ACCOUNT ; Recommending to Center national priorities for research described in subsection taking into
Index of Sec 1401. ...ACCOUNT potential for differences in effectiveness of health care items, services and systems used with various subpopulations ; Designing to take into
Index of Sec 1401. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT pending resolution of subsequent appeals ; Providing that amounts collected kept in
Index of Sec 1421. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...MANAGERIAL control or direction over facility or part or providing policies or procedures for operations of facility or providing financial or cash management services to facility ; Administrative or
Index of Sec 1411. ...ADMINISTRATIVE burden on persons required to collect data and adequately protecting privacy of patients' personal health information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing
Index of Sec 1442. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...AMBULATORY surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on health care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...AMBULATORY surgical Centers on health Care-associated infections ; Sec 1461, requirement for public reporting by hospitals and
Index of Sec 1461. ...AMBULATORY surgical Centers on health Care-associated infections ; Sec 1138a, requirement for public reporting by hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers during year ; Number and types of health care-associated infections reported under subsection in hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers ; Best practices to eliminate rates of occurrence type of infection in hospitals and
Index of Sec 1461. ...AMBULATORY surgical centers submitting reports taking effect on date as Secretary of Health and Human Services specifying ; Requirement under sectioning that hospitals and
Index of Sec 1461. ...APPOINTMENT to Commission or clinical perspective advisory panel described subsection ; Considering
Index of Sec 1401. ...APPOINTMENT of independent monitors under pilot program ; Chain to be responsible for portion of costs associated with
Index of Sec 1422. ...ASSESSMENT ; Secretary giving priority to development of quality measures allowing
Index of Sec 1442. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause of sections ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT of costs of conducting background checks ;
Index of Sec 1417. ...ASSESSMENT of impact of program on reducing number of incidents of neglect, abuse and misappropriation of resident property to extent practicable ;
Index of Sec 1417. ...AUDITABLE data in uniform format ; Secretary requiring skilled nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...AUDITABLE data in uniform format ; Secretary requiring nursing facility electronically to submit to Secretary direct care staffing information based on payroll and other verifiable and
Index of Sec 1416. ...BENEFICIARY programs ; 16 additional members representing broad constituencies of stakeholders including clinicians, patients, researchers, third-party payers and consumers of Federal and State
Index of Sec 1401. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or
Index of Sec 1451. ...DRUG, device, biological or medical supply required to report under subsection ; Applicable manufacturer or distributor of covered
Index of Sec 1451. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or manufacturer-direct
Index of Sec 1451. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...CERTIFICATION as referred in section 208(b)(3) of title 18, United States Code or waiver as referred in subparagraph for service on Commission at meeting of Commission ; Written
Index of Sec 1401. ...CERTIFICATIONS and complaint investigations making respecting facility during 3 preceding years available for individual to review upon request ; Reports with respect to surveys,
Index of Sec 1413. ...CERTIFICATIONS and complaint investigations making respecting facility during 3 preceding years available for individual to review upon request ; Reports with respect to surveys,
Index of Sec 1413. ...CERTIFICATION agency and State long-term care ombudsman program with respect to skilled nursing facility ; Secretary developing standardized complaint form for use by resident in filing complaint with State survey and
Index of Sec 1415. ...CERTIFICATION agency and State long-term care ombudsman program with respect to nursing facility ; Secretary developing standardized complaint form for use by resident in filing complaint with State survey and
Index of Sec 1415. ...CERTIFICATION programs ; Links to State internet websites with information regarding State survey and
Index of Sec 1413. ...CERTIFICATION programs ; Links to State internet websites with information regarding State survey and
Index of Sec 1413. ...CERTIFICATION recommendation making respecting skilled nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...CERTIFICATION recommendation making respecting nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...CHARITY care ; Kind items used for provision of
Index of Sec 1451. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE proceeding ; Nothing in paragraph to be construed to limit discovery or admissibility of information described in paragraph in criminal, civil or
Index of Sec 1451. ...CIVIL money penalties under subsection of section 1128a imposed and collected under section ; Penalty to be imposed and collected in same manner as
Index of Sec 1451. ...CIVIL money penalties imposed under subparagraph ; Total amount of
Index of Sec 1451. ...CIVIL money penalties under subsection of section 1128a imposed and collected under section ; Penalty to be imposed and collected in same manner as
Index of Sec 1451. ...CIVIL money penalties imposed under subparagraph with respect to annual submission of information under subsection or applicable reporting entity not exceeding $1,000,000 or greater ; Total amount of
Index of Sec 1451. ...CIVIL money penalty imposed under clause ; Case of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty imposed under subparagraph ; Case of
Index of Sec 1421. ...CIVIL money penalty in amount not to exceed $10,000 for daying or instance of noncompliance ; Secretary imposing
Index of Sec 1421. ...CIVIL money penalty imposed under clause ; Case of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty of not less than $1,000 ; Timely manner in accordance with regulations promulgated to carry out applicable subsection to be subject to
Index of Sec 1451. ...CIVIL money penalty under subsection to be used to carry out that section ; Funds collected by Secretary as result of imposition of
Index of Sec 1451. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNT under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of imposition of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow
Index of Sec 1421. ...ACCOUNTING or financial services to facility ; Providing management or administrative services, clinical consulting services or
Index of Sec 1411. ...CLINICAL procedures for specific clinical circumstances ; Term standards and protocols of clinical excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other
Index of Sec 1401. ...CLINICAL care ; Other health care practitioners engaged in
Index of Sec 1401. ...CLINICAL decision support, relevant expert organizations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...CLINICAL decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on
Index of Sec 1401. ...CLINICAL effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of
Index of Sec 1401. ...CLINICAL excellence developed by relevant expert organizations ; Take into consideations standards and protocols of
Index of Sec 1401. ...CLINICAL excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other clinical procedures for specific clinical circumstances ; Term standards and protocols of
Index of Sec 1401. ...CLINICAL investigation regarding new drug ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor in connection with
Index of Sec 1451. ...CLINICAL investigation registered on website maintained by National Institutes of Health pursuant to section 671 of Food and drugging Administration Amendments acting of 2007 ;
Index of Sec 1451. ...CLINICAL investigation meaning experiment involving one or more human subjects or materials derived from human subjects in which drug or device administered, dispensed or used ; Term
Index of Sec 1451. ...CLINICAL investigations ; Delaying reporting for payments making PURSUANT to
Index of Sec 1451. ...CLINICAL outcomes for specific research inquiry to be examined with respect to priority to ensure that information produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Evidence gaps in terms of
Index of Sec 1401. ...CLINICAL perspective advisory panels for research priorities under section consulting with patients and other stakeholders and advising Center on research questions ; Appointing
Index of Sec 1401. ...CLINICAL perspective advisory panel described in subsection ; Appointing members of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel described subsection ; Considering appointment to Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel described in subsection regarding particular matter ; Prior to meeting of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel described in subsection not participating with respect to particular matter considered in meeting of Commission or clinical perspective advisory panel if member having financial interest to be affected by advice given to Secretary with respect to matter ; Member of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel described in subsection essential expertise ; Determining necessary to afford Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel ; Participating as non-voting member with respect to particular matter considered in meeting of Commission or
Index of Sec 1401. ...CLINICAL perspective advisory panel receiving waiver ; No more than two nonvoting members of
Index of Sec 1401. ...CLINICAL perspective advisory panel for particular national research priority ; Research considering advice given to Center by
Index of Sec 1401. ...CLINICAL practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into
Index of Sec 1401. ...CLINICAL practice guidelines including voluntary health organization ; Development of national
Index of Sec 1401. ...CLINICAL procedures for specific clinical circumstances ; Term standards and protocols of clinical excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other
Index of Sec 1401. ...CLINICAL effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of
Index of Sec 1401. ...CLINICAL research including original research conducted subsequent to date of enactment of section ; Conduct and support systematic reviews of
Index of Sec 1401. ...CLINICAL research ; Separately listed information as funding for
Index of Sec 1451. ...CLINICAL specialty or other professional organization representing physicians based on field of medicine ;
Index of Sec 1401. ...CLINICAL studies ; Term relevant expert organization meaning organization with expertise in rigorous application of evidence-based scientific methods for design of
Index of Sec 1401. ...CLINICAL trial and costs otherwise to be covered under title with respect to beneficiary ; Benefits under title XVIII, XIX or XXI in case where individual participating in
Index of Sec 1401. ...COMMISSION or other similar form of payment from another seller for selling or arranging for sale of covered drug ; Buying and reselling or receiving
Index of Sec 1451. ...COMPARATIVE effectiveness of full spectrum of health care items, services and systems including pharmaceuticals ; Conducting, supporting and synthesizing research relevant to
Index of Sec 1401. ...COMPARATIVE effectiveness research ; Center awarding grants or contracts to private entities and governmental agencies with experience in conducting
Index of Sec 1401. ...COMPARATIVE effectiveness research recommended to be national priority under subparagraph ; Monitoring appropriateness of use of CERTF described in subsection with respect to timely production of
Index of Sec 1401. ...COMPARATIVE effectiveness research and studies conducted by Center under subsection ; Make recommendations to Center for priority for periodic reviews of previous
Index of Sec 1401. ...COMPARATIVE effectiveness studies and using methodologies appropriately ; Continuously developing rigorous scientific methodologies for conducting
Index of Sec 1401. ...COMPARATIVE effectiveness studies reviewed by Center ; Ensuring that comments from patients regarding proposed
Index of Sec 1401. ...COMPENSATION ; Providing transportation and subsistence for persons serving without
Index of Sec 1401. ...COMPENSATION, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including
Index of Sec 1451. ...COMPENSATION paid by applicable manufacturer or distributor to covered recipient directly employed and works solely for manufacturer or distributor ;
Index of Sec 1451. ...COMPENSATION and benefits and exeations damages where warranted and other relief as court deeming appropriate ; Reimbursement of lost wages,
Index of Sec 1415. ...COMPENSATION and benefits and exeations damages where warranted and other relief as court deeming appropriate ; Reimbursement of lost wages,
Index of Sec 1415. ...COMPLIANCE with standards ; Organization taking reasonable steps to achieve
Index of Sec 1412. ...COMPLIANCE with standards ; Organization taking reasonable steps to achieve
Index of Sec 1412. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...COMPLIANCE by facilities of chain with State and Federal laws and regulations applicable to facilities ; Publicly holding, involving owners of chain and principal business partners of owners in facilitating
Index of Sec 1422. ...COMPLIANCE with reporting requirements, success of validity procedures established and conflicting or overlapping between reporting required under sectioning and other reporting systems mandated by States or Federal Government ; Report including analysis of appropriateness of types of information required for submission,
Index of Sec 1461. ...COMPLIANCE with subsection ; Report including discussion of Center's
Index of Sec 1401. ...COMPLIANCE history or substantially failed to meet applicable requirements of Act ; Secretary identifying as poor
Index of Sec 1413. ...COMPLIANCE history or substantially failed to meet applicable requirements of Act ; Secretary identifying as poor
Index of Sec 1413. ...COMPLIANCE program ; Promulgating regulations for effective compliance and ethics program for operating organizations including model
Index of Sec 1412. ...COMPLIANCE program ; Promulgating regulations for effective compliance and ethics program for operating organizations including model
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...INFORMATION to consumers regarding skilled nursing facilities and nursing facilities in State forming 2567 State inspection reports ; State maintaining consumer-oriented website providing useful
Index of Sec 1413. ...HEALTH care decisions improving quality and value ; Findings of research conducted and supported under section enabling clinicians, patients, consumers and payers to make more informed
Index of Sec 1401. ...BENEFICIARY programs ; 16 additional members representing broad constituencies of stakeholders including clinicians, patients, researchers, third-party payers and consumers of Federal and State
Index of Sec 1401. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONSUMER involvement in assuring quality care in facilities and facility improvement initiatives approved by Secretary ; Support resident and family councils and other
Index of Sec 1421. ...CONTRACT or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or contract or other agreement ; Rights protected by paragraph not to be diminished by
Index of Sec 1415. ...CONTRACT or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or contract or other agreement ; Rights protected by paragraph not to be diminished by
Index of Sec 1415. ...CONTRACT with Secretary to participate in conduct of program ; Independent monitor entering into
Index of Sec 1422. ...CONTRACT with Secretary under section 1890 ; Term consensus-based entity meaning entity with
Index of Sec 1441. ...CONTRACT under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public health care programs ; Consensus-based entity entering into
Index of Sec 1443. ...CONTRACT provided under section 1890 ; Recommendations to be included in transmissions consensus-based entity makes to Secretary under
Index of Sec 1443. ...CONTRACT with Secretary under section 1890(a) ; Quality measuring specified under clause to be measures selected by Secretary from measures endorsed by entity with
Index of Sec 1444. ...CONTRACT under section 1890(a) ; Case of specified area or medical topic determined appropriate by Secretary For which feasible and practical quality measure not endorsed by entity with
Index of Sec 1444. ...CONTRACT with facility or provider and duties involving one-on-one contact with patient or resident of facility or provider as determining by State for purposes of nationwide program ; Term direct patient access employee meaning individual having access to patient or resident of long-term care facility or provider through employment or
Index of Sec 1417. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT for services terminated in good faith whether using form developed under subsection or other method for submitting complaint ; Privileges of employment or
Index of Sec 1415. ...CONTRACT for services terminated in good faith whether using form developed under subsection or other method for submitting complaint ; Privileges of employment or
Index of Sec 1415. ...CONTRACTS or making other arrangements ; Entering into
Index of Sec 1401. ...COMPARATIVE effectiveness research ; Center awarding grants or contracts to private entities and governmental agencies with experience in conducting
Index of Sec 1401. ...CONTRIBUTIONS as condition of receiving Federal match under clause ; State guaranteeing that State making available particular amount of non-Federal
Index of Sec 1417. ...CONTRIBUTIONS as condition of receiving Federal match under clause ; State guaranteeing that State making available particular amount of non-Federal
Index of Sec 1417. ...CONVICTION for relevant crime ; Overseeing design of appropriate privacy and security safeguards for use in review of results of State or national criminal history background checks conducted regarding prospective direct patient access employee to determine whether employee having
Index of Sec 1417. ...CONVICTION for relevant crime being subject to reporting under section 1128e of Social Security Act 42 USC 1320a-7e ; Case of employee with
Index of Sec 1417. ...CONVICTION to database established under section ; Reporting existence of
Index of Sec 1417. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care ; Effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Propensity to engage in criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE proceeding ; Nothing in paragraph to be construed to limit discovery or admissibility of information described in paragraph in criminal, civil or
Index of Sec 1451. ...SEARCH of State-based abuse and neglect registries and databases including abuse and neglect registries of another State in case where prospective employee previously resided in State ; Requiring that long-term care facility or provider obtaining State and national criminal or other background checks on prospective employee through means as Secretary determining appropriate utilizing
Index of Sec 1417. ...CRIMINAL history background check results of review ; Immediately reporting to long-term care facility or provider requesting
Index of Sec 1417. ...CRIMINAL history background check conducted with respect to employee at no charge in case where individual requesting copy ; Employee copy of results of
Index of Sec 1417. ...CRIMINAL history background check and pending completion of appeals process ; Providing for provisional period of employment by long-term care facility or provider of direct patient access employee pending completion of required
Index of Sec 1417. ...CRIMINAL history background checks requested by long-term care facility or provider utilizing search of State and Federal criminal history records including fingerprint check of records ; Overseeing coordination of State and national
Index of Sec 1417. ...CONVICTION for relevant crime ; Overseeing design of appropriate privacy and security safeguards for use in review of results of State or national criminal history background checks conducted regarding prospective direct patient access employee to determine whether employee having
Index of Sec 1417. ...CRIMINAL history records including fingerprint check using Integrated Automated Fingerprint Identification System of Federal Bureau of Investigation ; Records of proceedings in State containing disqualifying information about prospective employees and Federal
Index of Sec 1417. ...CRIMINAL history records including fingerprint check of records ; Overseeing coordination of State and national criminal history background checks requested by long-term care facility or provider utilizing search of State and Federal
Index of Sec 1417. ...CRIMINAL sexual abuse or other violations or crimes resulted in serious bodily injury ; Respect to instances of violations or crimes committed inside of facility being violations or crimes of abuse, neglect and exploitation,
Index of Sec 1413. ...CRIMINAL sexual abuse or other violations or crimes resulted in serious bodily injury ; Respect to instances of violations or crimes committed inside of facility being violations or crimes of abuse, neglect and exploitation,
Index of Sec 1413. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in subclause ; Secretary not reducing under subclause amount of penalty if penalty imposed for deficiency described in subclause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in clause ; State not reducing under clause amount of penalty if penalty imposed for deficiency described in clause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...IMPOSITION ; Case where facility self-reports and promptly corrects deficiency For which penalty imposed under clause not later than 10 calendar days after date of
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...DEFICIENCY citations, changes in quality performance or changes in other metrics of resident quality of care ; Evaluation determining if programs leading to changes in
Index of Sec 1412. ...DEFICIENCY citations, changes in quality performance or changes in other metrics of resident quality of care ; Evaluation determining if programs leading to changes in
Index of Sec 1412. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...ONCOLOGY services to Medicare beneficiaries under title XVIII ; Comptroller General of United States conducting study to evaluate extent of use of physician self-referral arrangements and effects of arrangements on cost of providing advanced diagnostic imaging and radiation
Index of Sec 1451. ...CLINICAL procedures for specific clinical circumstances ; Term standards and protocols of clinical excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other
Index of Sec 1401. ...DISCHARGE ; No person working at skilled nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCHARGE ; No person working at nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCIPLINARY agency because person complained in good faith ; Skilled nursing facility not filing complaint or report against person working with appropriate State professional
Index of Sec 1415. ...DISCIPLINARY mechanisms as appropriate ; Standards to be consistently enforced through appropriate
Index of Sec 1412. ...DISCIPLINARY mechanisms as appropriate ; Standards to be consistently enforced through appropriate
Index of Sec 1412. ...DISCLOSING entity ; Term facility meaning
Index of Sec 1411. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...DISCLOSURE or reporting of information not of type required to be disclosed or reported under section ;
Index of Sec 1451. ...DISCLOSURE or reporting of information described in subsection ;
Index of Sec 1451. ...DISCLOSURE or reporting of type of information by person or entity other than applicable manufacturer or covered recipient ;
Index of Sec 1451. ...DISCLOSURE or reporting of type of information required to be disclosed or reported under section to Federal ;
Index of Sec 1451. ...DISCLOSURE of ownership and additional DISCLOSABLE partying information ; Requiring
Index of Sec 1411. ...DISCLOSURE of ownership and additional DISCLOSABLE partying information ; Requiring
Index of Sec 1411. ...DISCLOSURE of payment or other transfer of value to physician by self-insured health plan ; Nothing in subsection to be construed to require
Index of Sec 1451. ...APPOINTMENT ; Comptroller General or Secretary reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...DISCRETIONARY authority to individuals organization knowing or known through exercise of due diligence ; Organization to have used due care not to delegate substantial
Index of Sec 1412. ...DISCRETIONARY authority to individuals organization knowing or known through exercise of due diligence ; Organization to have used due care not to delegate substantial
Index of Sec 1412. ...CLINICAL decision support, relevant expert organizations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...DISSEMINATION to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for conveying findings to different audiences including
Index of Sec 1401. ...DISSEMINATION of research from Commission or Center and findings making by Commission or Center to be consistent with processes established under subsection ;
Index of Sec 1401. ...DISSEMINATION of research findings in order to ensure effective communication of findings and use and incorporation of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding medical items and services ; Center developing protocols and strategies for appropriate
Index of Sec 1401. ...CONVEYING findings to different audiences including dissemination to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for
Index of Sec 1401. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or
Index of Sec 1451. ...DISTRIBUTION of covered drug, device, biological or medical supply ; Conversion, processing, marketing or manufacturer-direct
Index of Sec 1451. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...DRUG and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing
Index of Sec 1401. ...DRUG ; Term covered means with respect to
Index of Sec 1451. ...DRUG or device administered, dispensed or used ; Term clinical investigation meaning experiment involving one or more human subjects or materials derived from human subjects in which
Index of Sec 1451. ...DRUG ; Buying and reselling or receiving commission or other similar form of payment from another seller for selling or arranging for sale of covered
Index of Sec 1451. ...DRUG, device, biological or medical supply ; Conversion, processing, marketing or distribution of covered
Index of Sec 1451. ...DRUG, device, biological or medical supply required to report under subsection ; Applicable manufacturer or distributor of covered
Index of Sec 1451. ...DRUG, device, biological or medical supply ; Conversion, processing, marketing or manufacturer-direct distribution of covered
Index of Sec 1451. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor pursuant to product development agreement for services furnished in connection with development of new
Index of Sec 1451. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor in connection with clinical investigation regarding new
Index of Sec 1451. ...SEARCH of State-based abuse and neglect registries and databases including abuse and neglect registries of another State in case where prospective employee previously resided in State ; Requiring that long-term care facility or provider obtaining State and national criminal or other background checks on prospective employee through means as Secretary determining appropriate utilizing
Index of Sec 1417. ...ON-site supervision ; During that employee to be subject to direct
Index of Sec 1417. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...CONVICTION for relevant crime ; Overseeing design of appropriate privacy and security safeguards for use in review of results of State or national criminal history background checks conducted regarding prospective direct patient access employee to determine whether employee having
Index of Sec 1417. ...CONVICTION for relevant crime being subject to reporting under section 1128e of Social Security Act 42 USC 1320a-7e ; Case of employee with
Index of Sec 1417. ...CRIMINAL history background check conducted with respect to employee at no charge in case where individual requesting copy ; Employee copy of results of
Index of Sec 1417. ...INFORMATION under subsection ; Term not including physician being employee of applicable manufacturer required to submit
Index of Sec 1451. ...ON-one contact with patient or resident of long-term care facility or provider ; Term not including volunteer unless volunteer having duties being equivalent to duties of direct patient access employee and duties involving one-
Index of Sec 1417. ...CONVICTION ; Department immediately informing State and State immediately informing long-term care facility or provider employing direct patient access employee of
Index of Sec 1417. ...CONVICTION ; Department immediately informing State agency designated under clause and agency immediately informing facility or provider employing direct patient access employee of
Index of Sec 1417. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees, contractors and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act ; Organization to have established compliance standards and procedures to be followed by employees and other agents being reasonably capable of reducing prospect of criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act by employees and other agents and place and publicizing reporting system whereby employees and other agents reporting violations by others within organization without fear of retribution ; Utilizing monitoring and auditing systems reasonably designed to detect criminal, civil and
Index of Sec 1412. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...CRIMINAL history records including fingerprint check using Integrated Automated Fingerprint Identification System of Federal Bureau of Investigation ; Records of proceedings in State containing disqualifying information about prospective employees and Federal
Index of Sec 1417. ...HEALTH plan affiliated with applicable manufacturer for medical care provided to employees of manufacturer or dependents ; Payments making to covered recipient by applicable manufacturer or
Index of Sec 1451. ...TENURE and hours of care provided by category of certified employees referenced in clause per resident per day ; Including information on employee turnover and
Index of Sec 1416. ...TENURE and hours of care provided by category of certified employees referenced in clause per resident per day ; Including information on employee turnover and
Index of Sec 1416. ...EMPLOYEE'S fingerprints matching prints on file with State law enforcement department ;
Index of Sec 1417. ...EMPLOYEE'S fingerprints matching prints on file with State law enforcement department ;
Index of Sec 1417. ...DISCHARGE ; No person working at skilled nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...DISCHARGE ; No person working at nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including
Index of Sec 1415. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...CRIMINAL history background check and pending completion of appeals process ; Providing for provisional period of employment by long-term care facility or provider of direct patient access employee pending completion of required
Index of Sec 1417. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...ADMINISTRATIVE violations under Act and promoting quality of care consistent with regulations ; Ethics program being effective in preventing and detecting criminal, civil and
Index of Sec 1412. ...COMPLIANCE and ethics program for operating organizations including model compliance program ; Promulgating regulations for effective
Index of Sec 1412. ...COMPLIANCE and ethics program for operating organizations including model compliance program ; Promulgating regulations for effective
Index of Sec 1412. ...COMPLIANCE and ethics programs established under subparagraph in operation pursuant to clause ; Not later than 3 years after date on which
Index of Sec 1412. ...COMPLIANCE and ethics programs established under subparagraph in operation pursuant to clause ; Not later than 3 years after date on which
Index of Sec 1412. ...HEALTH disparities including associated with individual race, ethnicity, age, gender, place of residence or language ;
Index of Sec 1442. ...EXECUTIVE department for purpose prior to transmittal to Congress and President ; Reports under subparagraph not to be submitted to Office of Management and Budget or other Federal agency or
Index of Sec 1401. ...EXPENDITURES ; Sec 1414 reporting of
Index of Sec 1414. ...EXPENDITURES listed on cost reports ; Categorizing
Index of Sec 1414. ...EXPENDITURES submitted under subsection readily available to interested parties upon request ; Secretary establishing procedures to make information on
Index of Sec 1414. ...EXPENDITURES for wages and benefits for direct care staff registered nurses, licensed professional nurses, certified nurse assistants and other medical and therapy staff ; Separately report
Index of Sec 1414. ...MANAGERIAL control or direction over facility or part or providing policies or procedures for operations of facility or providing financial or cash management services to facility ; Administrative or
Index of Sec 1411. ...FINANCIAL interest to be affected by advice given to Secretary with respect to matter ; Member of Commission or clinical perspective advisory panel described in subsection not participating with respect to particular matter considered in meeting of Commission or clinical perspective advisory panel if member having
Index of Sec 1401. ...FINANCIAL interest meaning financial interest under section 208(a) of title 18, United States coding ; Term
Index of Sec 1401. ...FINANCIAL interests in accordance with requiring waiver under section 208(b) of title 18, United States Code or other interests as deemed relevant by Secretary ;
Index of Sec 1401. ...FINANCIAL relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare, medicaid or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians'
Index of Sec 1451. ...FINANCIAL relationships subjecting to delayed reporting under subsection of section and recommended improvements to collection or analysis of data reported under section ; Description of
Index of Sec 1451. ...FINANCIAL relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare, medicaid or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians'
Index of Sec 1451. ...FINANCIAL services to facility ; Providing management or administrative services, clinical consulting services or accounting or
Index of Sec 1411. ...FINGERPRINTING ; Requiring States to describe and test methods reducing duplicative
Index of Sec 1417. ...FINGERPRINTING ; Describing and test methods reducing duplicative
Index of Sec 1417. ...FISCAL year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and subsequent
Index of Sec 1444. ...FISCAL year 2009 ; Section 1890(d) of Social Security Act 42 USC 1395aaa(d) amended by striking for fiscal years 2009 through 2012 and inserting for
Index of Sec 1445. ...FISCAL year 2012 and subsequent fiscal year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during
Index of Sec 1444. ...FISCAL year 2012 ; Amendments making by section applying to quality measures applied for payment years beginning with 2012 or
Index of Sec 1444. ...FISCAL year 2009 ; Section 1890(d) of Social Security Act 42 USC 1395aaa(d) amended by striking for fiscal years 2009 through 2012 and inserting for
Index of Sec 1445. ...FISCAL years 2010 through 2012 ; Secretary of Health and Human Services notifying Secretary of Treasury of amount necessary to carry out nationwide program under section for period of
Index of Sec 1417. ...FISCAL years 2010 through 2014 ; $25,000,000 to Secretary for purposes of carrying out that section for
Index of Sec 1442. ...FISCAL years 2010 through 2014 ; $1,000,000 to Secretary for purposes of carrying out that subsection for
Index of Sec 1443. ...INTEREST in limited partnership being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership
Index of Sec 1411. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in subclause ; Secretary not reducing under subclause amount of penalty if penalty imposed for deficiency described in subclause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH or safety of resident or residents of facility or penalty imposed for deficiency described in clause ; State not reducing under clause amount of penalty if penalty imposed for deficiency described in clause or actual harm or widespread harm immediately jeopardizing
Index of Sec 1421. ...HEALTH ; Potential for new evidence concerning certain categories, health care services or treatments to improve patient
Index of Sec 1401. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...CLINICAL decision support, relevant expert organizations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...CLINICAL procedures for specific clinical circumstances ; Term standards and protocols of clinical excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other
Index of Sec 1401. ...HEALTH Care-associated infections ; Sec 1461, requirement for public reporting by hospitals and ambulatory surgical Centers on
Index of Sec 1461. ...HEALTH Care-associated infections ; Sec 1138a, requirement for public reporting by hospitals and ambulatory surgical Centers on
Index of Sec 1461. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...HEALTH care-associated infections ; Information to be set forth in manner allowing for comparison of information on
Index of Sec 1461. ...HEALTH care worker immunization rates ; Factors contributing to occurrence of infections including
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...HEALTH care delivered and related to receiving health care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where
Index of Sec 1461. ...HEALTH care meaning that infection not incubating or present at time health care provided ; Term related to receiving
Index of Sec 1461. ...CENTEREDNESS of health care including due to variations in care ; Greatest potential for improving performance, affordability and patient-
Index of Sec 1441. ...AMBULATORY surgical centers during year ; Number and types of health care-associated infections reported under subsection in hospitals and
Index of Sec 1461. ...CLINICAL care ; Other health care practitioners engaged in
Index of Sec 1401. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...HEALTH care delivered and related to receiving health care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where
Index of Sec 1461. ...HEALTH care provided ; Term related to receiving health care meaning that infection not incubating or present at time
Index of Sec 1461. ...HEALTH care costs resulted from increases or decreases in rates of occurrence type of infection during year ; Total increases or decreases in
Index of Sec 1461. ...HEALTH care decisions improving quality and value ; Findings of research conducted and supported under section enabling clinicians, patients, consumers and payers to make more informed
Index of Sec 1401. ...HEALTH care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning interest in entity ; Hospital or other
Index of Sec 1451. ...HEALTH care entity, applicable manufacturer, applicable distributor or applicable group purchasing organization required to report physician ownership under subsection ; Hospital, other
Index of Sec 1451. ...HEALTH care items, services and systems used with various subpopulations ; Designing to take into account potential for differences in effectiveness of
Index of Sec 1401. ...HEALTH care items, services and systems including pharmaceuticals ; Conducting, supporting and synthesizing research relevant to comparative effectiveness of full spectrum of
Index of Sec 1401. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...HEALTH care quality and patient safety ; Order to improve
Index of Sec 1461. ...HEALTH care services in United States needed ; Secretary determining areas in which quality measures for assessing
Index of Sec 1442. ...HEALTH care services or treatments to improve patient health ; Potential for new evidence concerning certain categories,
Index of Sec 1401. ...HEALTH care services ; Ability to be collected through use of health information technologies supporting better delivery of
Index of Sec 1442. ...HEALTH care services in United States ; Secretary ensuring that priority given to areas in delivery of
Index of Sec 1441. ...HEALTH care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other health care practitioners in delivery of
Index of Sec 1441. ...HEALTH care services in United States ; Secretary entering into agreements with qualified entities to develop quality measures for delivery of
Index of Sec 1442. ...HEALTH care settings including end of life care ; Continuity and coordination of care and care transitions for patients across providers and
Index of Sec 1442. ...HEALTH data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic
Index of Sec 1401. ...HEALTH disparities including associated with individual race, ethnicity, age, gender, place of residence or language ;
Index of Sec 1442. ...HEALTH organization ; Development of national clinical practice guidelines including voluntary
Index of Sec 1401. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...HEALTH plan affiliated with applicable manufacturer for medical care provided to employees of manufacturer or dependents ; Payments making to covered recipient by applicable manufacturer or
Index of Sec 1451. ...HEALTH plan ; Nothing in subsection to be construed to require disclosure of payment or other transfer of value to physician by self-insured
Index of Sec 1451. ...HEALTH plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on clinical decision support, relevant expert organizations and Federal and private
Index of Sec 1401. ...DRUG and medical device surveillance efforts and other forms of electronic health data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing
Index of Sec 1401. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...HOME and community-based setting ; State ensuring that residents of facility successfully relocated to another facility or alternative
Index of Sec 1423. ...HOME and community-based setting ; State ensuring that residents of facility successfully relocated to another facility or alternative
Index of Sec 1423. ...DISTRIBUTION, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit
Index of Sec 1451. ...HEALTH care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning interest in entity ; Hospital or other
Index of Sec 1451. ...HEALTH care entity, applicable manufacturer, applicable distributor or applicable group purchasing organization required to report physician ownership under subsection ; Hospital, other
Index of Sec 1451. ...AMBULATORY surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on health care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or
Index of Sec 1461. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...HOSPITAL ; Term hospital including critical access
Index of Sec 1461. ...HOSPITAL including critical access hospital ; Term
Index of Sec 1461. ...FISCAL year 2012 and subsequent fiscal year ; Purposes of reporting data on quality measures for inpatient hospital services furnished during
Index of Sec 1444. ...HOSPITAL services ; Provisions of clause of section 1886(b)(3)(c) applying to quality measures for covered OPD services under paragraph in same manner as provisions applying to quality measures for inpatient
Index of Sec 1444. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause ; Coordinating implementation of plan with quality
Index of Sec 1412. ...ASSESSMENT and assurance activities conducted under clause of sections ; Coordinating implementation of plan with quality
Index of Sec 1412. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...CIVIL money penalty applying to civil money penalty under clause in same manner as provisions applying to penalty or proceeding under section 1128a(a) ; Provisions requiring hearing prior to imposition of
Index of Sec 1421. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of State on earlier of date on which informal dispute resolution process under subclause completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty ; Providing for collection of civil money penalty and placement of amounts collected in escrow account under direction of Secretary on earlier of date on which informal dispute resolution process under item completed or date being 90 days after date of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under item completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under subclause completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION of penalty and ending on day on which informal dispute resolution process under item completed ; Not imposing penalty for day during period beginning on initial day of
Index of Sec 1421. ...IMPOSITION ; Case where facility self-reports and promptly corrects deficiency For which penalty imposed under clause not later than 10 calendar days after date of
Index of Sec 1421. ...CIVIL money penalty under subsection to be used to carry out that section ; Funds collected by Secretary as result of imposition of
Index of Sec 1451. ...INAPPROATIONS political or stakeholder influence ; Establishment of agenda and conduct of research to be insulated from
Index of Sec 1401. ...INCORPOATIONS ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of
Index of Sec 1401. ...CLINICAL practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on clinical decision support to promote timely incorporation of findings into
Index of Sec 1401. ...INCORPORATION of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding medical items and services ; Center developing protocols and strategies for appropriate dissemination of research findings in order to ensure effective communication of findings and use and
Index of Sec 1401. ...INFORMATION produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Evidence gaps in terms of clinical outcomes for specific research inquiry to be examined with respect to priority to ensure that
Index of Sec 1401. ...INFORMATION to Center on agreed upon schedule ; Head of department or agency furnishing that
Index of Sec 1401. ...INFORMATION for use by Center in making reports and recommendations ; Interesting party to submit
Index of Sec 1401. ...INFORMATION produced through data being timely and credible ; Make recommendations to Center for policies allowing for public access of data produced under section when ensuring that
Index of Sec 1401. ...INFORMATION produced by research being objective ; Annually reviewing processes of Center and make reports to Congress and President regarding research conducted, supported or synthesized by Center to confirm that
Index of Sec 1401. ...INFORMATION to Commission on agreed upon schedule ; Head of department or agency furnishing
Index of Sec 1401. ...INFORMATION ; Requiring disclosure of ownership and additional DISCLOSABLE partying
Index of Sec 1411. ...INFORMATION ; Requiring disclosure of ownership and additional DISCLOSABLE partying
Index of Sec 1411. ...INFORMATION described in paragraph available ; Facility to have
Index of Sec 1411. ...INFORMATION ; State or State long-term care ombudsman requesting
Index of Sec 1411. ...INFORMATION described in subparagraph after effective date of final regulations promulgated under paragraph ; Nothing in subparagraph to be construed as authorizing facility to dispose or delete
Index of Sec 1411. ...INFORMATION described in paragraph available to public upon request and updating information ; Making
Index of Sec 1411. ...INFORMATION described in subsections ;
Index of Sec 1411. ...INFORMATION reported by facility to Internal Revenue Service on Form 990 ;
Index of Sec 1411. ...INFORMATION described in paragraph to Secretary in standardized format and other regulations as necessary to carry out that subsection ; Secretary promulgating regulations requiring facility to report
Index of Sec 1411. ...INFORMATION after first day of first calendar quarter beginning after date being 90 days after date on which final regulations published in Federal Register ; Reporting of
Index of Sec 1411. ...INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary of Health and Human Services ;
Index of Sec 1411. ...INFORMATION reported to Secretary under section 1124(c)(4) ;
Index of Sec 1413. ...INFORMATION on Special Focus Facility program established by Centers for Medicare and Medicaid Services according to procedures established by Secretary ;
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...CERTIFICATION programs ; Links to State internet websites with information regarding State survey and
Index of Sec 1413. ...INFORMATION on complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION described in subparagraph included on website not later than 1 year after date of enactment of subsection ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION described in subparagraph and included on website not later than 1 year after dates on which data submitted to Secretary pursuant to section 1124(c)(4) and subsection ; Secretary ensuring that
Index of Sec 1413. ...CERTIFICATION recommendation making respecting skilled nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...INFORMATION reported to Secretary under section 1124(c)(4) ;
Index of Sec 1413. ...INFORMATION on Special Focus Facility program established by Centers for Medicare and Medicaid Services according to procedures established by Secretary ;
Index of Sec 1413. ...INFORMATION on staffing turnover and tenure in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including
Index of Sec 1413. ...CERTIFICATION programs ; Links to State internet websites with information regarding State survey and
Index of Sec 1413. ...INFORMATION about complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION described in subparagraph included on website not later than 1 year after date of enactment of subsection ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION described in subparagraph and included on website not later than 1 year after dates on which data submitted to Secretary pursuant to section 1124(c)(4) and subsection ; Secretary ensuring that
Index of Sec 1413. ...CERTIFICATION recommendation making respecting nursing facility to Secretary not later than date on which State sending information to facility ; State submitting information respecting survey or
Index of Sec 1413. ...INFORMATION about complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION about complainants or residents ; Facility not making available under clause identifying
Index of Sec 1413. ...INFORMATION on Nursing Home comparing ; Complaint investigation reports and facility's plan of correction or other response to Form 2567 State inspection reports on Internet website of State providing information on skilled nursing facilities and nursing facilities and Secretary including
Index of Sec 1413. ...EXPENDITURES submitted under subsection readily available to interested parties upon request ; Secretary establishing procedures to make information on
Index of Sec 1414. ...INFORMATION reported or disclosed in complaint being true ;
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION reported or disclosed in complaint being true ;
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION based on payroll data in A uniform Format ; Submission of staffing
Index of Sec 1416. ...INFORMATION on employee turnover and tenure and hours of care provided by category of certified employees referenced in clause per resident per day ; Including
Index of Sec 1416. ...INFORMATION based on payroll data in A uniform Format ; Submission of staffing
Index of Sec 1416. ...INFORMATION on employee turnover and tenure and hours of care provided by category of certified employees referenced in clause per resident per day ; Including
Index of Sec 1416. ...INFORMATION and timing as Secretary specifying ; Submiting application to Secretary containing
Index of Sec 1417. ...INFORMATION and timing as Secretary specifying ; Submiting application to Secretary containing
Index of Sec 1417. ...CRIMINAL history records including fingerprint check using Integrated Automated Fingerprint Identification System of Federal Bureau of Investigation ; Records of proceedings in State containing disqualifying information about prospective employees and Federal
Index of Sec 1417. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...INFORMATION as Secretary requiring ; Secretary selecting chains of skilled nursing facilities and nursing facilities described in paragraph to participate in pilot program among chains submitting application to Secretary at time and containing
Index of Sec 1422. ...INFORMATION submitted by applicable manufacturer or distributor under paragraph including aggregate amount of payments or other transfers of value provided by manufacturer or distributor to covered recipients during year ;
Index of Sec 1451. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...INFORMATION described in clauses of paragraph and information described in subsection ; Including
Index of Sec 1451. ...INFORMATION submitted under subsections ;
Index of Sec 1451. ...INFORMATION presented by name of applicable manufacturer or distributor ; Containing
Index of Sec 1451. ...INFORMATION separately from other information submitted under subsection and designating ;
Index of Sec 1451. ...INFORMATION making available to public with respect to covered recipient ; Providing covered recipient opportunity to submit corrections to
Index of Sec 1451. ...INFORMATION making public with respect to covered recipient and corrections to be transmitted to Secretary ; Secretary establishing procedures to ensure that covered recipient provided with opportunity to submit corrections to applicable reporting entity with regard to
Index of Sec 1451. ...INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...INFORMATION required under subsection ; Reporting entity failing to submit
Index of Sec 1451. ...INFORMATION required under subsection ; Reporting entity knowingly failing to submit
Index of Sec 1451. ...INFORMATION during year ; Information submitted under section during preceding year aggregated for applicable reporting entity submitting
Index of Sec 1451. ...INFORMATION under subsection ; Term not including physician being employee of applicable manufacturer required to submit
Index of Sec 1451. ...INFORMATION not of type required to be disclosed or reported under section ; Disclosure or reporting of
Index of Sec 1451. ...INFORMATION described in subsection ; Disclosure or reporting of
Index of Sec 1451. ...HEALTH care-associated infections developing in hospital or center as Secretary specifying ; Secretary providing that hospital or ambulatory surgical center meeting requirements of titles XVIII or XIX participating in programs established under titles only if hospital or center reporting information on
Index of Sec 1461. ...INFORMATION to be reported in accordance with reporting protocols established by Secretary through Director of Centers for Disease Control and Prevention and National Healthcare Safety Network of CDC or another reporting system of Centers as determined appropriate by Secretary in consulations with Director ;
Index of Sec 1461. ...INFORMATION appropriately compared across hospitals and centers ; Secretary establishing procedures regarding validity of information submitted under subsection in order to ensure that
Index of Sec 1461. ...INFORMATION reported under subsection ; Secretary promptly posting
Index of Sec 1461. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...INFORMATION submitted under subsections and making available under paragraph to be responsibility of reporting entity reporting under subsection ; Accuracy of
Index of Sec 1451. ...INFORMATION ; Secretary of Health and Human Services submitting to Congress report on appropriateness of expanding requirements under section to include additional
Index of Sec 1461. ...COMPLIANCE with reporting requirements, success of validity procedures established and conflicting or overlapping between reporting required under sectioning and other reporting systems mandated by States or Federal Government ; Report including analysis of appropriateness of types of information required for submission,
Index of Sec 1461. ...INFORMATION under subsection or applicable reporting entity not exceeding $1,000,000 or greater ; Total amount of civil money penalties imposed under subparagraph with respect to annual submission of
Index of Sec 1451. ...INFORMATION contained in report to be posted on official public Internet site of Center and Commission as applicable ; Appropriate
Index of Sec 1401. ...INFORMATION as Secretary determining to be necessary to carry out that section ; Made in manner and containing agreements, assurances and
Index of Sec 1442. ...INFORMATION submitted with respect to payment or other transfer of value described in subsection, lists ; Case of
Index of Sec 1451. ...INFORMATION described in clause of subsection ; Excepting in case of
Index of Sec 1451. ...INFORMATION described in subsection ; Including information described in clauses of paragraph and
Index of Sec 1451. ...INFORMATION described in clauses ; Information submitted by facility to Securities and exchanging Commission or information otherwise submitted to Secretary or other Federal agency containing
Index of Sec 1411. ...HEALTH care-associated infections ; Information to be set forth in manner allowing for comparison of information on
Index of Sec 1461. ...INFORMATION resulting from research ; Establishing independent Comparative Effectiveness Research Commission to advise Center and evaluating activities carried out by Center under subsection to ensure activities resulting in highly credible research and
Index of Sec 1401. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...ADMINISTRATIVE proceeding ; Nothing in paragraph to be construed to limit discovery or admissibility of information described in paragraph in criminal, civil or
Index of Sec 1451. ...INFORMATION described in paragraph ; Following
Index of Sec 1411. ...INFORMATION regarding ownership or investment interest holding by physician in applicable manufacturer, applicable group purchasing organization or applicable distributor during preceding year ; Following
Index of Sec 1451. ...INFORMATION to meet requirements of paragraph submitted in manner specified by Secretary ; Secretary allowing Form or
Index of Sec 1411. ...INFORMATION with respect ; Procedures providing for inclusion of
Index of Sec 1413. ...INFORMATION with respect ; Procedures providing for inclusion of
Index of Sec 1413. ...INFORMATION regarding ownership or investment interest Secretary determining appropriate ; Other
Index of Sec 1451. ...INFORMATION submitted under subsection and designating ; Information separately from other
Index of Sec 1451. ...INFORMATION Secretary determining to be helpful to average consumer ; Containing other
Index of Sec 1451. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...HEALTH information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal
Index of Sec 1442. ...INFORMATION with respect to manner of filing complaint ; Employee filing complaint with Secretary against skilled nursing facility violating provisions of paragraph and
Index of Sec 1415. ...INFORMATION with respect to manner of filing complaint ; Employee filing complaint with Secretary against nursing facility violating provisions of paragraph and
Index of Sec 1415. ...INFORMATION with respect to specific categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of
Index of Sec 1416. ...INFORMATION with respect to specific categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of
Index of Sec 1416. ...INFORMATION submitted under subsections ; Secretary submitting to States report including summary of
Index of Sec 1451. ...INFORMATION reported on websiteing as of day before date of enactment of subsection ; Clarity of presentation, timeliness and comprehensiveness of
Index of Sec 1413. ...INFORMATION reported on websiteing as of day before date of enactment of subsection ; Clarity of presentation, timeliness and comprehensiveness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION under subsection coordinated with systems established under HITECH Act where appropriate ; Ensuring that transmission of
Index of Sec 1461. ...INFORMATION regarding payment or other transfer of value provided by manufacturer to covered recipient ; 2011 subject to paragraph, provisions of section preempting law or regulation of State or political subdivision of State requiring applicable manufacturer and applicable distributor to disclose or report type of
Index of Sec 1451. ...INFORMATION by person or entity other than applicable manufacturer or covered recipient ; Disclosure or reporting of type of
Index of Sec 1451. ...INFORMATION required to be disclosed or reported under section to Federal ; Disclosure or reporting of type of
Index of Sec 1451. ...INFORMATION necessary to enable to carry out that section ; Center securing directly from department or agency of United States
Index of Sec 1401. ...INFORMATION necessary to enable Commission to carry out that section ; Commission securing directly from department or agency of United States
Index of Sec 1401. ...INFORMATION to consumers regarding skilled nursing facilities and nursing facilities in State forming 2567 State inspection reports ; State maintaining consumer-oriented website providing useful
Index of Sec 1413. ...CONVEYING findings to different audiences including dissemination to individuals with limited English proficiency ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for
Index of Sec 1401. ...INFORMATION ; Procedures to ensure validity of
Index of Sec 1461. ...HEALTH care services ; Ability to be collected through use of health information technologies supporting better delivery of
Index of Sec 1442. ...CLINICAL decision support to promote timely incorporation of findings into clinical practices and promoting ease of use of incorpoations ; Assisting users of health information technology focused on
Index of Sec 1401. ...CLINICAL decision support, relevant expert organizations and Federal and private health plans and other relevant stakeholders ; Center providing for dissemination of appropriate findings produced by research supported, conducted or synthesized under section to health care providers, patients, vendors of health information technology focused on
Index of Sec 1401. ...HEALTH care practitioners in delivery of health care services ; Term quality measure meaning national consensus standard for measuring performance and improvement of population health or institutional providers of services, physicians and other
Index of Sec 1441. ...INSTITUTIONAL providers of services to review and correct findings ; Standards under system providing for appropriate opportunity for physicians and other clinicians and
Index of Sec 1442. ...HEALTH care delivered and related to receiving health care ; Term health care-associated infection meaning infection developing in patient received care in institutional setting where
Index of Sec 1461. ...HEALTH benefiting plan ; Health insurance issuer, group health plan or other entity offering
Index of Sec 1451. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...INTEREST being equal or exceeding 5 percent of total property or asseal of entirety ;
Index of Sec 1411. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...INTEREST ; Subsection including owner of whole or part
Index of Sec 1411. ...INTEREST equal or exceeding 5 percent of total value of real property ; Leasing or subleasing real property to facility or owning whole or part
Index of Sec 1411. ...INTERNAL organization and operation of Commission ; Prescribing rules and regulations as deeming necessary with respect to
Index of Sec 1401. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...JEOPARDY ; Case of deficiency where facility cited for actual harm or immediate
Index of Sec 1421. ...LEASE agreement for covered device ; Items or services provided under contractual warranty where terms of warranty being set forth in purchase or
Index of Sec 1451. ...LOAN of covered device for short-term trial period to permit evaluation of covered device by covered recipient ;
Index of Sec 1451. ...MEDICAID or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare,
Index of Sec 1451. ...EXPENDITURES for wages and benefits for direct care staff registered nurses, licensed professional nurses, certified nurse assistants and other medical and therapy staff ; Separately report
Index of Sec 1414. ...MEDICAL care provided to employees of manufacturer or dependents ; Payments making to covered recipient by applicable manufacturer or health plan affiliated with applicable manufacturer for
Index of Sec 1451. ...MEDICAL items and services ; Center developing protocols and strategies for appropriate dissemination of research findings in order to ensure effective communication of findings and use and incorporation of findings into relevant activities for purpose of informing higher quality and more effective and efficient decisions regarding
Index of Sec 1401. ...MEDICAID or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare,
Index of Sec 1451. ...CONTRACT under section 1890(a) ; Case of specified area or medical topic determined appropriate by Secretary For which feasible and practical quality measure not endorsed by entity with
Index of Sec 1444. ...MEDICAID or Chip and entities billing for Services under medicare ; Sec 1128h, financial Reports on Physicians' financial relationships with Manufacturers and Distributors of covered Drugs, devices, biologicals or medical Supplies under medicare,
Index of Sec 1451. ...MEDICINE ; Clinical specialty or other professional organization representing physicians based on field of
Index of Sec 1401. ...MEDICINE ; Nothing in section to be construed to authorize Federal officer or employee to exercise supervision or control over practice of
Index of Sec 1401. ...MISAPPROPRIATION of resident property to extent practicable ; Assessment of impact of program on reducing number of incidents of neglect, abuse and
Index of Sec 1417. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...CIVIL monetary penalties levied against facility, employees, contractors and other agents ; Number of
Index of Sec 1413. ...CLINICAL perspective advisory panel receiving waiver ; No more than two nonvoting members of
Index of Sec 1401. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...NOTIFICATION submitted ; Ensuring that facility not admitting new residents after date on which written
Index of Sec 1423. ...NOTIFICATION submitted ; Ensuring that facility not admitting new residents after date on which written
Index of Sec 1423. ...ON-one contact with patient or resident of facility or provider as determining by State for purposes of nationwide program ; Term direct patient access employee meaning individual having access to patient or resident of long-term care facility or provider through employment or contract with facility or provider and duties involving one-
Index of Sec 1417. ...ON-site supervision ; During that employee to be subject to direct
Index of Sec 1417. ...ONCOLOGY services to Medicare beneficiaries under title XVIII ; Comptroller General of United States conducting study to evaluate extent of use of physician self-referral arrangements and effects of arrangements on cost of providing advanced diagnostic imaging and radiation
Index of Sec 1451. ...INTEREST including direct or indirect interests including interests in intermediate entities ; Ownership or control
Index of Sec 1411. ...INTEREST holding by physician in applicable manufacturer, applicable group purchasing organization or applicable distributor during preceding year ; Following information regarding ownership or investment
Index of Sec 1451. ...INTEREST ; Dollar amount invested by physician holding ownership or investment
Index of Sec 1451. ...INTEREST ; Payment or other transfer of value provided to physician holding ownership or investment
Index of Sec 1451. ...INTEREST Secretary determining appropriate ; Other information regarding ownership or investment
Index of Sec 1451. ...INTEREST not reported as required under subsection ; Not more than $10,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...INTEREST not reported as required under subsection ; Not more than $100,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...INTEREST holding by physician in manufacturer ; Term payment or other transfer of value including compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant or ownership or investment
Index of Sec 1451. ...OWNERSHIP under subsection ; Hospital, other health care entity, applicable manufacturer, applicable distributor or applicable group purchasing organization required to report physician
Index of Sec 1451. ...OWNERSHIP entity described in subparagraph and providing assistance or support to entity so described with respect to production, preparation, propagation ; Entity under common
Index of Sec 1451. ...INTEREST in corporation being equal or exceeding 5 percent ; Shareholders of corporation having ownership
Index of Sec 1411. ...INTEREST in limited partnership being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership
Index of Sec 1411. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...INTEREST in limited partnership being equal or exceeding 10 percent ; General partners and limited partners of limited partnership having ownership
Index of Sec 1411. ...PAYMENT for services under title XVIII or XIX of Social Security Act ; Term long-term care facility or provider meaning following facilities or providers receiving
Index of Sec 1417. ...PAYMENT or other transfer of value to entity or individual at request or designated on behalf of covered recipient ; Case where applicable manufacturer or distributor providing
Index of Sec 1451. ...INTEREST ; Payment or other transfer of value provided to physician holding ownership or investment
Index of Sec 1451. ...PAYMENT or other transfer of value provided to covered recipient indicated under subsection ; Date on which
Index of Sec 1451. ...PAYMENT or other transfer of value described in subsection, lists ; Case of information submitted with respect to
Index of Sec 1451. ...INTEREST not reported as required under subsection ; Not more than $10,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...INTEREST not reported as required under subsection ; Not more than $100,000 for payment or other transfer of value or ownership or investment
Index of Sec 1451. ...PAYMENT or other transfer of value provided by applicable manufacturer or distributor to covered recipient where amount transferred ;
Index of Sec 1451. ...PAYMENT or other transfer of value provided by manufacturer to covered recipient ; 2011 subject to paragraph, provisions of section preempting law or regulation of State or political subdivision of State requiring applicable manufacturer and applicable distributor to disclose or report type of information regarding
Index of Sec 1451. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor pursuant to product development agreement for services furnished in connection with development of new
Index of Sec 1451. ...CLINICAL investigation regarding new drug ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor in connection with
Index of Sec 1451. ...PAYMENT or other transfer of value in first reporting period under subsection in next reporting deadline after earlier of following ; Applicable manufacturer or distributor reporting value and recipient of
Index of Sec 1451. ...DRUG ; Buying and reselling or receiving commission or other similar form of payment from another seller for selling or arranging for sale of covered
Index of Sec 1451. ...COMPENSATION, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant or ownership or investment interest holding by physician in manufacturer ; Term payment or other transfer of value including
Index of Sec 1451. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...PAYMENTS making PURSUANT to product development agreements ; Delaying reporting for
Index of Sec 1451. ...CLINICAL investigations ; Delaying reporting for payments making PURSUANT to
Index of Sec 1451. ...HEALTH plan affiliated with applicable manufacturer for medical care provided to employees of manufacturer or dependents ; Payments making to covered recipient by applicable manufacturer or
Index of Sec 1451. ...PAYMENTS or other transfers of value provided by manufacturer or distributor to covered recipients during year ; Information submitted by applicable manufacturer or distributor under paragraph including aggregate amount of
Index of Sec 1451. ...PAYMENTS relating to work of Commission ; Make advance, progress and other
Index of Sec 1401. ...PAYMENTS as result of efforts to evade reporting requirements ; Changes occurring in pattern of
Index of Sec 1451. ...PAYMENT systems beginning in calendar year following year ; Selection for quality measurement by Secretary in rulemaking with respect to payment systems under title beginning in payment year beginning in yearing and
Index of Sec 1443. ...PAYMENT systems beginning in calendar year following year ; Selection for quality measurement by Secretary in rulemaking with respect to payment systems under title beginning in payment year beginning in yearing and
Index of Sec 1443. ...FISCAL year 2012 ; Amendments making by section applying to quality measures applied for payment years beginning with 2012 or
Index of Sec 1444. ...PERIODIC basis as determined by Secretary ; Secretary implementing policies modifying and strengthening quality assurance and performance improvement programs in skilled nursing facilities and nursing facilities on
Index of Sec 1412. ...COMPARATIVE effectiveness research and studies conducted by Center under subsection ; Make recommendations to Center for priority for periodic reviews of previous
Index of Sec 1401. ...COMPLIANCE with State and Federal laws and regulations applicable to facilities ; Conduct periodic reviews and preparing root-cause quality and deficiency analyses of chain to assess if facilities of chain in
Index of Sec 1422. ...INFORMATION regarding payment or other transfer of value provided by manufacturer to covered recipient ; 2011 subject to paragraph, provisions of section preempting law or regulation of State or political subdivision of State requiring applicable manufacturer and applicable distributor to disclose or report type of
Index of Sec 1451. ...POLITICAL subdivision of State requiring following ; Paragraph not preempting statute or regulation of State or
Index of Sec 1451. ...COMPLIANCE by facilities of chain with State and Federal laws and regulations applicable to facilities ; Publicly holding, involving owners of chain and principal business partners of owners in facilitating
Index of Sec 1422. ...CONVICTION for relevant crime ; Overseeing design of appropriate privacy and security safeguards for use in review of results of State or national criminal history background checks conducted regarding prospective direct patient access employee to determine whether employee having
Index of Sec 1417. ...HEALTH information and providing data security ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal
Index of Sec 1442. ...CONFIDENTIALITY agreements making with respect to use of data under section ; Dissemination of which violating privacy of research participants or violating
Index of Sec 1401. ...COMPARATIVE effectiveness research recommended to be national priority under subparagraph ; Monitoring appropriateness of use of CERTF described in subsection with respect to timely production of
Index of Sec 1401. ...PRODUCTION, preparation, propagation ; Entity under common ownership entity described in subparagraph and providing assistance or support to entity so described with respect to
Index of Sec 1451. ...PRODUCTION, preparation, propagation ; Term applicable manufacturer meaning entity engaged in
Index of Sec 1451. ...DISCIPLINARY agency because person complained in good faith ; Skilled nursing facility not filing complaint or report against person working with appropriate State professional
Index of Sec 1415. ...PROFESSIONAL capacity of covered recipient ; Transfer of anything of value to covered recipient when covered recipient being patient and not acting in
Index of Sec 1451. ...PROFESSIONAL nurses, certified nurse assistants and other medical and therapy staff ; Separately report expenditures for wages and benefits for direct care staff registered nurses, licensed
Index of Sec 1414. ...MEDICINE ; Clinical specialty or other professional organization representing physicians based on field of
Index of Sec 1401. ...PROFICIENCY ; Center consulting with stakeholders concerning types of dissemination to be useful to end users of information and providing for utilization of multiple formats for conveying findings to different audiences including dissemination to individuals with limited English
Index of Sec 1401. ...PROPERTY or asseal ; Deed of trust, note or other obligation secured by entity or
Index of Sec 1411. ...INTEREST equal or exceeding 5 percent of total value of real property ; Leasing or subleasing real property to facility or owning whole or part
Index of Sec 1411. ...PROPERTY to extent practicable ; Assessment of impact of program on reducing number of incidents of neglect, abuse and misappropriation of resident
Index of Sec 1417. ...PROPERTY or asseal of entirety ; Interest being equal or exceeding 5 percent of total
Index of Sec 1411. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...CONTRACT or other agreement ; Rights protected by paragraph not to be diminished by contract or other agreement and nothing in paragraph to be construed to diminish greater or additional protection provided by Federal or State law or
Index of Sec 1415. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...INFORMATION ; Making information described in paragraph available to public upon request and updating
Index of Sec 1411. ...INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary of Health and Human Services ;
Index of Sec 1411. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ; Improving timeliness of
Index of Sec 1413. ...INFORMATION making available to public with respect to covered recipient ; Providing covered recipient opportunity to submit corrections to
Index of Sec 1451. ...INFORMATION making public with respect to covered recipient and corrections to be transmitted to Secretary ; Secretary establishing procedures to ensure that covered recipient provided with opportunity to submit corrections to applicable reporting entity with regard to
Index of Sec 1451. ...INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary ;
Index of Sec 1451. ...HEALTH care programs ; Consensus-based entity entering into contract under section 1890 convening multi-stakeholder groups to provide recommendations on selection of individual or composite quality measures for use in reporting performance information to public or use in public
Index of Sec 1443. ...INFORMATION produced through data being timely and credible ; Make recommendations to Center for policies allowing for public access of data produced under section when ensuring that
Index of Sec 1401. ...PUBLIC comment on methods and findings of research ; Center providing opportunities for stakeholders involved to review and provide
Index of Sec 1401. ...PUBLIC Internet site of Center and Commission as applicable ; Appropriate information contained in report to be posted on official
Index of Sec 1401. ...PUBLIC internet website of Commission after date of transmittal ; Reports to be published on
Index of Sec 1401. ...NOMINATIONS ; Process under paragraph ensuring that selection of representatives of multi-stakeholder groups including provision for public
Index of Sec 1443. ...APPOINTMENT ; Comptroller General or Secretary reviewing expertise of individual and financial disclosure report filed by individual pursuant to Ethics in Government Act of 1978 for individual under consideations for
Index of Sec 1401. ...COMPLIANCE and ethics programs established under subparagraph in operation pursuant to clause ; Not later than 3 years after date on which
Index of Sec 1412. ...COMPLIANCE and ethics programs established under subparagraph in operation pursuant to clause ; Not later than 3 years after date on which
Index of Sec 1412. ...INFORMATION described in subparagraph and included on website not later than 1 year after dates on which data submitted to Secretary pursuant to section 1124(c)(4) and subsection ; Secretary ensuring that
Index of Sec 1413. ...INFORMATION described in subparagraph and included on website not later than 1 year after dates on which data submitted to Secretary pursuant to section 1124(c)(4) and subsection ; Secretary ensuring that
Index of Sec 1413. ...TRANSPARENT process for activities conducted pursuant to convening ; Consensus-based entity described in paragraph providing for open and
Index of Sec 1443. ...DRUG ; Case of payment or other transfer of value making to covered recipient by applicable manufacturer or distributor pursuant to product development agreement for services furnished in connection with development of new
Index of Sec 1451. ...DRUGGING Administration Amendments acting of 2007 ; Clinical investigation registered on website maintained by National Institutes of Health pursuant to section 671 of Food and
Index of Sec 1451. ...RAPID improvement due to existing evidence, standards of care or other reasons ; Potential for
Index of Sec 1441. ...COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ; Organization periodically undertaking reassessment of
Index of Sec 1412. ...COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ; Organization periodically undertaking reassessment of
Index of Sec 1412. ...EMPLOYMENT of individual ; Providing independent process by which provisional employee or employee appealing or disputing accuracy of information obtained in background check performed under nationwide program extenuating circumstances, demonstration of rehabilitation and relevancy of particular disqualifying information with respect to current
Index of Sec 1417. ...COMPENSATION and benefits and exeations damages where warranted and other relief as court deeming appropriate ; Reimbursement of lost wages,
Index of Sec 1415. ...COMPENSATION and benefits and exeations damages where warranted and other relief as court deeming appropriate ; Reimbursement of lost wages,
Index of Sec 1415. ...REINSTATEMENT ; Person aggrieved by violation of clause or clause obtaining appropriate relief including
Index of Sec 1415. ...REINSTATEMENT ; Person aggrieved by violation of clause or clause obtaining appropriate relief including
Index of Sec 1415. ...RESPONSIBILITY of reporting entity reporting under subsection ; Accuracy of information submitted under subsections and making available under paragraph to be
Index of Sec 1451. ...RESPONSIBILITY of State survey agency for making final recommendations for penalties ; Opportunity not affecting
Index of Sec 1421. ...RESPONSIBILITY of State survey agency for making final recommendations for penalties ; Opportunity not affecting
Index of Sec 1421. ...RETAIL pharmacy licensed under State law ; Term not including
Index of Sec 1451. ...SAFETY ; Order to improve health care quality and patient
Index of Sec 1461. ...SAFETY and quality of care deficiencies ; Criteria including evaluation of chain including one or more facilities participating in Special Focus Facility program or one or more facilities with record of repeated serious
Index of Sec 1422. ...SAFETY and quality of care problems ; Including where evidence suggesting that one or more facilities of chain experiencing serious
Index of Sec 1422. ...AMBULATORY surgical center ; Nothing in section to be construed as preempting or otherwise affecting provision of State law relating to disclosure of information on health care-associated infections or patient safety procedures for hospital or
Index of Sec 1461. ...CRIMINAL history records including fingerprint check of records ; Overseeing coordination of State and national criminal history background checks requested by long-term care facility or provider utilizing search of State and Federal
Index of Sec 1417. ...SEARCH of State-based abuse and neglect registries and databases including abuse and neglect registries of another State in case where prospective employee previously resided in State ; Requiring that long-term care facility or provider obtaining State and national criminal or other background checks on prospective employee through means as Secretary determining appropriate utilizing
Index of Sec 1417. ...SECURITY ; Data collection efforts under system use efficient and cost-effective means in manner minimizing administrative burden on persons required to collect data and adequately protecting privacy of patients' personal health information and providing data
Index of Sec 1442. ...SPECIFIC case and providing Secretary with opportunity to bring action under subsection and Secretary declining opportunity ; Providing notice to Secretary of intent to proceed under paragraph in
Index of Sec 1451. ...SPECIFIC categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of information with respect to
Index of Sec 1416. ...SPECIFIC categories ; Nothing in subparagraph to be construed as preventing Secretary from requiring submission of information with respect to
Index of Sec 1416. ...CLINICAL excellence meaning clinical or practice guidelines consisting of set of directions or principles based on evidence and designed to assist health care practitioner with decisions about appropriate diagnostic, therapeutic or other clinical procedures for specific clinical circumstances ; Term standards and protocols of
Index of Sec 1401. ...SPECIFIC elements or formality of program varying with size of organization ; Regulations with respect to
Index of Sec 1412. ...SPECIFIC elements or formality of program varying with size of organization ; Regulations with respect to
Index of Sec 1412. ...INFORMATION produced from research being clinically relevant to decisions making by clinicians and patients at point of care ; Evidence gaps in terms of clinical outcomes for specific research inquiry to be examined with respect to priority to ensure that
Index of Sec 1401. ...ON-site supervision ; During that employee to be subject to direct
Index of Sec 1417. ...DISCLOSURE under section 552 of title 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to
Index of Sec 1451. ...SUPERVISORY staff of skilled nursing facilities and nursing facilities ; Secretary conducting study on content of training for certified nurse aides and
Index of Sec 1432. ...CAPITALIATIONS ; Requirements relating to surety bonds, liability insurance or minimum
Index of Sec 1412. ...HEALTH data ; Encouraging development and use of clinical registries and development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts and other forms of electronic
Index of Sec 1401. ...TENURE in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including information on staffing turnover and
Index of Sec 1413. ...TENURE in format being clearly understandable to consumers of long-term care servicing and allowing consumers to compare differences in staffing between facilities and State and national averages for facilities ; Including information on staffing turnover and
Index of Sec 1413. ...TITLE with respect to beneficiary ; Benefits under title XVIII, XIX or XXI in case where individual participating in clinical trial and costs otherwise to be covered under
Index of Sec 1401. ...TITLE for cost reporting periods beginning after date being no more than two years after redesign of report specified in subparagraph ; Cost reports submitted under
Index of Sec 1414. ...TITLE ; Case of facility where Secretary terminating facility's participation under
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...TITLE ; Case of facility where Secretary terminating facility's participation under
Index of Sec 1423. ...NOTIFICATION under subparagraph during period beginning on date ; Secretary continuing to make payments under title with respect to residents of facility submitting
Index of Sec 1423. ...PAYMENT systems beginning in calendar year following year ; Selection for quality measurement by Secretary in rulemaking with respect to payment systems under title beginning in payment year beginning in yearing and
Index of Sec 1443. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...INFORMATION ; Violation of title occurring or occurring in relation to
Index of Sec 1415. ...TITLE 18, United States coding ; Term financial interest meaning financial interest under section 208(a) of
Index of Sec 1401. ...TITLE 18, United States Code or other interests as deemed relevant by Secretary ; Financial interests in accordance with requiring waiver under section 208(b) of
Index of Sec 1401. ...TITLE 18 ; Later requiring written determination as referred in section 208(b)(1) of
Index of Sec 1401. ...TITLE 18, United States Code or waiver as referred in subparagraph for service on Commission at meeting of Commission ; Written certification as referred in section 208(b)(3) of
Index of Sec 1401. ...TITLE 31, United States coding ; Term knowingly having meaning given term in section 3729(b) of
Index of Sec 1451. ...TITLE 42, Code of Federal Regulations ; Respect to meeting staffing requirement imposed by Secretary to carry out clause if not qualified dietitian of
Index of Sec 1433. ...TITLE 42, Code of Federal Regulations ; Respect to meeting staffing requirement imposed by Secretary to carry out clause if not qualified dietitian of
Index of Sec 1433. ...TITLE 5, United States Code or other similar Federal ; Information described in paragraph or considered confidential and not subject to disclosure under section 552 of
Index of Sec 1451. ...TITLE XI of Social Security Act amended by adding at end following new part ;
Index of Sec 1401. ...TITLE XI of Social Security Act being further amended by adding at end following new part ;
Index of Sec 1441. ...TITLE XI of Social Security Act amended by inserting after section 1138 following section ;
Index of Sec 1461. ...TITLE XI of Social Security Act amended by adding at end following new sections ; Part E of
Index of Sec 1442. ...CLINICAL trial and costs otherwise to be covered under title with respect to beneficiary ; Benefits under title XVIII, XIX or XXI in case where individual participating in
Index of Sec 1401. ...TITLE XVIII ; Comptroller General of United States conducting study to evaluate extent of use of physician self-referral arrangements and effects of arrangements on cost of providing advanced diagnostic imaging and radiation oncology services to Medicare beneficiaries under
Index of Sec 1451. ...TITLE XVIII or XIX of Social Security Act ; Term long-term care facility or provider meaning following facilities or providers receiving payment for services under
Index of Sec 1417. ...INTEREST in entity ; Hospital or other health care entity billing Secretary under part A or part B of title XVIII for services reporting on ownership shares of physician owning
Index of Sec 1451. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...DEMENTIA management training and resident abuse prevention training after curriculum ;
Index of Sec 1431. ...TRAINING hours for certified nurse aides required under sections 1819(f)(2)(a)(i) and 1919(f)(2)(a)(i) of Social Security Act 42 USC 1395i-3(f)(2)(a)(i) ; Number of initial
Index of Sec 1432. ...TRAINING programs or disseminating publications explaining in practical manner what required ; Requiring participation in
Index of Sec 1412. ...TRAINING programs or disseminating publications explaining in practical manner what required ; Requiring participation in
Index of Sec 1412. ...TRANSMITTAL to Congress and President ; Reports under subparagraph not to be submitted to Office of Management and Budget or other Federal agency or executive department for purpose prior to
Index of Sec 1401. ...TRANSMITTAL ; Reports to be published on public internet website of Commission after date of
Index of Sec 1401. ...TRANSPARENT process including consultations with appropriate stakeholders ; Consistent with standards of evidence developed under section and developed through
Index of Sec 1401. ...TRANSPARENT process for activities conducted pursuant to convening ; Consensus-based entity described in paragraph providing for open and
Index of Sec 1443. ...COMPENSATION ; Providing transportation and subsistence for persons serving without
Index of Sec 1401. ...PROPERTY or asseal ; Deed of trust, note or other obligation secured by entity or
Index of Sec 1411. ...UNDERCAPITALIZATION ; Options to address
Index of Sec 1412. ...USABILITY of proposed measures ; Testing funded under paragraph including testing of feasibility and
Index of Sec 1442. ...VALIDATION of data as relevant and scientifically credible ; System for collection of data for quality measures providing for
Index of Sec 1442. ...CLINICAL perspective advisory panel ; Participating as non-voting member with respect to particular matter considered in meeting of Commission or
Index of Sec 1401. ...CONTRACTUAL warranty where terms of warranty being set forth in purchase or lease agreement for covered device ; Items or services provided under
Index of Sec 1451. ...LEASE agreement for covered device ; Items or services provided under contractual warranty where terms of warranty being set forth in purchase or
Index of Sec 1451. ...IMMUNIZATION rates ; Factors contributing to occurrence of infections including health care worker
Index of Sec 1461. ...1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, 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
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
(a) In general.—Title XI of the Social Security Act is amended by adding at the end the following new part:
“Comparative effectiveness research
“Sec. 1181. (a) Center for comparative effectiveness research established.—
“(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
“(2) DUTIES.—The Center shall—
“(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;
“(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;
“(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;
“(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and Congress appropriate relevant reports described in subsection (d)(2);
“(E) not later than one year after the date of the enactment of this section, enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation and report on standards of evidence for highly credible research;
“(F) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data; and
“(G) appoint clinical perspective advisory panels for research priorities under this section, which shall consult with patients and other stakeholders and advise the Center on research questions, methods, and evidence gaps in terms of clinical outcomes for the specific research inquiry to be examined with respect to such priority to ensure that the information produced from such research is clinically relevant to decisions made by clinicians and patients at the point of care.
“(A) OBTAINING OFFICIAL DATA.—The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Center, the head of such department or agency shall furnish that information to the Center on an agreed upon schedule.
“(B) DATA COLLECTION.—In order to carry out its functions, the Center shall—
“(i) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section;
“(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; and
“(iii) adopt procedures allowing any interested party to submit information for the use by the Center in making reports and recommendations.
In carrying out clause (ii), the Center may award grants or contracts (or provide for intergovernmental transfers, as applicable) to private entities and governmental agencies with experience in conducting comparative effectiveness research, such as the National Institutes of Health and other relevant Federal health agencies.
“(C) ACCESS OF GAO TO INFORMATION.—The Comptroller General shall have unrestricted access to all deliberations, records, and nonproprietary data of the Center and Commission under subsection (b), immediately upon request.
“(D) PERIODIC AUDIT.—The Center and Commission under subsection (b) shall be subject to periodic audit by the Comptroller General.
(b) Comparative Effectiveness Research Trust Fund; financing for the trust fund.—For the provision establishing a Comparative Effectiveness Research Trust Fund and financing such Trust Fund, see section 1802.
(a) In general.—Section 1124 of the Social Security Act (42 U.S.C. 1320a–3) is amended by adding at the end the following new subsection:
“(c) Required Disclosure of Ownership and Additional Disclosable Parties Information.—
“(1) DISCLOSURE.—A facility (as defined in paragraph (6)(B)) shall have the information described in paragraph (3) available—
“(A) during the period beginning on the date of the enactment of this subsection and ending on the date such information is made available to the public under section 1411(b) of the Affordable Health Care for America Act, for submission to the Secretary, the Inspector General of the Department of Health and Human Services, the State in which the facility is located, and the State long-term care ombudsman in the case where the Secretary, the Inspector General, the State, or the State long-term care ombudsman requests such information; and
“(B) beginning on the effective date of the final regulations promulgated under paragraph (4)(A), for reporting such information in accordance with such final regulations.
Nothing in subparagraph (A) shall be construed as authorizing a facility to dispose of or delete information described in such subparagraph after the effective date of the final regulations promulgated under paragraph (4)(A).
“(2) PUBLIC AVAILABILITY OF INFORMATION.—During the period described in paragraph (1)(A), a facility shall—
“(A) make the information described in paragraph (3) available to the public upon request and update such information as may be necessary to reflect changes in such information; and
“(B) post a notice of the availability of such information in the lobby of the facility in a prominent manner.
“(A) IN GENERAL.—The following information is described in this paragraph:
“(i) The information described in subsections (a) and (b), subject to subparagraph (C).
“(ii) The identity of and information on—
“(I) each member of the governing body of the facility, including the name, title, and period of service of each such member;
“(II) each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and date of start of service of each such person or entity; and
“(III) each person or entity who is an additional disclosable party of the facility.
“(iii) A description of the organizational structure and the relationship of each person and entity described in subclauses (II) and (III) of clause (ii) to the facility and to one another.
“(B) SPECIAL RULE WHERE INFORMATION IS ALREADY REPORTED OR SUBMITTED.—To the extent that information reported by a facility to the Internal Revenue Service on Form 990, information submitted by a facility to the Securities and Exchange Commission, or information otherwise submitted to the Secretary or any other Federal agency contains the information described in clauses (i), (ii), or (iii) of subparagraph (A), the Secretary may allow, to the extent practicable, such Form or such information to meet the requirements of paragraph (1) and to be submitted in a manner specified by the Secretary.
“(C) SPECIAL RULE.—In applying subparagraph (A)(i)—
“(i) with respect to subsections (a) and (b), ‘ownership or control interest’ shall include direct or indirect interests, including such interests in intermediate entities; and
“(ii) subsection (a)(3)(A)(ii) shall include the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured, in whole or in part, by the entity or any of the property or assets thereof, if the interest is equal to or exceeds 5 percent of the total property or assets of the entirety.
“(A) IN GENERAL.—Not later than the date that is 2 years after the date of the enactment of this subsection, the Secretary shall promulgate regulations requiring a facility to report the information described in paragraph (3) to the Secretary in a standardized format, and such other regulations as are necessary to carry out this subsection. Such regulations shall specify the frequency of reporting, as determined by the Secretary. Such final regulations shall also require—
“(i) the reporting of such information on or after the first day of the first calendar quarter beginning after the date that is 90 days after the date on which such final regulations are published in the Federal Register; and—
“(ii) the certification, as a condition of participation under the program under title XVIII or XIX, that such information is accurate and current.
“(B) GUIDANCE.—The Secretary shall provide guidance and technical assistance to States on how to adopt the standardized format under subparagraph (A).
“(5) NO EFFECT ON EXISTING REPORTING REQUIREMENTS.—Nothing in this subsection shall reduce, diminish, or alter any reporting requirement for a facility that is in effect as of the date of the enactment of this subsection.
“(6) DEFINITIONS.—In this subsection:
“(A) ADDITIONAL DISCLOSABLE PARTY.—The term ‘additional disclosable party’ means, with respect to a facility, any person or entity who, through ownership interest, partnership interest, contract, or otherwise—
“(i) directly or indirectly exercises operational, financial, administrative, or managerial control or direction over the facility or a part thereof, or provides policies or procedures for any of the operations of the facility, or provides financial or cash management services to the facility;
“(ii) leases or subleases real property to the facility, or owns a whole or part interest equal to or exceeding 5 percent of the total value of such real property;
“(iii) lends funds or provides a financial guarantee to the facility in an amount which is equal to or exceeds $50,000; or
“(iv) provides management or administrative services, clinical consulting services, or accounting or financial services to the facility.
“(B) FACILITY.—The term ‘facility’ means a disclosing entity which is—
“(i) a skilled nursing facility (as defined in section 1819(a)); or
“(ii) a nursing facility (as defined in section 1919(a)).
“(C) MANAGING EMPLOYEE.—The term ‘managing employee’ means, with respect to a facility, an individual (including a general manager, business manager, administrator, director, or consultant) who directly or indirectly manages, advises, or supervises any element of the practices, finances, or operations of the facility.
“(D) ORGANIZATIONAL STRUCTURE.—The term ‘organizational structure’ means, in the case of—
“(i) a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 5 percent;
“(ii) a limited liability company, the members and managers of the limited liability company (including, as applicable, what percentage each member and manager has of the ownership interest in the limited liability company);
“(iii) a general partnership, the partners of the general partnership;
“(iv) a limited partnership, the general partners and any limited partners of the limited partnership who have an ownership interest in the limited partnership which is equal to or exceeds 10 percent;
“(v) a trust, the trustees of the trust;
“(vi) an individual, contact information for the individual; and
“(vii) any other person or entity, such information as the Secretary determines appropriate.”.
(b) Public Availability of Information.—Not later than the date that is 1 year after the date on which the final regulations promulgated under section 1124(c)(4)(A) of the Social Security Act, as added by subsection (a), are published in the Federal Register, the information reported in accordance with such final regulations shall be made available to the public in accordance with procedures established by the Secretary of Health and Human Services.
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)) is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)) is amended by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B).
(a) Effective Compliance and Ethics Programs.—
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)), as amended by section 1411(c)(1), is amended by adding at the end the following new subparagraph:
“(C) COMPLIANCE AND ETHICS PROGRAMS.—
“(i) REQUIREMENT.—On or after the first day of the first calendar quarter beginning after the date that is 1 year after the date on which regulations developed under clause (ii) are published in the Federal Register, a skilled nursing facility shall, with respect to the entity that operates or controls the facility (in this subparagraph referred to as the ‘operating organization’ or ‘organization’), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care consistent with such regulations.
“(ii) DEVELOPMENT OF REGULATIONS.—
“(I) IN GENERAL.—Not later than the date that is 2 years after the date of the enactment of this subparagraph, the Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall promulgate regulations for an effective compliance and ethics program for operating organizations, which may include a model compliance program.
“(II) DESIGN OF REGULATIONS.—Such regulations with respect to specific elements or formality of a program may vary with the size of the organization, such that larger organizations should have a more formal and rigorous program and include established written policies defining the standards and procedures to be followed by its employees. Such requirements shall specifically apply to the corporate level management of multi-unit nursing home chains.
“(III) EVALUATION.—Not later than 3 years after the date on which compliance and ethics programs established under this subparagraph are in operation pursuant to clause (i), the Secretary shall complete an evaluation of such programs. Such evaluation shall determine if such programs led to changes in deficiency citations, changes in quality performance, or changes in other metrics of resident quality of care. The Secretary shall submit to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
“(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a skilled nursing facility, a program of the operating organization that—
“(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and
“(II) includes at least the required components specified in clause (iv).
“(iv) REQUIRED COMPONENTS OF PROGRAM.—The required components of a compliance and ethics program of an organization are the following:
“(I) The organization must have established compliance standards and procedures to be followed by its employees, contractors, and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations under this Act.
“(II) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such standards and procedures and have sufficient resources and authority to assure such compliance.
“(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.
“(IV) The organization must have taken steps to communicate effectively its standards and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required.
“(V) The organization must have taken reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems reasonably designed to detect criminal, civil, and administrative violations under this Act by its employees and other agents and by having in place and publicizing a reporting system whereby employees and other agents could report violations by others within the organization without fear of retribution.
“(VI) The standards must have been consistently enforced through appropriate disciplinary mechanisms, including, as appropriate, discipline of individuals responsible for the failure to detect an offense.
“(VII) After an offense has been detected, the organization must have taken all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including repayment of any funds to which it was not entitled and any necessary modification to its program to prevent and detect criminal, civil, and administrative violations under this Act.
“(VIII) The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
“(v) COORDINATION.—The provisions of this subparagraph shall apply with respect to a skilled nursing facility in lieu of section 1874(d).”.
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)), as amended by section 1411(c)(2), is amended by adding at the end the following new subparagraph:
“(C) COMPLIANCE AND ETHICS PROGRAM.—
“(i) REQUIREMENT.—On or after the first day of the first calendar quarter beginning after the date that is 1 year after the date on which regulations developed under clause (ii) are published in the Federal Register, a skilled nursing facility shall, with respect to the entity that operates or controls the facility (in this subparagraph referred to as the ‘operating organization’ or ‘organization’), have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care consistent with such regulations.
“(iii) DEVELOPMENT OF REGULATIONS.—
“(I) IN GENERAL.—Not later than the date that is 2 years after the date of the enactment of this subparagraph, the Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall promulgate regulations for an effective compliance and ethics program for operating organizations, which may include a model compliance program.
“(II) DESIGN OF REGULATIONS.—Such regulations with respect to specific elements or formality of a program may vary with the size of the organization, such that larger organizations should have a more formal and rigorous program and include established written policies defining the standards and procedures to be followed by its employees. Such requirements shall specifically apply to the corporate level management of multi-unit nursing home chains.
“(III) EVALUATION.—Not later than 3 years after the date on which compliance and ethics programs established under this subparagraph are in operation pursuant to clause (i), the Secretary shall complete an evaluation of such programs. Such evaluation shall determine if such programs led to changes in deficiency citations, changes in quality performance, or changes in other metrics of resident quality of care. The Secretary shall submit to Congress a report on such evaluation and shall include in such report such recommendations regarding changes in the requirements for such programs as the Secretary determines appropriate.
“(v) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a nursing facility, a program of the operating organization that—
“(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and
“(II) includes at least the required components specified in clause (iv).
“(vi) REQUIRED COMPONENTS OF PROGRAM.—The required components of a compliance and ethics program of an organization are the following:
“(I) The organization must have established compliance standards and procedures to be followed by its employees and other agents that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations under this Act.
“(II) Specific individuals within high-level personnel of the organization must have been assigned overall responsibility to oversee compliance with such standards and procedures and has sufficient resources and authority to assure such compliance.
“(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.
“(IV) The organization must have taken steps to communicate effectively its standards and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required.
“(V) The organization must have taken reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems reasonably designed to detect criminal, civil, and administrative violations under this Act by its employees and other agents and by having in place and publicizing a reporting system whereby employees and other agents could report violations by others within the organization without fear of retribution.
“(VI) The standards must have been consistently enforced through appropriate disciplinary mechanisms, including, as appropriate, discipline of individuals responsible for the failure to detect an offense.
“(VII) After an offense has been detected, the organization must have taken all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including repayment of any funds to which it was not entitled and any necessary modification to its program to prevent and detect criminal, civil, and administrative violations under this Act.
“(VIII) The organization must periodically undertake reassessment of its compliance program to identify changes necessary to reflect changes within the organization and its facilities.
“(vii) COORDINATION.—The provisions of this subparagraph shall apply with respect to a nursing facility in lieu of section 1902(a)(77).”.
(b) Quality Assurance and Performance Improvement Program.—
(1) SKILLED NURSING FACILITIES.—Section 1819(b)(1)(B) of the Social Security Act (42 U.S.C. 1396r(b)(1)(B)) is amended—
(A) by striking “assurance” and inserting “assurance and quality assurance and performance improvement program”;
(B) by designating the matter beginning with “A skilled nursing facility” as a clause (i) with the heading “In general.—” and the appropriate indentation;
(C) in clause (i) (as so designated by subparagraph (B)), by redesignating clauses (i) and (ii) as subclauses (I) and (II), respectively; and
(D) by adding at the end the following new clause:
“(ii) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAM.—
“(I) IN GENERAL.—Not later than December 31, 2011, the Secretary shall establish and implement a quality assurance and performance improvement program (in this clause referred to as the ‘QAPI program’) for skilled nursing facilities, including multi-unit chains of such facilities. Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a skilled nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).
“(II) REGULATIONS.—The Secretary shall promulgate regulations to carry out this clause.”.
(2) NURSING FACILITIES.—Section 1919(b)(1)(B) of the Social Security Act (42 U.S.C. 1396r(b)(1)(B)) is amended—
(A) by striking “assurance” and inserting “assurance and quality assurance and performance improvement program”;
(B) by designating the matter beginning with “A nursing facility” as a clause (i) with the heading “In general.—” and the appropriate indentation; and
(C) by adding at the end the following new clause:
“(ii) QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAM.—
“(I) IN GENERAL.—Not later than December 31, 2011, the Secretary shall establish and implement a quality assurance and performance improvement program (in this clause referred to as the ‘QAPI program’) for nursing facilities, including multi-unit chains of such facilities. Under the QAPI program, the Secretary shall establish standards relating to such facilities and provide technical assistance to such facilities on the development of best practices in order to meet such standards. Not later than 1 year after the date on which the regulations are promulgated under subclause (II), a nursing facility must submit to the Secretary a plan for the facility to meet such standards and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i).
“(II) REGULATIONS.—The Secretary shall promulgate regulations to carry out this clause.”.
(3) PROPOSAL TO REVISE QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAMS.—The Secretary shall implement policies that modify and strengthen quality assurance and performance improvement programs in skilled nursing facilities and nursing facilities on a periodic basis, as determined by the Secretary.
(4) FACILITY PLAN.—Not later than 1 year after the date on which the regulations are promulgated under subclause (II) of clause (ii) of sections 1819(b)(1)(B) and 1919(b)(1)(B) of the Social Security Act, as added by paragraphs (1) and (2), a skilled nursing facility and a nursing facility must submit to the Secretary a plan for the facility to meet the standards under such regulations and implement such best practices, including how to coordinate the implementation of such plan with quality assessment and assurance activities conducted under clause (i) of such sections.
(c) GAO study on nursing facility undercapitalization.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are undercapitalizing such facilities.
(B) The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities.
(C) Options to address such undercapitalization, such as requirements relating to surety bonds, liability insurance, or minimum capitalization.
(2) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1).
(3) NURSING FACILITY.—In this subsection, the term “nursing facility” includes a skilled nursing facility.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819 of the Social Security Act (42 U.S.C. 1395i–3) is amended—
(A) by redesignating subsection (i) as subsection (j); and
(B) by inserting after subsection (h) the following new subsection:
“(i) Nursing Home Compare Website.—
“(1) INCLUSION OF ADDITIONAL INFORMATION.—
“(A) IN GENERAL.—The Secretary shall ensure that the Department of Health and Human Services includes, as part of the information provided for comparison of nursing homes on the official Internet website of the Federal Government for Medicare beneficiaries (commonly referred to as the ‘Nursing Home Compare’ Medicare website) (or a successor website), the following information in a manner that is prominent, easily accessible, readily understandable to consumers of long-term care services, and searchable:
“(i) Information that is reported to the Secretary under section 1124(c)(4).
“(ii) Information on the ‘Special Focus Facility program’ (or a successor program) established by the Centers for Medicare and Medicaid Services, according to procedures established by the Secretary. Such procedures shall provide for the inclusion of information with respect to, and the names and locations of, those facilities that, since the previous quarter—
“(I) were newly enrolled in the program;
“(II) are enrolled in the program and have failed to significantly improve;
“(III) are enrolled in the program and have significantly improved;
“(IV) have graduated from the program; and
“(V) have closed voluntarily or no longer participate under this title.
“(iii) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—
“(I) concise explanations of how to interpret the data (such as a plain English explanation of data reflecting ‘nursing home staff hours per resident day’);
“(II) differences in types of staff (such as training associated with different categories of staff);
“(III) the relationship between nurse staffing levels and quality of care; and
“(IV) an explanation that appropriate staffing levels vary based on patient case mix.
“(iv) Links to State internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report.
“(v) The standardized complaint form developed under subsection (f)(8), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
“(vi) Summary information on the number, type, severity, and outcome of substantiated complaints.
“(vii) The number of adjudicated instances of criminal violations by employees of a nursing facility—
“(I) that were committed inside the facility;
“(II) with respect to such instances of violations or crimes committed inside of the facility that were the violations or crimes of abuse, neglect, and exploitation, criminal sexual abuse, or other violations or crimes that resulted in serious bodily injury; and
“(viii) The number of civil monetary penalties levied against the facility, employees, contractors, and other agents.
“(ix) Any other information that the Secretary determines appropriate.
The facility shall not make available under clause (iv) identifying information on complainants or residents.
“(B) DEADLINE FOR PROVISION OF INFORMATION.—
“(i) IN GENERAL.—Except as provided in clause (ii), the Secretary shall ensure that the information described in subparagraph (A) is included on such website (or a successor website) not later than 1 year after the date of the enactment of this subsection.
“(ii) EXCEPTION.—The Secretary shall ensure that the information described in subparagraph (A)(i) and (A)(iii) is included on such website (or a successor website) not later than 1 year after the dates on which the data are submitted to the Secretary pursuant to section 1124(c)(4) and subsection (b)(8)(C), respectively.
“(2) REVIEW AND MODIFICATION OF WEBSITE.—
“(A) IN GENERAL.—The Secretary shall establish a process—
“(i) to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
“(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
“(B) CONSULTATION.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
“(i) State long-term care ombudsman programs;
“(ii) consumer advocacy groups;
“(iii) provider stakeholder groups; and
“(iv) any other representatives of programs or groups the Secretary determines appropriate.”.
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION.—
(A) IN GENERAL.—Section 1819(g)(5) of the Social Security Act (42 U.S.C. 1395i–3(g)(5)) is amended by adding at the end the following new subparagraph:
“(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.—In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification recommendation made respecting a skilled nursing facility (including any enforcement actions taken by the State or any Federal enforcement action recommended by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.”.
(B) EFFECTIVE DATE.—The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1819(f) of such Act is amended by adding at the end the following new paragraph:
“(8) SPECIAL FOCUS FACILITY PROGRAM.—
“(A) IN GENERAL.—The Secretary shall conduct a special focus facility program for enforcement of requirements for skilled nursing facilities that the Secretary has identified as having a poor compliance history or that substantially failed to meet applicable requirements of this Act
“(B) PERIODIC SURVEYS.—Under such program the Secretary shall conduct surveys of each facility in the program not less than once every 6 months.”.
(1) IN GENERAL.—Section 1919 of the Social Security Act (42 U.S.C. 1396r) is amended—
(A) by redesignating subsection (i) as subsection (j); and
(B) by inserting after subsection (h) the following new subsection:
“(i) Nursing Home Compare Website.—
“(1) INCLUSION OF ADDITIONAL INFORMATION.—
“(A) IN GENERAL.—The Secretary shall ensure that the Department of Health and Human Services includes, as part of the information provided for comparison of nursing homes on the official internet website of the Federal Government for Medicare beneficiaries (commonly referred to as the ‘Nursing Home Compare’ Medicare website) (or a successor website), the following information in a manner that is prominent, easily accessible, readily understandable to consumers of long-term care services, and searchable:
“(i) Information that is reported to the Secretary under section 1124(c)(4)
“(ii) Information on the ‘Special Focus Facility program’ (or a successor program) established by the Centers for Medicare & Medicaid Services, according to procedures established by the Secretary. Such procedures shall provide for the inclusion of information with respect to, and the names and locations of, those facilities that, since the previous quarter—
“(I) were newly enrolled in the program;
“(II) are enrolled in the program and have failed to significantly improve;
“(III) are enrolled in the program and have significantly improved;
“(IV) have graduated from the program; and
“(V) have closed voluntarily or no longer participate under this title.
“(iii) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—
“(I) concise explanations of how to interpret the data (such as plain English explanation of data reflecting ‘nursing home staff hours per resident day’);
“(II) differences in types of staff (such as training associated with different categories of staff);
“(III) the relationship between nurse staffing levels and quality of care; and
“(IV) an explanation that appropriate staffing levels vary based on patient case mix.
“(iv) Links to State internet websites with information regarding State survey and certification programs, links to Form 2567 State inspection reports (or a successor form) on such websites, information to guide consumers in how to interpret and understand such reports, and the facility plan of correction or other response to such report.
“(v) The standardized complaint form developed under subsection (f)(10), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.
“(vi) Summary information on the number, type, severity, and outcome of substantiated complaints.
“(vii) The number of adjudicated instances of criminal violations by employees of a nursing facility—
“(I) that were committed inside of the facility; and
“(II) with respect to such instances of violations or crimes committed inside of the facility that were the violations or crimes of abuse, neglect, and exploitation, criminal sexual abuse, or other violations or crimes that resulted in serious bodily injury.
“(viii) the number of civil monetary penalties levied against the facility, employees, contractors, and other agents.
“(ix) Any other information that the Secretary determines appropriate.
The facility shall not make available under clause (ii) identifying information about complainants or residents.
“(B) DEADLINE FOR PROVISION OF INFORMATION.—
“(i) IN GENERAL.—Except as provided in clause (ii), the Secretary shall ensure that the information described in subparagraph (A) is included on such website (or a successor website) not later than 1 year after the date of the enactment of this subsection.
“(ii) EXCEPTION.—The Secretary shall ensure that the information described in subparagraph (A)(i) and (A)(iii) is included on such website (or a successor website) not later than 1 year after the dates on which the data are submitted to the Secretary pursuant to section 1124(c)(4) and subsection (b)(8)(C), respectively.
“(2) REVIEW AND MODIFICATION OF WEBSITE.—
“(A) IN GENERAL.—The Secretary shall establish a process—
“(i) to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of information reported on such website as of the day before the date of the enactment of this subsection; and
“(ii) not later than 1 year after the date of the enactment of this subsection, to modify or revamp such website in accordance with the review conducted under clause (i).
“(B) CONSULTATION.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
“(i) State long-term care ombudsman programs;
“(ii) consumer advocacy groups;
“(iii) provider stakeholder groups;
“(iv) skilled nursing facility employees and their representatives; and
“(v) any other representatives of programs or groups the Secretary determines appropriate.”.
(2) TIMELINESS OF SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION.—
(A) IN GENERAL.—Section 1919(g)(5) of the Social Security Act (42 U.S.C. 1396r(g)(5)) is amended by adding at the end the following new subparagraph:
“(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.—In order to improve the timeliness of information made available to the public under subparagraph (A) and provided on the Nursing Home Compare Medicare website under subsection (i), each State shall submit information respecting any survey or certification recommendation made respecting a nursing facility (including any enforcement actions taken by the State or any Federal enforcement action recommended by the State) to the Secretary not later than the date on which the State sends such information to the facility. The Secretary shall use the information submitted under the preceding sentence to update the information provided on the Nursing Home Compare Medicare website as expeditiously as practicable but not less frequently than quarterly.”.
(B) EFFECTIVE DATE.—The amendment made by this paragraph shall take effect 1 year after the date of the enactment of this Act.
(3) SPECIAL FOCUS FACILITY PROGRAM.—Section 1919(f) of such Act is amended by adding at the end of the following new paragraph:
“(10) SPECIAL FOCUS FACILITY PROGRAM.—
“(A) IN GENERAL.—The Secretary shall conduct a special focus facility program for enforcement of requirements for nursing facilities that the Secretary has identified as having a poor compliance history or that substantially failed to meet applicable requirements of this Act
“(B) PERIODIC SURVEYS.—Under such program the Secretary shall conduct surveys of each facility in the program not less often than once every 6 months.”.
(c) Availability of Reports on Surveys, Certifications, and Complaint Investigations.—
(1) SKILLED NURSING FACILITIES.—Section 1819(d)(1) of the Social Security Act (42 U.S.C. 1395i–3(d)(1)), as amended by sections 1411 and 1412, is amended by adding at the end the following new subparagraph:
“(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS.—A skilled nursing facility must—
“(i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
“(ii) post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
The facility shall not make available under clause (i) identifying information about complainants or residents.”.
(2) NURSING FACILITIES.—Section 1919(d)(1) of the Social Security Act (42 U.S.C. 1396r(d)(1)), as amended by sections 1411 and 1412, is amended by adding at the end the following new subparagraph:
“(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS.—A nursing facility must—
“(i) have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and
“(ii) post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
The facility shall not make available under clause (i) identifying information about complainants or residents.”.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall take effect 1 year after the date of the enactment of this Act.
(d) Guidance to States on Form 2567 State Inspection Reports and Complaint Investigation Reports.—
(1) GUIDANCE.—The Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility’s plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities and the Secretary shall, if possible, include such information on Nursing Home Compare.
(2) REQUIREMENT.—Section 1902(a)(9) of the Social Security Act (42 U.S.C. 1396a(a)(9)) is amended—
(A) by striking “and” at the end of subparagraph (B);
(B) by striking the semicolon at the end of subparagraph (C) and inserting “, and”; and
(C) by adding at the end the following new subparagraph:
“(D) that the State maintain a consumer-oriented website providing useful information to consumers regarding all skilled nursing facilities and all nursing facilities in the State, including for each facility, Form 2567 State inspection reports (or a successor form), complaint investigation reports, the facility’s plan of correction, and such other information that the State or the Secretary considers useful in assisting the public to assess the quality of long term care options and the quality of care provided by individual facilities;”.
(3) DEFINITIONS.—In this subsection:
(A) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(B) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.
(C) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).
Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the following new subsection:
(a) Skilled Nursing Facilities.—
(1) DEVELOPMENT BY THE SECRETARY.—Section 1819(f) of the Social Security Act (42 U.S.C. 1395i–3(f)), as amended by section 1413(a)(3), is amended by adding at the end the following new paragraph:
“(9) STANDARDIZED COMPLAINT FORM.—The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a skilled nursing facility.”.
(2) STATE REQUIREMENTS.—Section 1819(e) of the Social Security Act (42 U.S.C. 1395i–3(e)) is amended by adding at the end the following new paragraph:
“(6) COMPLAINT PROCESSES AND WHISTLE-BLOWER PROTECTION.—
“(A) COMPLAINT FORMS.—The State must make the standardized complaint form developed under subsection (f)(9) available upon request to—
“(i) a resident of a skilled nursing facility;
“(ii) any person acting on the resident’s behalf; and
“(iii) any person who works at a skilled nursing facility or is a representative of such a worker.
“(B) COMPLAINT RESOLUTION PROCESS.—The State must establish a complaint resolution process in order to ensure that a resident, the legal representative of a resident of a skilled nursing facility, or other responsible party is not retaliated against if the resident, legal representative, or responsible party has complained, in good faith, about the quality of care or other issues relating to the skilled nursing facility, that the legal representative of a resident of a skilled nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if such representative party has complained, in good faith, about the quality of care provided by the facility or other issues relating to the facility, and that a person who works at a skilled nursing facility is not retaliated against if the worker has complained, in good faith, about quality of care or services or an issue relating to the quality of care or services provided at the facility, whether the resident, legal representative, other responsible party, or worker used the form developed under subsection (f)(9) or some other method for submitting the complaint. Such complaint resolution process shall include—
“(i) procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
“(ii) procedures to determine the likely severity of a complaint and for the investigation of the complaint;
“(iii) deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation; and
“(iv) procedures to ensure that the identity of the complainant will be kept confidential.
“(C) WHISTLEBLOWER PROTECTION.—
“(i) PROHIBITION AGAINST RETALIATION.—No person who works at a skilled nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained, in good faith, about the quality of care or services provided by a skilled nursing facility or about other issues relating to quality of care or services, whether using the form developed under subsection (f)(9) or some other method for submitting the complaint.
“(ii) RETALIATORY REPORTING.—A skilled nursing facility may not file a complaint or a report against a person who works (or has worked at the facility) with the appropriate State professional disciplinary agency because the person (or anyone acting at the person’s request) complained in good faith, as described in clause (i).
“(iii) RELIEF.—Any person aggrieved by a violation of clause (i) or clause (ii) may, in a civil action, obtain all appropriate relief, including reinstatement, reimbursement of lost wages, compensation, and benefits, and exemplary damages where warranted, and such other relief as the court deems appropriate, as well as costs of suit and reasonable attorney and expert witness fees.
“(iv) RIGHTS NOT WAIVABLE.—The rights protected by this paragraph may not be diminished by contract or other agreement, and nothing in this paragraph shall be construed to diminish any greater or additional protection provided by Federal or State law or by contract or other agreement.
“(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.—Each skilled nursing facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of persons under this paragraph and including a statement that an employee may file a complaint with the Secretary against a skilled nursing facility that violates the provisions of this paragraph and information with respect to the manner of filing such a complaint.
“(D) RULE OF CONSTRUCTION.—Nothing in this paragraph shall be construed as preventing a resident of a skilled nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(9) (including submitting a complaint orally).
“(E) GOOD FAITH DEFINED.—For purposes of this paragraph, an individual shall be deemed to be acting in good faith with respect to the filing of a complaint if the individual reasonably believes—
“(i) the information reported or disclosed in the complaint is true; and
“(ii) the violation of this title has occurred or may occur in relation to such information.”.
(1) DEVELOPMENT BY THE SECRETARY.—Section 1919(f) of the Social Security Act (42 U.S.C. 1395i–3(f)), as amended by section 1413(b), is amended by adding at the end the following new paragraph:
“(11) STANDARDIZED COMPLAINT FORM.—The Secretary shall develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a State survey and certification agency and a State long-term care ombudsman program with respect to a nursing facility.”.
(2) STATE REQUIREMENTS.—Section 1919(e) of the Social Security Act (42 U.S.C. 1395i–3(e)) is amended by adding at the end the following new paragraph:
“(8) COMPLAINT PROCESSES AND WHISTLEBLOWER PROTECTION.—
“(A) COMPLAINT FORMS.—The State must make the standardized complaint form developed under subsection (f)(11) available upon request to—
“(i) a resident of a nursing facility;
“(ii) any person acting on the resident’s behalf; and
“(iii) any person who works at a nursing facility or a representative of such a worker.
“(B) COMPLAINT RESOLUTION PROCESS.—The State must establish a complaint resolution process in order to ensure that a resident, the legal representative of a resident of a nursing facility, or other responsible party is not retaliated against if the resident, legal representative, or responsible party has complained, in good faith, about the quality of care or other issues relating to the nursing facility, that the legal representative of a resident of a nursing facility or other responsible party is not denied access to such resident or otherwise retaliated against if such representative party has complained, in good faith, about the quality of care provided by the facility or other issues relating to the facility, and that a person who works at a nursing facility is not retaliated against if the worker has complained, in good faith, about quality of care or services or an issue relating to the quality of care or services provided at the facility, whether the resident, legal representative, other responsible party, or worker used the form developed under subsection (f)(11) or some other method for submitting the complaint. Such complaint resolution process shall include—
“(i) procedures to assure accurate tracking of complaints received, including notification to the complainant that a complaint has been received;
“(ii) procedures to determine the likely severity of a complaint and for the investigation of the complaint;
“(iii) deadlines for responding to a complaint and for notifying the complainant of the outcome of the investigation; and
“(iv) procedures to ensure that the identity of the complainant will be kept confidential.
“(C) WHISTLEBLOWER PROTECTION.—
“(i) PROHIBITION AGAINST RETALIATION.—No person who works at a nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained, in good faith, about the quality of care or services provided by a nursing facility or about other issues relating to quality of care or services, whether using the form developed under subsection (f)(11) or some other method for submitting the complaint.
“(ii) RETALIATORY REPORTING.—A nursing facility may not file a complaint or a report against a person who works (or has worked at the facility with the appropriate State professional disciplinary agency because the person (or anyone acting at the person’s request) complained in good faith, as described in clause (i).
“(iii) RELIEF.—Any person aggrieved by a violation of clause (i) or clause (ii) may, in a civil action, obtain all appropriate relief, including reinstatement, reimbursement of lost wages, compensation, and benefits, and exemplary damages where warranted, and such other relief as the court deems appropriate, as well as costs of suit and reasonable attorney and expert witness fees.
“(iv) RIGHTS NOT WAIVABLE.—The rights protected by this paragraph may not be diminished by contract or other agreement, and nothing in this paragraph shall be construed to diminish any greater or additional protection provided by Federal or State law or by contract or other agreement.
“(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.—Each nursing facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of persons under this paragraph and including a statement that an employee may file a complaint with the Secretary against a nursing facility that violates the provisions of this paragraph and information with respect to the manner of filing such a complaint.
“(D) RULE OF CONSTRUCTION.—Nothing in this paragraph shall be construed as preventing a resident of a nursing facility (or a person acting on the resident’s behalf) from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection (f)(11) (including submitting a complaint orally).
“(E) GOOD FAITH DEFINED.—For purposes of this paragraph, an individual shall be deemed to be acting in good faith with respect to the filing of a complaint if the individual reasonably believes—
“(i) the information reported or disclosed in the complaint is true; and
“(ii) the violation of this title has occurred or may occur in relation to such information.”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(a) Skilled nursing facilities.—Section 1819(b)(8) of the Social Security Act (42 U.S.C. 1395i–3(b)(8)) is amended by adding at the end the following new subparagraph:
“(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.—On and after the first day of the first calendar quarter beginning after the date that is 2 years after the date of enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
“(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
“(ii) include resident census data and information on resident case mix;
“(iii) include a regular reporting schedule; and
“(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.
Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.”.
(b) Nursing facilities.—Section 1919(b)(8) of the Social Security Act (42 U.S.C. 1396r(b)(8)) is amended by adding at the end the following new subparagraph:
“(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.—On and after the first day of the first calendar quarter beginning after the date that is 2 years after the date of enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence—
“(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
“(ii) include resident census data and information on resident case mix;
“(iii) include a regular reporting schedule; and
“(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.
Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.”.
(a) In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”), shall establish a program to identify efficient, effective, and economical procedures for long term care facilities or providers to conduct background checks on prospective direct patient access employees on a nationwide basis (in this subsection, such program shall be referred to as the “nationwide program”). The Secretary shall carry out the nationwide program under similar terms and conditions as the pilot program under section 307 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2257), including the prohibition on hiring abusive workers and the authorization of the imposition of penalties by a participating State under subsections (b)(3)(A) and (b)(6), respectively, of such section 307. The program under this subsection shall contain the following modifications to such pilot program:
(A) NEWLY PARTICIPATING STATES.—The Secretary shall enter into agreements with each State—
(i) that the Secretary has not entered into an agreement with under subsection (c)(1) of such section 307;
(ii) that agrees to conduct background checks under the nationwide program on a Statewide basis; and
(iii) that submits an application to the Secretary containing such information and at such time as the Secretary may specify.
(B) CERTAIN PREVIOUSLY PARTICIPATING STATES.—The Secretary shall enter into agreements with each State—
(i) that the Secretary has entered into an agreement with under such subsection (c)(1);
(ii) that agrees to conduct background checks under the nationwide program on a Statewide basis; and
(iii) that submits an application to the Secretary containing such information and at such time as the Secretary may specify.
(2) NONAPPLICATION OF SELECTION CRITERIA.—The selection criteria required under subsection (c)(3)(B) of such section 307 shall not apply.
(3) REQUIRED FINGERPRINT CHECK AS PART OF CRIMINAL BACKGROUND CHECK.—The procedures established under subsection (b)(1) of such section 307 shall—
(A) require that the long-term care facility or provider (or the designated agent of the long-term care facility or provider) obtain State and national criminal or other background checks on the prospective employee through such means as the Secretary determines appropriate that utilize a search of State-based abuse and neglect registries and databases, including the abuse and neglect registries of another State in the case where a prospective employee previously resided in that State, State criminal history records, the records of any proceedings in the State that may contain disqualifying information about prospective employees (such as proceedings conducted by State professional licensing and disciplinary boards and State Medicaid Fraud Control Units), and Federal criminal history records, including a fingerprint check using the Integrated Automated Fingerprint Identification System of the Federal Bureau of Investigation; and
(B) require States to describe and test methods that reduce duplicative fingerprinting, including providing for the development of “rap back” capability by the State such that, if a direct patient access employee of a long-term care facility or provider is convicted of a crime following the initial criminal history background check conducted with respect to such employee, and the employee’s fingerprints match the prints on file with the State law enforcement department, the department will immediately inform the State and the State will immediately inform the long-term care facility or provider which employs the direct patient access employee of such conviction.
(4) STATE REQUIREMENTS.—An agreement entered into under paragraph (1) shall require that a participating State—
(A) be responsible for monitoring compliance with the requirements of the nationwide program;
(B) have procedures in place to—
(i) conduct screening and criminal or other background checks under the nationwide program in accordance with the requirements of this section;
(ii) monitor compliance by long-term care facilities and providers with the procedures and requirements of the nationwide program;
(iii) as appropriate, provide for a provisional period of employment by a long-term care facility or provider of a direct patient access employee, not to exceed 60 days, pending completion of the required criminal history background check and, in the case where the employee has appealed the results of such background check, pending completion of the appeals process, during which the employee shall be subject to direct on-site supervision (in accordance with procedures established by the State to ensure that a long-term care facility or provider furnishes such direct on-site supervision);
(iv) provide an independent process by which a provisional employee or an employee may appeal or dispute the accuracy of the information obtained in a background check performed under the nationwide program, including the specification of criteria for appeals for direct patient access employees found to have disqualifying information which shall include consideration of the passage of time, extenuating circumstances, demonstration of rehabilitation, and relevancy of the particular disqualifying information with respect to the current employment of the individual;
(v) provide for the designation of a single State agency as responsible for—
(I) overseeing the coordination of any State and national criminal history background checks requested by a long-term care facility or provider (or the designated agent of the long-term care facility or provider) utilizing a search of State and Federal criminal history records, including a fingerprint check of such records;
(II) overseeing the design of appropriate privacy and security safeguards for use in the review of the results of any State or national criminal history background checks conducted regarding a prospective direct patient access employee to determine whether the employee has any conviction for a relevant crime;
(III) immediately reporting to the long-term care facility or provider that requested the criminal history background check the results of such review; and
(IV) in the case of an employee with a conviction for a relevant crime that is subject to reporting under section 1128E of the Social Security Act (42 U.S.C. 1320a–7e), reporting the existence of such conviction to the database established under that section;
(vi) determine which individuals are direct patient access employees (as defined in paragraph (6)(B)) for purposes of the nationwide program;
(vii) as appropriate, specify offenses, including convictions for violent crimes, for purposes of the nationwide program; and
(viii) describe and test methods that reduce duplicative fingerprinting, including providing for the development of “rap back” capability such that, if a direct patient access employee of a long-term care facility or provider is convicted of a crime following the initial criminal history background check conducted with respect to such employee, and the employee’s fingerprints match the prints on file with the State law enforcement department—
(I) the department will immediately inform the State agency designated under clause (v) and such agency will immediately inform the facility or provider which employs the direct patient access employee of such conviction; and
(II) the State will provide, or will require the facility to provide, to the employee a copy of the results of the criminal history background check conducted with respect to the employee at no charge in the case where the individual requests such a copy.
Background checks and screenings under this subsection shall be valid for a period of no longer than 2 years, as determined by the State and approved by the Secretary.
(A) NEWLY PARTICIPATING STATES.—
(i) IN GENERAL.—As part of the application submitted by a State under paragraph (1)(A)(iii), the State shall guarantee, with respect to the costs to be incurred by the State in carrying out the nationwide program, that the State will make available (directly or through donations from public or private entities) a particular amount of non-Federal contributions, as a condition of receiving the Federal match under clause (ii).
(ii) FEDERAL MATCH.—The payment amount to each State that the Secretary enters into an agreement with under paragraph (1)(A) shall be 3 times the amount that the State guarantees to make available under clause (i).
(B) PREVIOUSLY PARTICIPATING STATES.—
(i) IN GENERAL.—As part of the application submitted by a State under paragraph (1)(B)(iii), the State shall guarantee, with respect to the costs to be incurred by the State in carrying out the nationwide program, that the State will make available (directly or through donations from public or private entities) a particular amount of non-Federal contributions, as a condition of receiving the Federal match under clause (ii).
(ii) FEDERAL MATCH.—The payment amount to each State that the Secretary enters into an agreement with under paragraph (1)(B) shall be 3 times the amount that the State guarantees to make available under clause (i).
(6) DEFINITIONS.—Under the nationwide program:
(A) LONG-TERM CARE FACILITY OR PROVIDER.—The term “long-term care facility or provider” means the following facilities or providers which receive payment for services under title XVIII or XIX of the Social Security Act:
(i) A skilled nursing facility (as defined in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a))).
(ii) A nursing facility (as defined in section 1919(a) of such Act (42 U.S.C. 1396r(a))).
(iii) A home health agency.
(iv) A provider of hospice care (as defined in section 1861(dd)(1) of such Act (42 U.S.C. 1395x(dd)(1))).
(v) A long-term care hospital (as described in section 1886(d)(1)(B)(iv) of such Act (42 U.S.C. 1395ww(d)(1)(B)(iv))).
(vi) A provider of personal care services.
(vii) A provider of adult day care.
(viii) A residential care provider that arranges for, or directly provides, long-term care services, including an assisted living facility that provides a nursing home level of care conveyed by State licensure or State definition.
(ix) An intermediate care facility for the mentally retarded (as defined in section 1905(d) of such Act (42 U.S.C. 1396d(d))).
(x) Any other facility or provider of long-term care services under such titles as the participating State determines appropriate.
(B) DIRECT PATIENT ACCESS EMPLOYEE.—The term “direct patient access employee” means any individual who has access to a patient or resident of a long-term care facility or provider through employment or through a contract with such facility or provider and has duties that involve (or may involve) one-on-one contact with a patient or resident of the facility or provider, as determined by the State for purposes of the nationwide program. Such term does not include a volunteer unless the volunteer has duties that are equivalent to the duties of a direct patient access employee and those duties involve (or may involve) one-on-one contact with a patient or resident of the long-term care facility or provider.
(A) EVALUATION.—The Inspector General of the Department of Health and Human Services shall conduct an evaluation of the nationwide program. Such evaluation shall include—
(i) a review of the various procedures implemented by participating States for long-term care facilities or providers, including staffing agencies, to conduct background checks of direct patient access employees and identify the most efficient, effective, and economical procedures for conducting such background checks;
(ii) an assessment of the costs of conducting such background checks (including start-up and administrative costs);
(iii) a determination of the extent to which conducting such background checks leads to any unintended consequences, including a reduction in the available workforce for such facilities or providers;
(iv) an assessment of the impact of the program on reducing the number of incidents of neglect, abuse, and misappropriation of resident property to the extent practicable; and
(v) an evaluation of other aspects of the program, as determined appropriate by the Secretary.
(B) REPORT.—Not later than 180 days after the completion of the nationwide program, the Inspector General of the Department of Health and Human Services shall submit a report to Congress containing the results of the evaluation conducted under subparagraph (A).
(1) NOTIFICATION.—The Secretary of Health and Human Services shall notify the Secretary of the Treasury of the amount necessary to carry out the nationwide program under this section, including costs for the Department of Health and Human Services to administer and evaluate the program, for the period of fiscal years 2010 through 2012, except that in no case shall such amount exceed $160,000,000.
(2) TRANSFER OF FUNDS.—Out of any funds in the Treasury not otherwise appropriated, the Secretary of the Treasury shall provide for the transfer to the Secretary of Health and Human Services of the amount specified as necessary to carry out the nationwide program under paragraph (1). Such amount shall remain available until expended.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395i–3(h)(2)(B)(ii)) is amended to read as follows:
“(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
“(I) AMOUNT.—The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).
“(II) APPLICABLE PER INSTANCE AMOUNT.—In this clause, the term ‘applicable per instance amount’ means—
“(aa) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000.
“(bb) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(cc) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.
“(III) APPLICABLE PER DAY AMOUNT.—In this clause, the term ‘applicable per day amount’ means—
“(aa) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000 and
“(bb) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.
“(IV) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to subclauses (V) and (VI), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
“(V) PROHIBITION ON REDUCTION FOR CERTAIN DEFICIENCIES.—
“(aa) REPEAT DEFICIENCIES.—The Secretary may not reduce under subclause (IV) the amount of a penalty if the deficiency is a repeat deficiency.
“(bb) CERTAIN OTHER DEFICIENCIES.—The Secretary may not reduce under subclause (IV) the amount of a penalty if the penalty is imposed for a deficiency described in subclause (II)(aa) or (III)(aa) and the actual harm or widespread harm immediately jeopardizes the health or safety of a resident or residents of the facility, or if the penalty is imposed for a deficiency described in subclause (II)(bb).
“(VI) LIMITATION ON AGGREGATE REDUCTIONS.—The aggregate reduction in a penalty under subclause (IV) may not exceed 35 percent on the basis of self-reporting, on the basis of a waiver of an appeal (as provided for under regulations under section 488.436 of title 42, Code of Federal Regulations), or on the basis of both.
“(VII) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary—
“(aa) subject to item (cc), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process, established by the State survey agency, which generates a written record prior to the collection of such penalty, but such opportunity shall not affect the responsibility of the State survey agency for making final recommendations for such penalties;
“(bb) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
“(cc) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary on the earlier of the date on which the informal dispute resolution process under item (aa) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(dd) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(ee) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(ff) in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary).
“(VIII) PROCEDURE.—The provisions of section 1128A (other than subsections (a) and (b) and except to the extent that such provisions require a hearing prior to the imposition of a civil money penalty) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”.
(2) CONFORMING AMENDMENT.—The second sentence of section 1819(h)(5) of the Social Security Act (42 U.S.C. 1395i–3(h)(5)) is amended by inserting “(ii),”after “(i),”.
(1) PENALTIES IMPOSED BY THE STATE.—
(A) IN GENERAL.—Section 1919(h)(2) of the Social Security Act (42 U.S.C. 1396r(h)(2)) is amended—
(i) in subparagraph (A)(ii), by striking the first sentence and inserting the following: “A civil money penalty in accordance with subparagraph (G).”; and
(ii) by adding at the end the following new subparagraph:
“(i) IN GENERAL.—The State may impose a civil money penalty under subparagraph (A)(ii) in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).
“(ii) APPLICABLE PER INSTANCE AMOUNT.—In this subparagraph, the term ‘applicable per instance amount’ means—
“(I) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000.
“(II) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and
“(III) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.
“(iii) APPLICABLE PER DAY AMOUNT.—In this subparagraph, the term ‘applicable per day amount’ means—
“(I) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000 and
“(II) in each case of any other deficiency, an amount not less than $250 and not to exceed $3,050.
“(iv) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to clauses (v) and (vi), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under subparagraph (A)(ii) not later than 10 calendar days after the date of such imposition, the State may reduce the amount of the penalty imposed by not more than 50 percent.
“(v) PROHIBITION ON REDUCTION FOR CERTAIN DEFICIENCIES.—
“(I) REPEAT DEFICIENCIES.—The State may not reduce under clause (iv) the amount of a penalty if the State had reduced a penalty imposed on the facility in the preceding year under such clause with respect to a repeat deficiency.
“(II) CERTAIN OTHER DEFICIENCIES.—The State may not reduce under clause (iv) the amount of a penalty if the penalty is imposed for a deficiency described in clause (ii)(II) or (iii)(I) and the actual harm or widespread harm that immediately jeopardizes the health or safety of a resident or residents of the facility, or if the penalty is imposed for a deficiency described in clause (ii)(I).
“(III) LIMITATION ON AGGREGATE REDUCTIONS.—The aggregate reduction in a penalty under clause (iv) may not exceed 35 percent on the basis of self-reporting, on the basis of a waiver of an appeal (as provided for under regulations under section 488.436 of title 42, Code of Federal Regulations), or on the basis of both.
“(vi) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under subparagraph (A)(ii), the State—
“(I) subject to subclause (III), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process, established by the State survey agency, which generates a written record prior to the collection of such penalty, but such opportunity shall not affect the responsibility of the State survey agency for making final recommendations for such penalties;
“(II) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under subclause (I) is completed;
“(III) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the State on the earlier of the date on which the informal dispute resolution process under subclause (I) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(IV) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(V) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(VI) in the case where all such appeals are unsuccessful, may provide that such funds collected shall be used for the purposes described in the second sentence of subparagraph (A)(ii).”.
(B) CONFORMING AMENDMENT.—The second sentence of section 1919(h)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(2)(A)(ii)) is amended by inserting before the period at the end the following: “, and some portion of such funds may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, providing technical assistance to facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary)”.
(2) PENALTIES IMPOSED BY THE SECRETARY.—
(A) IN GENERAL.—Section 1919(h)(3)(C)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(3)(C)) is amended to read as follows:
“(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
“(I) AMOUNT.—Subject to subclause (II), the Secretary may impose a civil money penalty in an amount not to exceed $10,000 for each day or each instance of noncompliance (as determined appropriate by the Secretary).
“(II) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.—Subject to subclause (III), in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than 10 calendar days after the date of such imposition, the Secretary may reduce the amount of the penalty imposed by not more than 50 percent.
“(III) PROHIBITION ON REDUCTION FOR REPEAT DEFICIENCIES.—The Secretary may not reduce the amount of a penalty under subclause (II) if the Secretary had reduced a penalty imposed on the facility in the preceding year under such subclause with respect to a repeat deficiency.
“(IV) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary—
“(aa) subject to item (bb), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process which generates a written record prior to the collection of such penalty;
“(bb) in the case where the penalty is imposed for each day of noncompliance, shall not impose a penalty for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the informal dispute resolution process under item (aa) is completed;
“(cc) may provide for the collection of such civil money penalty and the placement of such amounts collected in an escrow account under the direction of the Secretary on the earlier of the date on which the informal dispute resolution process under item (aa) is completed or the date that is 90 days after the date of the imposition of the penalty;
“(dd) may provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals;
“(ee) in the case where the facility successfully appeals the penalty, may provide for the return of such amounts collected (plus interest) to the facility; and
“(ff) in the case where all such appeals are unsuccessful, may provide that some portion of such amounts collected may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community-based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities, and facility improvement initiatives approved by the Secretary (including joint training of facility staff and surveyors, technical assistance for facilities under quality assurance programs, the appointment of temporary management, and other activities approved by the Secretary).
“(V) PROCEDURE.—The provisions of section 1128A (other than subsections (a) and (b) and except to the extent that such provisions require a hearing prior to the imposition of a civil money penalty) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”.
(B) CONFORMING AMENDMENT.—Section 1919(h)(8) of the Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is amended by inserting “and in paragraph (3)(C)(ii)” after “paragraph (2)(A)”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(1) IN GENERAL.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish a pilot program (in this section referred to as the “pilot program”) to develop, test, and implement use of an independent monitor to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.
(2) SELECTION.—The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(3) DURATION.—The Secretary shall conduct the pilot program for a two-year period.
(4) IMPLEMENTATION.—The Secretary shall implement the pilot program not later than one year after the date of the enactment of this Act.
(b) Requirements.—The Secretary shall evaluate chains selected to participate in the pilot program based on criteria selected by the Secretary, including where evidence suggests that one or more facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes one or more facilities participating in the “Special Focus Facility” program (or a successor program) or one or more facilities with a record of repeated serious safety and quality of care deficiencies.
(c) Responsibilities of the independent monitor.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of such program shall—
(1) conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities;
(2) undertake sustained oversight of the chain, whether publicly or privately held, to involve the owners of the chain and the principal business partners of such owners in facilitating compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;
(3) analyze the management structure, distribution of expenditures, and nurse staffing levels of facilities of the chain in relation to resident census, staff turnover rates, and tenure;
(4) report findings and recommendations with respect to such reviews, analyses, and oversight to the chain and facilities of the chain, to the Secretary and to relevant States; and
(5) publish the results of such reviews, analyses, and oversight.
(d) Implementation of recommendations.—
(1) RECEIPT OF FINDING BY CHAIN.—Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the pilot program shall submit to the independent monitor a report—
(A) outlining corrective actions the chain will take to implement the recommendations in such report; or
(B) indicating that the chain will not implement such recommendations and why it will not do so.
(2) RECEIPT OF REPORT BY INDEPENDENT MONITOR.—Not later than 10 days after the date of receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State (or States) involved, as appropriate, containing such final recommendations.
(e) Cost of appointment.—A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the pilot program. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary).
(f) Waiver authority.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the pilot program.
(g) Authorization of appropriations.—There are authorized to be appropriated such sums as may be necessary to carry out this section.
(h) Definitions.—In this section:
(1) FACILITY.—The term “facility” means a skilled nursing facility or a nursing facility.
(2) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(3) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
(4) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)).
(1) EVALUATION.—The Inspector General of the Department of Health and Human Services shall evaluate the pilot program. Such evaluation shall—
(A) determine whether the independent monitor program should be established on a permanent basis; and
(B) if the Inspector General determines that the independent monitor program should be established on a permanent basis, recommend appropriate procedures and mechanisms for such establishment.
(2) REPORT.—Not later than 180 days after the completion of the pilot program, the Inspector General shall submit to Congress and the Secretary a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate.
(a) Skilled Nursing Facilities.—
(1) IN GENERAL.—Section 1819(c) of the Social Security Act (42 U.S.C. 1395i–3(c)) is amended by adding at the end the following new paragraph:
“(7) NOTIFICATION OF FACILITY CLOSURE.—
“(A) IN GENERAL.—Any individual who is the administrator of a skilled nursing facility must—
“(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
“(I) subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
“(II) in the case of a facility where the Secretary terminates the facility’s participation under this title, not later than the date that the Secretary determines appropriate;
“(ii) ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
“(iii) include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
“(i) IN GENERAL.—The State shall ensure that, before a facility closes, all residents of the facility have been successfully relocated to another facility or an alternative home and community-based setting.
“(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.—The Secretary may, as the Secretary determines appropriate, continue to make payments under this title with respect to residents of a facility that has submitted a notification under subparagraph (A) during the period beginning on the date such notification is submitted and ending on the date on which the resident is successfully relocated.”.
(2) CONFORMING AMENDMENTS.—Section 1819(h)(4) of the Social Security Act (42 U.S.C. 1395i–3(h)(4)) is amended—
(A) in the first sentence, by striking “the Secretary shall terminate” and inserting “the Secretary, subject to subsection (c)(7), shall terminate”; and
(B) in the second sentence, by striking “subsection (c)(2)” and inserting “paragraphs (2) and (7) of subsection (c)”.
(1) IN GENERAL.—Section 1919(c) of the Social Security Act (42 U.S.C. 1396r(c)) is amended by adding at the end the following new paragraph:
“(9) NOTIFICATION OF FACILITY CLOSURE.—
“(A) IN GENERAL.—Any individual who is an administrator of a nursing facility must—
“(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
“(I) subject to subclause (II), not later than the date that is 60 days prior to the date of such closure; and
“(II) in the case of a facility where the Secretary terminates the facility’s participation under this title, not later than the date that the Secretary determines appropriate;
“(ii) ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
“(iii) include in the notice a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.
“(i) IN GENERAL.—The State shall ensure that, before a facility closes, all residents of the facility have been successfully relocated to another facility or an alternative home and community-based setting.
“(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.—The Secretary may, as the Secretary determines appropriate, continue to make payments under this title with respect to residents of a facility that has submitted a notification under subparagraph (A) during the period beginning on the date such notification is submitted and ending on the date on which the resident is successfully relocated.”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(a) Skilled nursing facilities.—Section 1819(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(I)) is amended by inserting “(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training and resident abuse prevention training)” after “curriculum”.
(b) Nursing facilities.—Section 1919(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by inserting “(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training and resident abuse prevention training)” after “curriculum”.
(c) Effective date.—The amendments made by this section shall take effect 1 year after the date of the enactment of this Act.
(1) IN GENERAL.—The Secretary shall conduct a study on the content of training for certified nurse aides and supervisory staff of skilled nursing facilities and nursing facilities. The study shall include an analysis of the following:
(A) Whether the number of initial training hours for certified nurse aides required under sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 1396r(f)(2)(A)(i)(II)) should be increased from 75 and, if so, what the required number of initial training hours should be, including any recommendations for the content of such training (including training related to dementia).
(B) Whether requirements for ongoing training under such sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) should be increased from 12 hours per year, including any recommendations for the content of such training.
(2) CONSULTATION.—In conducting the analysis under paragraph (1)(A), the Secretary shall consult with States that, as of the date of the enactment of this Act, require more than 75 hours of training for certified nurse aides.
(3) DEFINITIONS.—In this section:
(A) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).
(B) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.
(C) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)).
(b) Report.—Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
(a) Medicare.—Section 1819(b)(4)(A) of the Social Security Act (42 U.S.C. 1395i–3(b)(4)(A)) is amended by adding at the end the following: “With respect to meeting the staffing requirement imposed by the Secretary to carry out clause (iv), the full-time director of food services of the facility, if not a qualified dietitian (as defined in section 483.35(a)(2) of title 42, Code of Federal Regulations, as in effect as of the date of the enactment of this sentence), shall be a Certified Dietary Manager meeting the requirements of the Certifying Board for Dietary Managers, or a Dietetic Technician, Registered meeting the requirements of the Commission on Dietetic Registration or have equivalent military, academic, or other qualifications (as specified by the Secretary).”.
(b) Medicaid.—Section 1919(b)(4)(A) of the Social Security Act (42 U.S.C. 1396r(b)(4)(A)) is amended by adding at the end the following: “With respect to meeting the staffing requirement imposed by the Secretary to carry out clause (iv), the full-time director of food services of the facility, if not a qualified dietitian (as defined in section 483.35(a)(2) of title 42, Code of Federal Regulations, as in effect as of the date of the enactment of this sentence), shall be a Certified Dietary Manager meeting the requirements of the Certifying Board for Dietary Managers, or a Dietetic Technician, Registered meeting the requirements of the Commission on Dietetic Registration or have equivalent military, academic, or other qualifications (as specified by the Secretary).”.
(c) Effective date.—The amendments made by this section shall take effect on the date that is 180 days after the date of enactment of this Act.
Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
“Establishment of national priorities for performance improvement
“Sec. 1191. (a) Establishment of national priorities by the Secretary.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
Part E of title XI of the Social Security Act, as added by section 1441, is amended by adding at the end the following new sections:
“(a) Agreements with qualified entities.—
“(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.
“(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise.
“(3) RECOMMENDATIONS OF CONSENSUS-BASED ENTITY.—In carrying out this section, the Secretary shall—
“(A) seek public input; and
“(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a).
“(b) Determination of areas where quality measures are required.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed.
“(c) Development of quality measures.—
“(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES.—In entering into agreements under subsection (a), the Secretary shall give priority to the development of quality measures that allow the assessment of—
“(A) health outcomes, presence of impairment, and functional status of patients;
“(B) the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;
“(C) patient experience and patient engagement;
“(D) the safety, effectiveness, and timeliness of care;
“(E) health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language; and
“(F) the efficiency and resource use in the provision of care.
“(2) USE OF FUNDS.—An entity that enters into an agreement under subsection (a) shall develop quality measures that—
“(A) to the extent feasible, have the ability to be collected through the use of health information technologies supporting better delivery of health care services; and
“(B) are available free of charge to users for the use of such measures.
“(3) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public.
“(4) TESTING OF PROPOSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities. Testing funded under this paragraph shall include testing of the feasibility and usability of proposed measures.
“(5) UPDATING OF ENDORSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the updating (and testing, if applicable) by consensus-based entities of quality measures that have been previously endorsed by such an entity as new evidence is developed, in a manner consistent with section 1890(b)(3).
“(d) Qualified entities.—Before entering into agreements with a qualified entity, the Secretary shall ensure that the entity is a public, private, or academic institution with technical expertise in the area of health quality measurement.
“(e) Application for grant.—A grant may be made under this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
“(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $25,000,000, to the Secretary for purposes of carrying out this section for each of the fiscal years 2010 through 2014.
“(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $25,000,000 for each of the fiscal years 2010 through 2014.
“(a) GAO evaluations.—The Comptroller General of the United States shall conduct periodic evaluations of the implementation of the data collection processes for quality measures used by the Secretary.
“(b) Considerations.—In carrying out the evaluation under subsection (a), the Comptroller General shall determine—
“(1) whether the system for the collection of data for quality measures provides for validation of data as relevant and scientifically credible;
“(2) whether data collection efforts under the system use the most efficient and cost-effective means in a manner that minimizes administrative burden on persons required to collect data and that adequately protects the privacy of patients’ personal health information and provides data security;
“(3) whether standards under the system provide for an appropriate opportunity for physicians and other clinicians and institutional providers of services to review and correct findings; and
“(4) the extent to which quality measures are consistent with section 1192(c)(1) or result in direct or indirect costs to users of such measures.
“(c) Report.—The Comptroller General shall submit reports to Congress and to the Secretary containing a description of the findings and conclusions of the results of each such evaluation.”.
Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection:
(a) Inpatient hospital services.—Section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) is amended by adding at the end the following new clause:
“(x)(I) Subject to subclause (II), for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).
“(II) In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(b) Outpatient hospital services.—Section 1833(t)(17) of such Act (42 U.S.C. 1395l(t)(17)) is amended by adding at the end the following new subparagraph:
“(F) USE OF ENDORSED QUALITY MEASURES.—The provisions of clause (x) of section 1886(b)(3)(C) shall apply to quality measures for covered OPD services under this paragraph in the same manner as such provisions apply to quality measures for inpatient hospital services.”.
(c) Physicians’ services.—Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w-4(k)(2)(C)(ii)) is amended by adding at the end the following: “The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(d) Renal dialysis services.—Section 1881(h)(2)(B)(ii) of such Act (42 U.S.C. 1395rr(h)(2)(B)(ii)) is amended by adding at the end the following: “The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.”.
(e) Endorsement of standards.—Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding after and below subparagraph (B) the following:
“If the entity does not endorse a measure, such entity shall explain the reasons and provide suggestions about changes to such measure that might make it a potentially endorsable measure.”.
(f) Effective date.—Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be.
Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by striking “for each of fiscal years 2009 through 2012” and inserting “for fiscal year 2009, and $12,000,000 for each of the fiscal years 2010 through 2012”
(a) In general.—Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.), as amended by section 1631(a), is further amended by inserting after section 1128G the following new section:
“(a) Reporting of payments or other transfers of value.—
“(1) IN GENERAL.—Except as provided in this subsection, not later than March 31, 2011, and annually thereafter, each applicable manufacturer or distributor that provides a payment or other transfer of value to a covered recipient, or to an entity or individual at the request of or designated on behalf of a covered recipient, shall submit to the Secretary, in such electronic form as the Secretary shall require, the following information with respect to the preceding calendar year:
“(A) With respect to the covered recipient, the recipient’s name, business address, physician specialty, and national provider identifier.
“(B) With respect to the payment or other transfer of value, other than a drug sample—
“(i) its value and date;
“(ii) the name of the related drug, device, or supply, if available, to the level of specificity available; and
“(iii) a description of its form, indicated (as appropriate for all that apply) as—
“(I) cash or a cash equivalent;
“(II) in-kind items or services;
“(III) stock, a stock option, or any other ownership interest, dividend, profit, or other return on investment; or
“(IV) any other form (as defined by the Secretary).
“(C) With respect to a drug sample, the name, number, date, and dosage units of the sample.
“(2) AGGREGATE REPORTING.—Information submitted by an applicable manufacturer or distributor under paragraph (1) shall include the aggregate amount of all payments or other transfers of value provided by the manufacturer or distributor to covered recipients (and to entities or individuals at the request of or designated on behalf of a covered recipient) during the year involved, including all payments and transfers of value regardless of whether such payments or transfer of value were individually disclosed.
“(3) SPECIAL RULE FOR CERTAIN PAYMENTS OR OTHER TRANSFERS OF VALUE.—In the case where an applicable manufacturer or distributor provides a payment or other transfer of value to an entity or individual at the request of or designated on behalf of a covered recipient, the manufacturer or distributor shall disclose that payment or other transfer of value under the name of the covered recipient.
“(4) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO PRODUCT DEVELOPMENT AGREEMENTS.—In the case of a payment or other transfer of value made to a covered recipient by an applicable manufacturer or distributor pursuant to a product development agreement for services furnished in connection with the development of a new drug, device, biological, or medical supply, the applicable manufacturer or distributor may report the value and recipient of such payment or other transfer of value in the first reporting period under this subsection in the next reporting deadline after the earlier of the following:
“(A) The date of the approval or clearance of the covered drug, device, biological, or medical supply by the Food and Drug Administration.
“(B) Two calendar years after the date such payment or other transfer of value was made.
“(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.—In the case of a payment or other transfer of value made to a covered recipient by an applicable manufacturer or distributor in connection with a clinical investigation regarding a new drug, device, biological, or medical supply, the applicable manufacturer or distributor may report as required under this section in the next reporting period under this subsection after the earlier of the following:
“(A) The date that the clinical investigation is registered on the website maintained by the National Institutes of Health pursuant to section 671 of the Food and Drug Administration Amendments Act of 2007.
“(B) Two calendar years after the date such payment or other transfer of value was made.
“(6) CONFIDENTIALITY.—Information described in paragraph (4) or (5) shall be considered confidential and shall not be subject to disclosure under section 552 of title 5, United States Code, or any other similar Federal, State, or local law, until or after the date on which the information is made available to the public under such paragraph.
“(7) PHYSICIANS IN SELF-INSURED HEALTH PLANS.—Nothing in this subsection shall be construed to require the disclosure of a payment or other transfer of value to a physician by a self-insured health plan.
“(b) Reporting of ownership interest by physicians.—
“(1) HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.—Not later than March 31 of each year (beginning with 2011), each hospital or other health care entity (not including a Medicare Advantage organization) that bills the Secretary under part A or part B of title XVIII for services shall report on the ownership shares (other than ownership shares described in section 1877(c)) of each physician who, directly or indirectly, owns an interest in the entity.
“(2) ADDITIONAL PHYSICIAN OWNERSHIP.—Not later than March 31 of each year (beginning with 2011), in addition to the requirement under subsection (a)(1), any applicable manufacturer, applicable group purchasing organization, or applicable distributor shall submit to the Secretary, in such electronic form as the Secretary shall require, the following information regarding any ownership or investment interest (other than an ownership or investment interest in a publicly traded security and mutual fund, as described in section 1877(c)) held by a physician (or an immediate family member of such physician (as defined for purposes of section 1877(a))) in the applicable manufacturer, applicable group purchasing organization or applicable distributor during the preceding year:
“(A) The dollar amount invested by each physician holding such an ownership or investment interest.
“(B) The value and terms of each such ownership or investment interest.
“(C) Any payment or other transfer of value provided to a physician holding such an ownership or investment interest (or to an entity or individual at the request of or designated on behalf of a physician holding such an ownership or investment interest), including the information described in clauses (i) through (iii) of paragraph (a)(1)(B), and information described in subsection (f)(8)(A) and (f)(8)(B).
“(D) Any other information regarding the ownership or investment interest the Secretary determines appropriate.
“(3) DEFINITIONS.—In this subsection:
“(A) PHYSICIAN.—The term ‘physician’ includes a physician’s immediate family members (as defined for purposes of section 1877(a)).
“(B) APPLICABLE GROUP PURCHASING ORGANIZATION.—The term ‘applicable group purchasing organization’ means any organization or other entity (as defined by the Secretary) that purchases, arranges for, or negotiates the purchase of a covered drug, device, biological, or medical supply.
“(4) STUDY OF PRACTICE PATTERNS IN ADVANCED DIAGNOSTIC IMAGING AND RADIATION ONCOLOGY SERVICES.—The Comptroller General of the United States shall conduct a study to evaluate the extent of use of physician self-referral arrangements and the effects of such arrangements on the cost of providing advanced diagnostic imaging and radiation oncology services to Medicare beneficiaries under title XVIII. The study shall be completed and submitted to Congress not later than July 1, 2011.
“(1) IN GENERAL.—The Secretary shall establish procedures to ensure that, not later than September 30, 2011, and on June 30 of each year beginning thereafter, the information submitted under subsections (a) and (b), other than information regard drug samples, with respect to the preceding calendar year is made available through an Internet website that—
“(A) is searchable and is in a format that is clear and understandable;
“(B) contains information that is presented by the name of the applicable manufacturer or distributor, the name of the covered recipient, the business address of the covered recipient, the specialty (if applicable) of the covered recipient, the value of the payment or other transfer of value, the date on which the payment or other transfer of value was provided to the covered recipient, the form of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(ii), the nature of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(iii), and the name of the covered drug, device, biological, or medical supply, as applicable;
“(C) contains information that is able to be easily aggregated and downloaded;
“(D) contains a description of any enforcement actions taken to carry out this section, including any penalties imposed under subsection (d), during the preceding year;
“(E) contains background information on industry-physician relationships;
“(F) in the case of information submitted with respect to a payment or other transfer of value described in subsection (a)(5), lists such information separately from the other information submitted under subsection (a) and designates such separately listed information as funding for clinical research;
“(G) contains any other information the Secretary determines would be helpful to the average consumer; and
“(H) provides the covered recipient an opportunity to submit corrections to the information made available to the public with respect to the covered recipient.
“(2) ACCURACY OF REPORTING.—The accuracy of the information that is submitted under subsections (a) and (b) and made available under paragraph (1) shall be the responsibility of the reporting entity reporting under subsection (a) or (b), as applicable. The Secretary shall establish procedures to ensure that the covered recipient is provided with an opportunity to submit corrections to the applicable reporting entity with regard to information made public with respect to the covered recipient and, under such procedures, the corrections shall be transmitted to the Secretary.
“(3) SPECIAL RULE FOR DRUG SAMPLES.—Information relating to drug samples provided under subsection (a) shall not be made available to the public by the Secretary but may be made available outside the Department of Health and Human Services by the Secretary for research or legitimate business purposes pursuant to data use agreements.
“(4) SPECIAL RULE FOR NATIONAL PROVIDER IDENTIFIERS.—Information relating to national provider identifiers provided under subsection (a) shall not be made available to the public by the Secretary but may be made available outside the Department of Health and Human Services by the Secretary for research or legitimate business purposes pursuant to data use agreements.
“(d) Penalties for Noncompliance.—
“(A) IN GENERAL.—Subject to subparagraph (B), except as provided in paragraph (2), any reporting entity that fails to submit information required under subsection (a) or (b), as applicable, in a timely manner in accordance with regulations promulgated to carry out such applicable subsection shall be subject to a civil money penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported as required under such subsection. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section.
“(B) LIMITATION.—The total amount of civil money penalties imposed under subparagraph (A), with respect to each annual submission of information under subsection (a) by a reporting entity, shall not exceed $150,000.
“(2) KNOWING FAILURE TO REPORT.—
“(A) IN GENERAL.—Subject to subparagraph (B), any reporting entity that knowingly fails to submit information required under subsection (a) or (b), as applicable, in a timely manner in accordance with regulations promulgated to carry out such applicable subsection, shall be subject to a civil money penalty of not less than $10,000, but not more than $100,000, for each payment or other transfer of value or ownership or investment interest not reported as required under such subsection. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section.
“(B) LIMITATION.—The total amount of civil money penalties imposed under subparagraph (A) with respect to each annual submission of information under subsection (a) or (b) by an applicable reporting entity shall not exceed $1,000,000, or, if greater, 0.1 percentage of the total annual revenues of the reporting entity.
“(3) USE OF FUNDS.—Funds collected by the Secretary as a result of the imposition of a civil money penalty under this subsection shall be used to carry out this section.
“(4) ENFORCEMENT THROUGH STATE ATTORNEYS GENERAL.—The attorney general of a State, after providing notice to the Secretary of an intent to proceed under this paragraph in a specific case and providing the Secretary with an opportunity to bring an action under this subsection and the Secretary declining such opportunity, may proceed under this subsection against an applicable manufacturer or distributor in the State.
“(e) Annual report to Congress.—Not later than April 1 of each year beginning with 2011, the Secretary shall submit to Congress a report that includes the following:
“(1) The information submitted under this section during the preceding year, aggregated for each applicable reporting entity that submitted such information during such year.
“(2) A description of any enforcement actions taken to carry out this section, including any penalties imposed under subsection (d), during the preceding year.
“(f) Definitions.—In this section:
“(1) APPLICABLE DISTRIBUTOR.—The term ‘applicable distributor’ means—
“(A) any entity, other than an applicable group purchasing organization, that buys and resells, or receives a commission or other similar form of payment, from another seller, for selling or arranging for the sale of a covered drug, device, biological, or medical supply; or
“(B) any entity under common ownership with such an entity described in subparagraph (A) and which provides assistance or support to such entity so described with respect to the production, preparation, propagation, compounding, conversion, processing, marketing, or distribution of a covered drug, device, biological, or medical supply.
Such term does not include a wholesale pharmaceutical distributor.
“(2) APPLICABLE MANUFACTURER.—The term ‘applicable manufacturer’ means any entity which is engaged in the production, preparation, propagation, compounding, conversion, processing, marketing, or manufacturer-direct distribution of a covered drug, device, biological, or medical supply (or any entity under common ownership with such entity and which provides assistance or support to such entity with respect to the production, preparation, propagation, compounding, conversion, processing, marketing, or distribution or a covered drug, device, biological, or medical supply). For purposes of this section only, such term does not include a retail pharmacy licensed under State law.
“(3) CLINICAL INVESTIGATION.—The term ‘clinical investigation’ means any experiment involving one or more human subjects, or materials derived from human subjects, in which a drug or device is administered, dispensed, or used.
“(4) COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.—The term ‘covered’ means, with respect to a drug, device, biological, or medical supply, such a drug, device, biological, or medical supply for which payment is available under title XVIII or a State plan under title XIX or XXI (or a waiver of such a plan).
“(5) COVERED RECIPIENT.—The term ‘covered recipient’ means the following:
“(A) A physician.
“(B) A physician group practice.
“(C) Any other prescriber of a covered drug, device, biological, or medical supply.
“(D) A pharmacy or pharmacist.
“(E) A health insurance issuer, group health plan, or other entity offering a health benefits plan, including any employee of such an issuer, plan, or entity.
“(F) A pharmacy benefit manager, including any employee of such a manager.
“(G) A hospital.
“(H) A medical school.
“(I) A sponsor of a continuing medical education program.
“(J) A patient advocacy or disease specific group.
“(K) A organization of health care professionals.
“(L) A biomedical researcher.
“(M) A group purchasing organization.
“(6) EMPLOYEE.—The term ‘employee’ has the meaning given such term in section 1877(h)(2).
“(7) KNOWINGLY.—The term ‘knowingly’ has the meaning given such term in section 3729(b) of title 31, United States Code.
“(8) PAYMENT OR OTHER TRANSFER OF VALUE.—
“(A) IN GENERAL.—The term ‘payment or other transfer of value’ means a transfer of anything of value for or of any of the following:
“(i) Gift, food, or entertainment.
“(ii) Travel or trip.
“(iii) Honoraria.
“(iv) Research funding or grant.
“(v) Education or conference funding.
“(vi) Consulting fees.
“(vii) Ownership or investment interest and royalties or license fee.
“(B) INCLUSIONS.—Subject to subparagraph (C), the term ‘payment or other transfer of value’ includes any compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant, or any ownership or investment interest held by a physician in a manufacturer (excluding a dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security or mutual fund (as described in section 1877(c))).
“(C) EXCLUSIONS.—The term ‘payment or other transfer of value’ does not include the following:
“(i) Any payment or other transfer of value provided by an applicable manufacturer or distributor to a covered recipient where the amount transferred to, requested by, or designated on behalf of the covered recipient does not exceed $5.
“(ii) The loan of a covered device for a short-term trial period, not to exceed 90 days, to permit evaluation of the covered device by the covered recipient.
“(iii) Items or services provided under a contractual warranty, including the replacement of a covered device, where the terms of the warranty are set forth in the purchase or lease agreement for the covered device.
“(iv) A transfer of anything of value to a covered recipient when the covered recipient is a patient and not acting in the professional capacity of a covered recipient.
“(v) In-kind items used for the provision of charity care.
“(vi) A dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security and mutual fund (as described in section 1877(c)).
“(vii) Compensation paid by an applicable manufacturer or distributor to a covered recipient who is directly employed by and works solely for such manufacturer or distributor.
“(viii) Payments made to a covered recipient by an applicable manufacturer or by a health plan affiliated with an applicable manufacturer for medical care provided to employees of such manufacturer or their dependents.
“(ix) Any discount (including a rebate).
“(x) Any payment or other transfer of value that is made to a covered recipient indirectly through an entity other than the applicable manufacturer in connection with an activity or service—
“(I) in which the applicable manufacturer is unaware of the identity of the covered recipient and is not using such activity or service to market its product to the covered recipient; and
“(II) that is not designed to market or promote the product to the covered recipient.
“(xi) In the case of an applicable manufacturer who offers a self-insured plan, payments for the provision of health care to employees under the plan.
“(9) PHYSICIAN.—The term ‘physician’ has the meaning given that term in section 1861(r). For purposes of this section, such term does not include a physician who is an employee of the applicable manufacturer that is required to submit information under subsection (a).
“(10) REPORTING ENTITY.—The term ‘reporting entity’ means—
“(A) with respect to the reporting requirement under subsection (a), an applicable manufacturer or distributor of a covered drug, device, biological, or medical supply required to report under such subsection; and
“(B) with respect to the reporting requirement under subsection (b), a hospital, other health care entity, applicable manufacturer, applicable distributor, or applicable group purchasing organization required to report physician ownership under such subsection.
“(g) Annual reports to States.—Not later than April 1 of each year beginning with 2011, the Secretary shall submit to States a report that includes a summary of the information submitted under subsections (a), (b), and (e) during the preceding year with respect to covered recipients or other hospitals and entities in the State.
“(1) IN GENERAL.—Effective on January 1, 2011, subject to paragraph (2), the provisions of this section shall preempt any law or regulation of a State or of a political subdivision of a State that requires an applicable manufacturer and applicable distributor (as such terms are defined in subsection (f)) to disclose or report, in any format, the type of information (described in subsection (a)) regarding a payment or other transfer of value provided by the manufacturer to a covered recipient (as so defined).
“(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS.—Paragraph (1) shall not preempt any statute or regulation of a State or political subdivision of a State that requires any of the following:
“(A) The disclosure or reporting of information not of the type required to be disclosed or reported under this section.
“(B) The disclosure or reporting, in any format, of information described in subsection (f)(8)(C), except in the case of information described in clause (i) of subsection (f)(8)(C).
“(C) The disclosure or reporting, in any format, of the type of information by any person or entity other than an applicable manufacturer (as so defined) or a covered recipient (as defined in subsection (f)).
“(D) The disclosure or reporting, in any format, of the type of information required to be disclosed or reported under this section to a Federal, State, or local governmental agency for public health surveillance, investigation, or other public health purposes or health oversight purposes.
Nothing in paragraph (1) shall be construed to limit the discovery or admissibility of information described in this paragraph in a criminal, civil, or administrative proceeding.”.
(b) Availability of information from the disclosure of financial relationship report (DFRR).—The Secretary of Health and Human Services shall submit to Congress a report on the full results of the Disclosure of Physician Financial Relationships surveys required pursuant to section 5006 of the Deficit Reduction Act of 2005. Such report shall be submitted to Congress not later than the date that is 6 months after the date such surveys are collected and shall be made publicly available on an Internet website of the Department of Health and Human Services.
(c) GAO report.—Not later than December 31, 2012, the Comptroller General of the United States shall submit to Congress a report on section 1128H of the Social Security Act, as added by subsection (a). Such report shall address the extent to which important transfers of value are being adequately reported under such section (including unreported transfers required by such section as well as transfers not required to be reported by such section), the impact on States of the federal preemption provision under subsection (h) of such section, whether changes have occurred in the pattern of payments as a result of efforts to evade reporting requirements, a description of the financial relationships subject to delayed reporting under subsection (a) of such section, and any recommended improvements to the collection or the analysis of data reported under such section.
(a) In general.—Title XI of the Social Security Act is amended by inserting after section 1138 the following section:
“(1) IN GENERAL.—The Secretary shall provide that a hospital (as defined in subsection (g)) or ambulatory surgical center meeting the requirements of titles XVIII or XIX may participate in the programs established under such titles only if, in accordance with this section, the hospital or center reports such information on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.
“(2) REPORTING PROTOCOLS.— Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.
“(3) COORDINATION WITH HIT.—The Secretary, through the Director of the CDC and the Office of the National Coordinator for Health Information Technology, shall ensure that the transmission of information under this subsection is coordinated with systems established under the HITECH Act, where appropriate.
“(4) PROCEDURES TO ENSURE THE VALIDITY OF INFORMATION.—The Secretary shall establish procedures regarding the validity of the information submitted under this subsection in order to ensure that such information is appropriately compared across hospitals and centers. Such procedures shall address failures to report as well as errors in reporting.
“(5) IMPLEMENTATION.—Not later than 1 year after the date of enactment of this section, the Secretary, through the Director of CDC, shall promulgate regulations to carry out this section.
“(b) Public posting of information.—The Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the information reported under subsection (a). Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infections—
“(1) among hospitals and ambulatory surgical centers; and
“(2) by demographic information.
“(c) Annual report to Congress.—On an annual basis the Secretary shall submit to the Congress a report that summarizes each of the following:
“(1) The number and types of health care-associated infections reported under subsection (a) in hospitals and ambulatory surgical centers during such year.
“(2) Factors that contribute to the occurrence of such infections, including health care worker immunization rates.
“(3) Based on the most recent information available to the Secretary on the composition of the professional staff of hospitals and ambulatory surgical centers, the number of certified infection control professionals on the staff of hospitals and ambulatory surgical centers.
“(4) The total increases or decreases in health care costs that resulted from increases or decreases in the rates of occurrence of each such type of infection during such year.
“(5) Recommendations, in coordination with the Center for Quality Improvement established under section 931 of the Public Health Service Act, for best practices to eliminate the rates of occurrence of each such type of infection in hospitals and ambulatory surgical centers.
“(d) Non-preemption of State laws.—Nothing in this section shall be construed as preempting or otherwise affecting any provision of State law relating to the disclosure of information on health care-associated infections or patient safety procedures for a hospital or ambulatory surgical center.
“(e) Health care-associated infection.—For purposes of this section:
“(1) IN GENERAL.—The term ‘health care-associated infection’ means an infection that develops in a patient who has received care in any institutional setting where health care is delivered and is related to receiving health care.
“(2) RELATED TO RECEIVING HEALTH CARE.—The term ‘related to receiving health care’, with respect to an infection, means that the infection was not incubating or present at the time health care was provided.
“(f) Application to critical access hospitals.—For purposes of this section, the term ‘hospital’ includes a critical access hospital, as defined in section 1861(mm)(1).”.
(b) Effective date.—With respect to section 1138A of the Social Security Act (as inserted by subsection (a) of this section), the requirement under such section that hospitals and ambulatory surgical centers submit reports takes effect on such date (not later than 2 years after the date of the enactment of this Act) as the Secretary of Health and Human Services shall specify. In order to meet such deadline, the Secretary may implement such section through guidance or other instructions.
(c) GAO report.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the program established under section 1138A of the Social Security Act, as inserted by subsection (a). Such report shall include an analysis of the appropriateness of the types of information required for submission, compliance with reporting requirements, the success of the validity procedures established, and any conflict or overlap between the reporting required under such section and any other reporting systems mandated by either the States or the Federal Government.
(d) Report on additional data.—Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to the Congress a report on the appropriateness of expanding the requirements under such section to include additional information (such as health care worker immunization rates), in order to improve health care quality and patient safety.