post daily for each nursing unit of the facility and for each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care and the number of residents per unit and per shift. The information shall be displayed in a uniform manner and in a clearly visible place.''. (b) Medicaid Amendments.--Section 1919(b) of the Social Security Act (42 U.S.C. 1396r(b)), as amended by section 6(b), is amended by adding at the end the following new paragraph: ``(9) Information on nurse staffing.--A nursing facility shall post daily for each nursing unit of the facility and for each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care and the number of residents per unit and per shift. The information shall be displayed in a uniform manner and in a clearly visible place.''. (c) Effective Date.--The amendments made by this section take effect on the first day of the first month that begins at least 6 months after the date of the enactment of this Act.
summary: Directs the Secretary to award competitive grants to States for improving staffing levels in nursing facilities. Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to require skilled nursing and nursing facilities to report to the Secretary on nurse staffing levels and information regarding patient classification.