Linking Investors and Nursing Home Quality Act or the LINHQ Act
This bill establishes additional requirements for Medicare skilled nursing facilities and Medicaid nursing facilities with respect to ownership disclosures and quality control, including conditioning Medicare and Medicaid payment on timely ownership disclosures. The bill also establishes dedicated task forces to review disclosures, develop quality metrics, and report violations.
To amend title XI of the Social Security Act to provide for additional 
 requirements for disclosing entities relating to the quality of care 
 furnished at skilled nursing facilties and nursing facilites, 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 ``Linking Investors and Nursing Home 
Quality Act'' or the ``LINHQ Act''.

SEC. 2. REGULATING OWNERSHIP OF SKILLED NURSING FACILITIES AND NURSING 
              FACILITIES.

    (a) Requirement To Submit Timely Disclosures To Admit New Residents 
of Skilled Nursing Facilities and Nursing Facilities.--Section 1124 of 
the Social Security Act (42 U.S.C. 1320a-3) is amended by adding at the 
end the following new subsection:
    ``(d) Suspension of Certain Payments for Certain Entities That Fail 
To Submit Timely Ownership Disclosures.--
            ``(1) In general.--In the case of a covered nursing 
        facility that fails to submit specified information to the 
        Secretary by the date that is 30 days after the date that such 
        information is required to be submitted pursuant to regulations 
        or contract provisions described in subsection (a)(1) (or, in 
        the case of a party with an ownership interest in such facility 
        that fails to submit information to the Secretary in accordance 
        with paragraph (3))--
                    ``(A) the Secretary shall suspend payment under 
                title XVIII with respect to items and services 
                furnished to a specified resident during the applicable 
                payment suspension period; and
                    ``(B) the Secretary shall suspend payment under 
                title XIX for medical assistance consisting of items 
                and services furnished by such facility to such a 
                resident during such period.
            ``(2) Quality review.--
                    ``(A) In general.--The Secretary shall, with 
                respect to each covered nursing facility, on a periodic 
                basis, conduct a review of the quality of care 
                furnished by each such facility using information 
                reported by such a facility as part of a survey 
                conducted under section 1819(g) or 1919(g) or as part 
                of the minimum data set described in section 1819(f)(6) 
                or 1919(f)(6). For purposes of conducting such reviews, 
                the Secretary shall establish quality metrics relating 
                to such information to evaluate each such facility.
                    ``(B) Quality metrics.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A), the quality metrics described 
                        in this subparagraph are quality metrics 
                        specified by the Secretary, taking into account 
                        input from the Data Liaison Team established 
                        under section 2(c) of the LINHQ Act, that may 
                        be used to evaluate the information described 
                        in subparagraph (A). Such metrics shall include 
                        a metric with respect to the average number of 
                        direct care hours furnished to residents.
                            ``(ii) Specification.--The Secretary shall 
                        publish on a public website each quality 
                        measure specified under this subparagraph at 
                        least 180 days prior to such quality metric 
                        being used in a quality review under this 
                        paragraph, except that, with respect to such 
                        reviews beginning during the 1-year period 
                        beginning on the date of the enactment of this 
                        subsection, the Secretary may use any such 
                        metric that the Secretary publishes on such a 
                        website at least 14 days prior to the beginning 
                        of such review.
                    ``(C) Establishment of standards.--The Secretary 
                shall specify standards with respect to quality 
                measures described in subparagraph (B), taking into 
                account input from the Data Liaison Team so described. 
                Such standards shall include, with respect to the 
                metric relating to the average number of direct care 
                hours furnished to residents, a standard of at least 
                4.1 direct care hours furnished per resident per day.
                    ``(D) Notification and publication of facilities 
                falling below standards.--If the Secretary determines 
                that a covered nursing facility has failed to meet a 
                standard established under subparagraph (C) with 
                respect to a quality measure described in subparagraph 
                (B) pursuant to a review conducted under this 
                paragraph, the Secretary shall--
                            ``(i) notify such facility of such 
                        determination;
                            ``(ii) publish the name of such facility on 
                        the Care Compare website (or a successor 
                        website) described in section 1819(i) with an 
                        explanation that such facility has failed to 
                        meet such standard; and
                            ``(iii) suspend payment under title XVIII 
                        to such facility, and payment under title XIX 
                        for medical assistance furnished by such 
                        facility, until such facility demonstrates that 
                        such facility has met such standard.
            ``(3) Submission of third-party information.--The Secretary 
        shall establish a process under which, with respect to a 
        covered nursing facility, any party that has an ownership 
        interest in such facility and that also has an ownership 
        interest in an entity that contracts with such facility to 
        provide any service to such facility submits to the Secretary 
        the following information:
                    ``(A) A balance sheet detailing the assets, 
                liabilities, and net worth of the entity.
                    ``(B) A statement of income, expenses, and 
                operating surplus or deficit.
                    ``(C) A statement of cashflows, including ongoing 
                and new capital expenditures and depreciation.
            ``(4) Submission of additional info by facilities.--The 
        Secretary shall require a covered nursing facility, as part of 
        the information submitted under subsection (a)(1), to provide 
        to the Secretary a detailed document outlining a visual 
        representation of the facility's structure that includes both 
        of the following:
                    ``(A) Any entity in which any party that has an 
                ownership or control interest in the covered nursing 
                facility and that also has an ownership interest or 
                control interest of 5 percent or more in such entity 
                that provides any service, facility, or supply to such 
                covered nursing facility.
                    ``(B) Unrelated parties that provide services to 
                such facility or to facilities that are operated, 
                conducted, owned, managed, or maintained by the 
                organization, including management companies and 
                property companies, and that are paid more than 
                $200,000 by such facility.
            ``(5) Definitions.--In this subsection:
                    ``(A) Applicable payment suspension period.--The 
                term `applicable payment suspension period' means, with 
                respect to specified information required to be 
                submitted by a covered nursing facility pursuant to 
                regulations or contract provisions described in 
                subsection (a)(1) (or with respect to third-party 
                information required to be submitted by a party with an 
                ownership interest in such facility), the period 
                beginning on the day that is 30 days after the date 
                that such information is required to be so submitted by 
                such facility (or party) and ending on the date that is 
                5 days after such facility (or party) submits such 
                information.
                    ``(B) Covered nursing facility.--The term `covered 
                nursing facility' means a skilled nursing facility (as 
                defined in section 1819(a)(1)) or a nursing facility 
                (as defined in section 1919(a)(1)).
                    ``(C) Specified information.--The term `specified 
                information' means any information required to be 
                submitted under subsection (a)(1).
                    ``(D) Specified resident.--The term `specified 
                resident' means a resident of a covered nursing 
                facility who is admitted to such facility during an 
                applicable payment suspension period with respect to 
                such facility.
                    ``(E) Ownership interest.--The term `ownership 
                interest' means a direct or indirect interest of at 
                least 5 percent.''.
    (b) Requiring Annual Reporting for Disclosing Entities.--Section 
1124(c)(3)(A) of the Social Security Act (42 U.S.C. 1320a-3(c)(3)(A)) 
is amended by adding at the end the following new sentence: ``The 
Secretary shall, not later than 90 days after the date of the enactment 
of this sentence, amend such regulations to provide that such 
information is reported not less frequently than annually.''.
    (c) Increasing Oversight of Facilities.--
            (1) Data liaison team.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, the Secretary of 
                Health and Human Services (in this subsection referred 
                to as the ``Secretary'') shall establish a task force 
                (in this paragraph, referred to as the ``Data Liaison 
                Team'') to carry out the activities described in 
                subparagraph (B).
                    (B) Activities described.--For purposes of 
                subparagraph (A), the activities described in this 
                subparagraph are--
                            (i) reviewing information submitted under 
                        section 1124 of the Social Security Act (42 
                        U.S.C. 1320a-3) to identify any common 
                        ownership patterns with respect to skilled 
                        nursing facilities' (as defined in section 
                        1819(a)(1) of such Act (42 U.S.C. 1395i-
                        3(a)(1))) and nursing facilities' (as defined 
                        in section 1919(a)(1) of such Act (42 U.S.C. 
                        1396r(a)(1))) that--
                                    (I) are at least 30 days delinquent 
                                in supplying the ownership information 
                                required pursuant to section 1124(a)(1) 
                                of such Act (42 U.S.C. 1320a-3(a)(1));
                                    (II) in the preceding quarterly 
                                reporting period, failed to meet a 
                                payroll based journal level of 4.1 
                                hours of direct resident care hours 
                                (including registered nurse, licensed 
                                practical nurse, and nursing assistant 
                                or certified nursing assistant care) 
                                per resident per day; or
                                    (III) in the preceding year of 
                                reporting, failed to meet any quality 
                                standard established by the Secretary 
                                under subsection (d) of such section or 
                                established by the Secretary or a State 
                                with respect to surveys conducted under 
                                section 1819(g) or 1919(g) of such Act 
                                (42 U.S.C. 1395i-3(g); 42 U.S.C. 
                                1396r(g));
                            (ii) assessing potential misuse of payments 
                        under titles XVIII and XIX of such Act (42 
                        U.S.C. 1395 et seq.; 1396 et seq.) through 
                        review of data collected by the Treasury 
                        Department, facility organization charts, and 
                        cost reports submitted under such title XVIII;
                            (iii) on a monthly basis, reporting any 
                        disclosing entities (as defined for purposes of 
                        section 1124 of such Act (42 U.S.C. 1320a-3)) 
                        with common ownership identified pursuant to 
                        clause (i), or with respect to which the Team 
                        has found a potential misuse of payments 
                        pursuant to clause (ii), to the Interagency 
                        Board, the Office of Inspector General of the 
                        Department of Health and Human Services, and 
                        the Department of Justice;
                            (iv) regularly reviewing skilled nursing 
                        facilities and nursing facilities with a one-
                        star rating in health inspections or staffing 
                        on the Care Compare website (or a successor 
                        website) described in section 1819(i) of such 
                        Act (42 U.S.C. 1395i-3(i)), as well as such 
                        facilities that are ranked among the lowest 20 
                        percent of facilities on such website with 
                        respect to quality; and
                            (v) at the discretion of the Data Liaison 
                        Team, requiring skilled nursing facilities and 
                        nursing facilities to submit to the Team 
                        information on whether such facilities--
                                    (I) do business (including business 
                                relating to laundry services, staffing 
                                agencies, food and beverage services, 
                                medical supplies, or consulting) with 
                                any other entity (including a 
                                specification of such other entity);
                                    (II) lease their building or 
                                property from another entity (including 
                                a specification of such other entity); 
                                or
                                    (III) share an individual who has 
                                directly or indirectly (as determined 
                                by the Secretary pursuant to a notice 
                                and comment rulemaking) any ownership 
                                interest of 5 percent or more in an 
                                entity described in subclause (II) and 
                                the skilled nursing facility or nursing 
                                facility.
                    (C) Provision of information.--
                            (i) Treasury information.--For purposes of 
                        subparagraph (B)(ii), the Secretary of the 
                        Treasury shall furnish to the Data Liaison Team 
                        such information as such Team may request.
                            (ii) Facility information.--For purposes of 
                        subparagraph (B)(v), a skilled nursing facility 
                        or nursing facility shall submit to the Data 
                        Liaison Team such information as may be 
                        requested by the Team. Any failure to submit 
                        such information shall be deemed to constitute 
                        a violation of section 1124(a)(1) of such Act 
                        (42 U.S.C. 1320a-3(a)(1)).
                    (D) Composition.--
                            (i) In general.--The Data Liaison Team 
                        shall consist of--
                                    (I) the Administrator of the 
                                Centers for Medicare & Medicaid 
                                Services of the Department of Health 
                                and Human Services (or designee); and
                                    (II) any other employees of the 
                                agency specified in subclause (I) (as 
                                determined appropriate by the 
                                Secretary).
                            (ii) Manager.--An employee of the Centers 
                        for Medicare & Medicaid Services of the 
                        Department of Health and Human Services shall 
                        manage the Data Liaison Team.
            (2) Interagency board.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, the Secretary of 
                Health and Human Services shall establish a task force 
                (in this paragraph, referred to as the ``Interagency 
                Board'') to carry out the activities described in 
                subparagraph (B).
                    (B) Activities described.--For purposes of 
                subparagraph (A), the activities described in this 
                subparagraph are--
                            (i) reviewing the list of disclosing 
                        entities reported pursuant to paragraph 
                        (1)(B)(iii) to determine which entities to 
                        refer to the Office of Inspector General of the 
                        Department of Health and Human Services and the 
                        Department of Justice for further 
                        investigation;
                            (ii) reporting any such referrals to the 
                        Data Liaison Team, and the reasoning for any 
                        such referrals, not later than 7 days after 
                        such a referral is made; and
                            (iii) on an biannual basis, submitting to 
                        Congress a report on the findings made by and 
                        results from any referrals made by the 
                        Interagency Board, including any reason for not 
                        pursuing action on referrals in the event that 
                        action was not taken (if the Interagency Board 
                        has been informed of such reason).
                    (C) Composition.--
                            (i) In general.--The Interagency Board 
                        shall consist of--
                                    (I) the Administrator of Centers 
                                for Medicare & Medicaid Services of the 
                                Department of Health and Human Services 
                                (or designee);
                                    (II) the Inspector General of the 
                                Office of the Inspector General of the 
                                Department of Health and Human Services 
                                (or designee);
                                    (III) the Attorney General of the 
                                Department of Justice (or designee); 
                                and
                                    (IV) any other employees of the 
                                agencies specified in subclauses (I) 
                                through (III) (as determined 
                                appropriate by the Secretary of Health 
                                and Human Services).
                            (ii) Chair.--An employee of the Office of 
                        Inspector General of the Department of Health 
                        and Human Services shall chair the Interagency 
                        Board.

SEC. 3. FUNDING FOR NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE 
              AND USE OF INFORMATION TECHNOLOGY IN NURSING HOMES.

    Section 6114 of the Patient Protection and Affordable Care Act (42 
U.S.C. 1395i-3 note) is amended--
            (1) in subsection (a), by adding at the end the following 
        new sentence: ``Beginning in fiscal year 2023, the Secretary 
        shall implement 2 additional demonstration projects, split in 
        accordance with the previous sentence.'';
            (2) in subsection (b)--
                    (A) in paragraph (1), by adding at the end the 
                following new sentence: ``For the carrying out of the 
                implementation of demonstration projects beginning in 
                fiscal year 2023, the Secretary shall award grants (in 
                a number determined appropriate) in accordance with the 
                provisions of this subsection.''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Requirement for one of the renewed demonstration 
        projects.--With respect to the grants which are awarded under 1 
        of the 2 demonstration projects which is implemented pursuant 
        to the second sentence of subsection (a), all of the grants 
        which are so awarded shall be awarded to skilled nursing 
        facilities and nursing facilities which have a high proportion 
        of residents receiving medical assistance under title XIX of 
        the Social Security Act for nursing facility services.'';
            (3) in subsection (c)--
                    (A) in paragraph (1), by striking ``The 
                demonstration projects'' and inserting ``Subject to 
                paragraph (3), the demonstration projects''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Implementation of demonstration projects.--The 
        demonstration projects described in the second sentence of 
        subsection (a) shall be implemented for a period not to exceed 
        5 years.'';
            (4) in subsection (d), by adding at the end the following 
        new paragraph:
            ``(4) Culture change.--The term `culture change' means, 
        with respect to a skilled nursing facility or a nursing 
        facility carrying out a demonstration project under this 
        section, the process of promoting person-centered care and 
        person-centered work culture at such facility.''; and
            (5) in subsection (e), by adding at the end the following 
        new sentence: ``With respect to the implementation of the 
        demonstration projects pursuant to the second sentence of 
        subsection (a), there are authorized to be appropriated 
        $50,000,000 to carry out the demonstration project relating to 
        culture change and $30,000,000 to carry out the demonstration 
        project relating to information technology for the period of 
        fiscal years 2023 through 2027.''.
                                 <all>
LINHQ Act
To amend title XI of the Social Security Act to provide for additional requirements for disclosing entities relating to the quality of care furnished at skilled nursing facilties and nursing facilites, and for other purposes.
LINHQ Act
Linking Investors and Nursing Home Quality Act
Rep. Schakowsky, Janice D.