text: 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.
target: 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.
feat_title: Nursing Home Staff Improvement Act of 2000