42 USC 1395 - Requirements for, and assuring quality of care in, skilled nursing facilities

1 See References in Text note below.

2 So in original. Probably should be “as nurse aides”.

by the facility as of

3 So in original. Probably should be “credit”.

all interest earned on such separate account to such account. With respect to any other personal funds, the facility must maintain such funds in a non-interest bearing account or petty cash fund.

4 So in original. Two subpars. (C) have been enacted. See Amendment of Subsection (d)(1) note below.

Skilled nursing facility administrator

5 So in original. A closing parenthesis probably should appear before the comma.

(II) minimum hours of initial and ongoing training and retraining (including not less than 75 hours in the case of initial training), (III) qualifications of instructors, and (IV) procedures for determination of competency;

6 So in original. Probably should be “pro rata”.

basis during the period in which the nurse aide is so employed.

7 So in original. Probably should be “requirements”.

of this chapter.

8 So in original. Probably should be cl. (vi).

the number of civil monetary penalties levied against the facility, employees, contractors, and other agents.

Amendment of Subsection (d)(1)

Puspan. L. 111–148, title VI, § 6101(c)(1)(A), (2), Mar. 23, 2010, 124 Stat. 702, provided that, effective on the date on which the Secretary of Health and Human Services makes certain information available to the public, subsection (d)(1) of this section is amended by striking subparagraph (B) and redesignating subparagraph (C) relating to skilled nursing facility administrator as subparagraph (B). See 2010 Amendment note and Effective Date of 2010 Amendment note below.

Editorial Notes

References in Text

The Older Americans Act of 1965, referred to in subsecs. (span)(4)(C)(ii)(IV), (c)(2)(B)(iii)(II), and (g)(5)(B), is Puspan. L. 89–73, July 14, 1965, 79 Stat. 218. Section 307(a)(12) of the Act was repealed by Puspan. L. 106–501, title III, § 306(5), Nov. 13, 2000, 114 Stat. 2244. Similar provisions are now contained in section 307(a)(9) of the Act, which is classified to section 3027(a)(9) of this title. Titles III and VII of the Act are classified generally to subchapters III (§ 3021 et seq.) and XI (§ 3058 et seq.) of chapter 35 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 3001 of this title and Tables.

Subparagraphs (B), (C), and (D) of section 6901(span)(4) of the Omnibus Budget Reconciliation Act of 1989 [Puspan. L. 101–239], referred to in subsec. (e)(2)(A), are set out below.

Section 21(span) of the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977, referred to in subsec. (f)(7)(A), probably means section 21(span) of the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Puspan. L. 95–142, which is set out as a note under section 1395x of this title.

Amendments

2021—Subsec. (k). Puspan. L. 117–2 added subsec. (k).

2014—Subsec. (i)(3). Puspan. L. 113–185 added par. (3).

2010—Subsec. (span)(5)(F). Puspan. L. 111–148, § 6121(a)(2), inserted concluding provisions.

Subsec. (d)(1)(B). Puspan. L. 111–148, § 6101(c)(1)(A), redesignated subpar. (C) as (B) and struck out former subpar. (B) which related to required notice to a State licensing agency of change in ownership, control interest, management, or certain positions of responsibility for a skilled nursing facility.

Subsec. (d)(1)(C). Puspan. L. 111–148, § 6103(c)(1), added subpar. (C). Former subpar. (C) redesignated (B).

Subsec. (f)(2)(A)(i)(I). Puspan. L. 111–148, § 6121(a)(1), inserted “(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training, and patient abuse prevention training” after “curriculum”.

Subsec. (f)(8). Puspan. L. 111–148, § 6103(a)(3), added par. (8).

Subsec. (g)(5)(E). Puspan. L. 111–148, § 6103(a)(2)(A), added subpar. (E).

Subsec. (h)(2)(B)(ii). Puspan. L. 111–148, § 6111(a)(1), designated existing provisions as subcl. (I), inserted span, substituted “Subject to subclause (II), the Secretary” for “The Secretary”, and added subcls. (II) to (IV).

Subsec. (h)(4). Puspan. L. 111–148, § 6113(span), substituted “the Secretary, subject to section 1320a–7(h) of this title, shall terminate” for “the Secretary shall terminate” and “subsection (c)(2) and section 1320a–7j(h) of this title” for “subsection (c)(2)”.

Subsec. (h)(5). Puspan. L. 111–148, § 6111(a)(2), inserted “(ii)(IV),” after “(i),”.

Subsecs. (i), (j). Puspan. L. 111–148, § 6103(a)(1), added subsec. (i) and redesignated former subsec. (i) as (j).

2003—Subsec. (span)(4)(C)(i). Puspan. L. 108–173, § 736(a)(8)(A), substituted “at least” for “at least at least”.

Subsec. (d)(1)(A). Puspan. L. 108–173, § 736(a)(8)(B), substituted “physical, mental” for “physical mental”.

Subsec. (f)(2)(B)(iii). Puspan. L. 108–173, § 932(c)(2)(A), substituted “subparagraphs (C) and (D)” for “subparagraph (C)” in introductory provisions.

Puspan. L. 108–173, § 736(a)(8)(C), realigned margins of concluding provisions.

Subsec. (f)(2)(D). Puspan. L. 108–173, § 932(c)(2)(B), added subpar. (D).

2000–Subsec. (span)(8). Puspan. L. 106–554 added par. (8).

1997—Subsec. (span)(3)(C)(i). Puspan. L. 105–33, § 4432(span)(5)(A), substituted “Subject to the timeframes prescribed by the Secretary under section 1395yy(e)(6) of this title, such” for “Such” in introductory provisions.

Subsec. (f)(2)(B)(iii). Puspan. L. 105–15, § 1(1), inserted “subject to subparagraph (C),” after “(iii)”.

Subsec. (f)(2)(C). Puspan. L. 105–15, § 1(2), added subpar. (C).

Subsec. (g)(1)(D), (E). Puspan. L. 105–33, § 4755(a), added subpar. (D) and redesignated former subpar. (D) as (E).

1994—Subsec. (span)(3)(C)(i)(I). Puspan. L. 103–432, § 110(span), substituted “but no later than 14 days” for “but no later than not later than 14 days”.

Subsec. (span)(5)(D). Puspan. L. 103–432, § 106(d)(1), struck out comma before “or a new competency evaluation program”.

Subsec. (span)(5)(G). Puspan. L. 103–432, § 106(d)(2), substituted “licensed or certified social worker, registered respiratory therapist, or certified respiratory therapy technician” for “or licensed or certified social worker”.

Subsec. (c)(1)(D). Puspan. L. 103–432, § 106(c)(2)(A), inserted at end “In determining whether such a consultant is qualified to conduct reviews under the preceding sentence, the Secretary shall take into account the needs of nursing facilities under this subchapter to have access to the services of such a consultant on a timely basis.”

Subsec. (c)(6)(B)(i). Puspan. L. 103–432, § 106(c)(3)(A), substituted “$100” for “$50”.

Subsec. (e)(2)(B). Puspan. L. 103–432, § 106(c)(4)(A), inserted “, but shall not include any allegations of resident abuse or neglect or misappropriation of resident property that are not specifically documented by the State under such subsection” after “individual disputing the findings” in first sentence.

Subsec. (f)(2)(B)(i). Puspan. L. 103–432, § 106(d)(3), substituted “facilities (subject to clause (iii)),” for “facilities,”.

Subsec. (f)(2)(B)(iii)(I)(span). Puspan. L. 103–432, § 106(c)(1)(A), inserted before semicolon at end “, unless the survey shows that the facility is in compliance with the requirements of subsections (span), (c), and (d) of this section”.

Subsec. (f)(2)(B)(iii)(I)(c). Puspan. L. 103–432, § 106(d)(4), substituted “clause” for “clauses” in two places.

Subsec. (g)(1)(C). Puspan. L. 103–432, § 106(c)(4)(B), substituted second sentence for former second sentence which read as follows: “The State shall, after notice to the individual involved and a reasonable opportunity for a hearing for the individual to rebut allegations, make a finding as to the accuracy of the allegations.”

Subsec. (g)(5)(B). Puspan. L. 103–432, § 106(d)(5), substituted “paragraph” for “paragraphs” before “(1), (2), or (4) of subsection (h)”.

1992—Subsecs. (c)(2)(B)(iii)(II), (g)(5)(B). Puspan. L. 102–375 substituted “title III or VII of the Older Americans Act of 1965 in accordance with section 712 of the Act” for “section 307(a)(12) of the Older Americans Act of 1965”.

1990—Subsec. (span)(1)(B). Puspan. L. 101–508, § 4008(h)(2)(B), inserted at end “A State or the Secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this subparagraph.”

Subsec. (span)(3)(C)(i)(I). Puspan. L. 101–508, § 4008(h)(2)(C), substituted “not later than 14 days” for “4 days”.

Subsec. (span)(4)(A)(vii). Puspan. L. 101–508, § 4008(h)(2)(D), added cl. (vii).

Subsec. (span)(4)(C)(ii)(IV), (V). Puspan. L. 101–508, § 4008(h)(2)(E), added subcls. (IV) and (V).

Subsec. (span)(5)(A). Puspan. L. 101–508, § 4008(h)(1)(B), designated existing provisions as cl. (i), in introductory provisions substituted “Except as provided in clause (ii), a skilled nursing facility” for “A skilled nursing facility” and “on a full-time basis” for “(on a full-time, temporary, per diem, or other basis)”, redesignated former cls. (i) and (ii) as subcls. (I) and (II), respectively, and added cl. (ii).

Subsec. (span)(5)(C). Puspan. L. 101–508, § 4008(h)(1)(C), substituted “any State registry established under subsection (e)(2)(A) that the facility believes will include information” for “the State registry established under subsection (e)(2)(A) as to information in the registry”.

Subsec. (span)(5)(D). Puspan. L. 101–508, § 4008(h)(1)(D), inserted before period at end “, or a new competency evaluation program” after “and competency evaluation program”.

Subsec. (span)(5)(F)(i). Puspan. L. 101–508, § 4008(h)(2)(F), substituted “(G)) or a registered dietician,” for “(G)),”.

Subsec. (c)(1)(A). Puspan. L. 101–508, § 4008(h)(2)(G)(B)[(ii)], inserted at end “A resident’s exercise of a right to refuse transfer under clause (x) shall not affect the resident’s eligibility or entitlement to benefits under this subchapter or to medical assistance under subchapter XIX of this chapter.”

Subsec. (c)(1)(A)(iv). Puspan. L. 101–508, § 4008(h)(2)(H), inserted before period at end “and to access to current clinical records of the resident upon request by the resident or the resident’s legal representative, within 24 hours (excluding hours occurring during a weekend or holiday) after making such a request”.

Subsec. (c)(1)(A)(x), (xi). Puspan. L. 101–508, § 4008(h)(2)(G)(i), added cl. (x) and redesignated former cl. (x) as (xi).

Subsec. (c)(1)(B)(ii). Puspan. L. 101–508, § 4008(h)(2)(I), inserted “including the notice (if any) of the State developed under section 1396r(e)(6) of this title” after “in such rights)”.

Subsec. (c)(1)(E). Puspan. L. 101–508, § 4206(d)(1), added subpar. (E).

Subsec. (e)(1)(A). Puspan. L. 101–508, § 4008(h)(2)(J), substituted “subsection (f)(2)” for “clause (i) or (ii) of subsection (f)(2)(A)”.

Subsec. (e)(2)(A). Puspan. L. 101–508, § 4008(h)(2)(K)(i), inserted before period at end “, or any individual described in subsection (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(span)(4) of the Omnibus Budget Reconciliation Act of 1989”.

Subsec. (e)(2)(C). Puspan. L. 101–508, § 4008(h)(2)(K)(ii), added subpar. (C).

Subsec. (f)(2)(A)(ii). Puspan. L. 101–508, § 4008(m)(3)(F)[(E)], struck out “and” after semicolon at end.

Subsec. (f)(2)(A)(iv). Puspan. L. 101–508, § 4008(h)(1)(E), struck out “and” at end of subcl. (I), inserted “who is employed by (or who has received an offer of employment from) a facility on the date on which the aide begins either such program” after “nurse aide” and substituted “, and” for period at end of subcl. (II), and added subcl. (III).

Subsec. (f)(2)(B). Puspan. L. 101–508, § 4008(h)(1)(G), inserted “(through subcontract or otherwise)” after “may not delegate” in second sentence.

Subsec. (f)(2)(B)(iii)(I). Puspan. L. 101–508, § 4008(h)(1)(F)(i), amended subcl. (I) generally. Prior to amendment, subcl. (I) read as follows: “offered by or in a skilled nursing facility which has been determined to be out of compliance with the requirements of subsection (span), (c), or (d) of this section, within the previous 2 years, or”.

Subsec. (g)(1)(C). Puspan. L. 101–508, § 4008(h)(2)(L), inserted at end “A State shall not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual.”

Subsec. (g)(5)(A)(i). Puspan. L. 101–508, § 4008(h)(2)(M), substituted “deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans” for “deficiencies and plans”.

Subsec. (g)(5)(B). Puspan. L. 101–508, § 4008(h)(2)(N), substituted “or of any adverse action taken against a skilled nursing facility under paragraphs (1), (2), or (4) of subsection (h), with respect” for “with respect”.

1989—Subsec. (span)(5)(A). Puspan. L. 101–239, § 6901(span)(1)(A), substituted “October 1, 1990” for “January 1, 1990” in introductory provisions.

Subsec. (span)(5)(B). Puspan. L. 101–239, § 6901(span)(1)(B), substituted “January 1, 1990” and “October 1, 1990” for “July 1, 1989” and “January 1, 1990”, respectively.

Subsec. (c)(1)(A)(ii)(II). Puspan. L. 101–239, § 6901(d)(4)(A), substituted “Secretary until such an order could reasonably be obtained)” for “Secretary) until such an order could reasonably be obtained”.

Subsec. (c)(1)(A)(v)(I). Puspan. L. 101–239, § 6901(d)(4)(B), substituted “accommodation” for “accommodations”.

Subsec. (f)(2)(A)(i)(I). Puspan. L. 101–239, § 6901(d)(4)(C), substituted “and span of the curriculum” for “, span of the curriculum”.

Puspan. L. 101–239, § 6901(span)(3)(A), inserted “care of cognitively impaired residents,” after “social service needs,”.

Subsec. (f)(2)(A)(ii). Puspan. L. 101–239, § 6901(span)(3)(B), substituted “recognition of mental health and social service needs, care of cognitively impaired residents” for “cognitive, behavioral and social care”.

Subsec. (f)(2)(A)(iv). Puspan. L. 101–239, § 6901(span)(3)(C), (D), added cl. (iv).

Subsec. (h)(2)(C). Puspan. L. 101–239, § 6901(d)(4)(D), inserted “after the effective date of the findings” after “6 months” in introductory provisions.

1988—Subsec. (span)(3)(A)(iii). Puspan. L. 100–360, § 411(l)(2)(B), struck out “in the case of a resident eligible for benefits under subchapter XIX of this chapter,” before “uses an instrument”.

Subsec. (span)(3)(A)(iv). Puspan. L. 100–360, § 411(l)(2)(A), as amended by Puspan. L. 100–485, § 608(d)(27)(C), struck out “in the case of a resident eligible for benefits under this part,” before “includes the identification”.

Subsec. (span)(3)(B)(ii)(III). Puspan. L. 100–360, § 411(l)(2)(C), amended subcl. (III) generally. Prior to amendment, subcl. (III) read as follows: “The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penalties under section 1320a–7a of this title.”

Subsec. (span)(3)(C)(i)(I). Puspan. L. 100–360, § 411(l)(1)(A)(i), substituted “than January 1, 1991” for “than October 1, 1990”.

Subsec. (span)(4)(C)(i). Puspan. L. 100–360, § 411(l)(1)(A)(ii), substituted “24-hour licensed nursing” for “24-hour nursing”, “must use” for “must employ”, and “at least 8 consecutive hours a day,” for “during the day tour of duty (of at least 8 hours a day)”.

Subsec. (span)(5)(A). Puspan. L. 100–360, § 411(l)(2)(D)(i), as amended by Puspan. L. 100–485, § 608(d)(27)(D), struck out “, who is not a licensed health professional (as defined in subparagraph (E)),” after “any individual”.

Puspan. L. 100–360, § 411(l)(1)(A)(iii), substituted “January 1, 1990” for “October 1, 1989, (or January 1, 1990, in the case of an individual used by the facility as a nurse aide before July 1, 1989)”.

Subsec. (span)(5)(A)(ii). Puspan. L. 100–360, § 411(l)(2)(D)(ii), substituted “nursing or nursing-related services” for “such services”.

Subsec. (span)(5)(G). Puspan. L. 100–360, § 411(l)(2)(D)(iii), inserted “physical or occupational therapy assistant,” after “occupational therapist,”.

Subsec. (c)(1)(D). Puspan. L. 100–360, § 411(l)(1)(A)(iv), as added by Puspan. L. 100–485, § 608(d)(27)(A), added subpar. (D).

Subsec. (c)(2)(A)(v). Puspan. L. 100–360, § 411(l)(2)(F), substituted “for a stay at the facility” for “an allowable charge imposed by the facility for an item or service requested by the resident and for which a charge may be imposed consistent with this subchapter and subchapter XIX of this chapter”.

Subsec. (c)(6). Puspan. L. 100–360, § 411(l)(2)(G), substituted “upon the written” for “once the facility accepts the written” in subpar. (A)(ii), and “Upon written” for “Upon a facility’s acceptance of written” in subpar. (B).

Subsec. (e)(1)(A). Puspan. L. 100–360, § 411(l)(1)(A)(v), formerly § 411(l)(1)(A)(iv), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.

Subsec. (e)(1)(B). Puspan. L. 100–360, § 411(l)(1)(A)(vi), formerly § 411(l)(1)(A)(v), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.

Subsec. (e)(2)(A). Puspan. L. 100–360, § 411(l)(1)(A)(vii), formerly § 411(l)(1)(A)(vi), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.

Subsec. (e)(2)(B). Puspan. L. 100–360, § 411(l)(2)(H), inserted after first sentence “The State shall make available to the public information in the registry.”

Subsec. (e)(3). Puspan. L. 100–360, § 411(l)(2)(I), inserted “and discharges” after “transfers” in span and in two places in text.

Puspan. L. 100–360, § 411(l)(1)(A)(viii), formerly § 411(l)(1)(A)(vii), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “1989” for “1990”.

Subsec. (e)(5). Puspan. L. 100–360, § 411(l)(1)(A)(ix), formerly § 411(l)(1)(A)(viii), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “1990” for “1989” in introductory provisions.

Subsec. (f)(2)(A)(i)(I). Puspan. L. 100–360, § 411(l)(2)(J), substituted “recognition of mental health and social service needs” for “cognitive, behavioral and social care”.

Subsec. (f)(3). Puspan. L. 100–360, § 411(l)(2)(I), inserted “and discharges” after “transfers” in span and in text.

Puspan. L. 100–360, § 411(l)(1)(A)(x), formerly § 411(l)(1)(A)(ix), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “1988” for “1989”.

Subsec. (f)(6)(A). Puspan. L. 100–360, § 411(l)(1)(A)(xi), formerly § 411(l)(1)(A)(x), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “January” for “July”.

Subsec. (f)(6)(B). Puspan. L. 100–360, § 411(l)(1)(A)(xii), formerly § 411(l)(1)(A)(xi), as redesignated by Puspan. L. 100–485, § 608(d)(27)(A), substituted “April” for “October”.

Subsec. (f)(7)(A). Puspan. L. 100–360, § 411(l)(2)(K), substituted “residents” for “patients”.

Subsec. (f)(7)(B). Puspan. L. 100–360, § 411(l)(2)(L)(i), substituted “shall include” for “shall not include”.

Subsec. (g)(1)(C). Puspan. L. 100–360, § 411(l)(5)(A)–(C), substituted “and timely review” for “, review,”, inserted “or by another individual used by the facility in providing services to such a resident” after “a nursing facility”, and substituted “The State shall, after notice to the individual involved and a reasonable opportunity for a hearing for the individual to rebut allegations, make a finding as to the accuracy of the allegations. If the State finds that a nurse aide has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the nurse aide and the registry of such finding. If the State finds that any other individual used by the facility has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the appropriate licensure authority.” for “If the State finds, after notice to the nurse aide involved and a reasonable opportunity for a hearing for the nurse aide to rebut allegations, that a nurse aide whose name is contained in a nurse aide registry has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the nurse aide and the registry of such finding.”

Subsec. (g)(1)(D). Puspan. L. 100–360, § 411(l)(5)(D), substituted “to issue regulations to carry out this subsection” for “to establish standards under subsection (f) of this section”.

Subsec. (g)(2)(A)(i). Puspan. L. 100–360, § 411(l)(5)(E), amended third sentence generally. Prior to amendment, third sentence read as follows: “The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penalties under section 1320a–7a of this title.”

Subsec. (g)(2)(B)(ii). Puspan. L. 100–360, § 411(l)(5)(F), as added by Puspan. L. 100–485, § 608(d)(27)(I), substituted “practicable” for “practical”.

Subsec. (g)(2)(C)(i). Puspan. L. 100–360, § 411(l)(4), substituted “January” for “October”.

Subsec. (g)(3)(D). Puspan. L. 100–360, § 411(l)(5)(G), formerly § 411(l)(5)(F), as redesignated by Puspan. L. 100–485, § 608(d)(27)(I), substituted “on the basis of that survey” for “on that basis”.

Subsec. (g)(4). Puspan. L. 100–360, § 411(l)(5)(H), formerly § 411(l)(5)(G), as redesignated by Puspan. L. 100–485, § 608(d)(27)(I), struck out “chronically” after “enforcement actions against” in last sentence.

Subsec. (h)(2)(B)(ii). Puspan. L. 100–360, § 411(l)(7)(A), substituted “. The provisions of section 1320a–7a of this title (other than subsections (a) and (span)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1320a–7a(a) of this title.” for “and the Secretary shall impose and collect such a penalty in the same manner as civil money penalties are imposed and collected under section 1320a–7a of this title.”

Subsec. (h)(5). Puspan. L. 100–360, § 411(l)(11), as added by Puspan. L. 100–485, § 608(d)(27)(L), substituted “clauses (i), and (iii) of paragraph (2)(B)” for “clauses (i), (iii), and (iv) of paragraph (2)(A)”.

Subsec. (h)(6). Puspan. L. 100–360, § 411(l)(7)(B), inserted “by such facilities” after “be made available”.

1987—Subsecs. (g) to (i). Puspan. L. 100–203, §§ 4202(a)(2), 4203(a)(2), 4206, added subsecs. (g), (h), and (i), respectively.

Statutory Notes and Related Subsidiaries

Effective Date of 2010 Amendment

Puspan. L. 111–148, title VI, § 6101(c)(2), Mar. 23, 2010, 124 Stat. 702, provided that: “The amendments made by paragraph (1) [amending this section and section 1396r of this title] shall take effect on the date on which the Secretary [of Health and Human Services] makes the information described in subsection (span)(1) [probably means subsec. (span) of section 6101, which is set out as a note under section 1320a–3 of this title] available to the public under such subsection.”

Puspan. L. 111–148, title VI, § 6103(a)(2)(B), Mar. 23, 2010, 124 Stat. 706, provided that: “The amendment made by this paragraph [amending this section] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

Puspan. L. 111–148, title VI, § 6103(c)(3), Mar. 23, 2010, 124 Stat. 710, provided that: “The amendments made by this subsection [amending this section and section 1396r of this title] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

Puspan. L. 111–148, title VI, § 6111(c), Mar. 23, 2010, 124 Stat. 716, provided that: “The amendments made by this section [amending this section and section 1396r of this title] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

Amendment by section 6113(span) of Puspan. L. 111–148 effective 1 year after Mar. 23, 2010, see section 6113(c) of Puspan. L. 111–148, set out as a note under section 1320a–7j of this title.

Puspan. L. 111–148, title VI, § 6121(c), Mar. 23, 2010, 124 Stat. 721, provided that: “The amendments made by this section [amending this section and section 1396r of this title] shall take effect 1 year after the date of the enactment of this Act [Mar. 23, 2010].”

Effective Date of 2003 Amendment

Puspan. L. 108–173, title IX, § 932(d), Dec. 8, 2003, 117 Stat. 2402, provided that: “The amendments made by this section [amending this section and sections 1395cc, 1395ff, and 1396r of this title] shall apply to appeals filed on or after October 1, 2004.”

Effective Date of 2000 Amendment

Puspan. L. 106–554, § 1(a)(6) [title IX, § 941(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A–586, provided that: “The amendments made by this section [amending this section and section 1396r of this title] shall take effect on January 1, 2003.”

Effective Date of 1997 Amendment

Puspan. L. 105–33, title IV, § 4432(d), Aug. 5, 1997, 111 Stat. 422, provided that: “The amendments made by this section [amending this section and sections 1395k, 1395l, 1395u, 1395x, 1395y, 1395cc, 1395tt, and 1395yy of this title] are effective for cost reporting periods beginning on or after July 1, 1998; except that the amendments made by subsection (span) [amending this section and sections 1395k, 1395l, 1395u, 1395x, 1395y, 1395cc, 1395tt, and 1395yy of this title] shall apply to items and services furnished on or after July 1, 1998.”

Effective Date of 1994 Amendment

Puspan. L. 103–432, title I, § 106(c)(1)(B), Oct. 31, 1994, 108 Stat. 4406, provided that: “The amendment made by subparagraph (A) [amending this section] shall take effect as if included in the enactment of OBRA–1990 [Puspan. L. 101–508].”

Puspan. L. 103–432, title I, § 106(c)(2)(B), Oct. 31, 1994, 108 Stat. 4406, provided that: “The amendment made by subparagraph (A) [amending this section] shall take effect as if included in the enactment of OBRA–1987 [Puspan. L. 100–203].”

Puspan. L. 103–432, title I, § 106(c)(3)(B), Oct. 31, 1994, 108 Stat. 4406, provided that: “The amendment made by subparagraph (A) [amending this section] shall take effect January 1, 1995.”

Puspan. L. 103–432, title I, § 106(c)(4)(C), Oct. 31, 1994, 108 Stat. 4407, provided that: “The amendments made by this paragraph [amending this section] shall take effect January 1, 1995.”

Puspan. L. 103–432, title I, § 106(d)(7), Oct. 31, 1994, 108 Stat. 4407, provided that: “The amendments made by this subsection [amending this section and provisions set out as a note below] shall take effect as if included in the enactment of OBRA–1990 [Puspan. L. 101–508].”

Effective Date of 1992 Amendment

Amendment by Puspan. L. 102–375 inapplicable with respect to fiscal year 1993, see section 4(span) of Puspan. L. 103–171, set out as a note under section 3001 of this title.

Amendment by Puspan. L. 102–375 inapplicable with respect to fiscal year 1992, see section 905(span)(6) of Puspan. L. 102–375, set out as a note under section 3001 of this title.

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4008(h)(1)(F)(ii), Nov. 5, 1990, 104 Stat. 1388–47, as amended by Puspan. L. 103–432, title I, § 106(d)(6), Oct. 31, 1994, 108 Stat. 4407, provided that:

“(I) The amendments made by clause (i) [amending this section] shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203], except that a State may not approve a training and competency evaluation program or a competency evaluation program offered by or in a skilled nursing facility which, pursuant to any Federal or State law within the 2-year period beginning on October 1, 1988—

“(aa) had its participation terminated under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] or under the State plan under title XIX of such Act [42 U.S.C. 1396 et seq.];

“(bspan) was subject to a denial of payment under either such title;

“(cc) was assessed a civil money penalty not less than $5,000 for deficiencies in skilled nursing facility standards;

“(dd) operated under a temporary management appointed to oversee the operation of the facility and to ensure the health and safety of the facility’s residents; or

“(ee) pursuant to State action, was closed or had its residents transferred.

“(II) Notwithstanding subclause (I) and subject to section 1819(f)(2)(B)(iii)(I) of the Social Security Act [42 U.S.C. 1395i–3(f)(2)(B)(iii)(I)] (as amended by clause (i)), a State may approve a training and competency evaluation program or a competency evaluation program offered by or in a skilled nursing facility described in subclause (I) if, during the previous 2 years, item (aa), (bspan), (cc), (dd), or (ee) of subclause (I) did not apply to the facility.”

Puspan. L. 101–508, title IV, § 4008(h)(1)(H), Nov. 5, 1990, 104 Stat. 1388–48, provided that: “Except as provided in subparagraph (F) [amending this section and enacting provisions set out as a note above], the amendments made by this subsection [probably means this paragraph, amending this section] shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203].”

Puspan. L. 101–508, title IV, § 4008(h)(2)(P), Nov. 5, 1990, 104 Stat. 1388–50, provided that: “The amendments made by this paragraph [amending this section and sections 1395x and 1395yy of this title] shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203].”

Puspan. L. 101–508, title IV, § 4206(e)(1), Nov. 5, 1990, 104 Stat. 1388–117, provided that: “The amendments made by subsections (a) and (d) [amending this section and sections 1395cc and 1395bbspan of this title] shall apply with respect to services furnished on or after the first day of the first month beginning more than 1 year after the date of the enactment of this Act [Nov. 5, 1990].”

Effective Date of 1989 Amendment

Puspan. L. 101–239, title VI, § 6901(span)(6), Dec. 19, 1989, 103 Stat. 2300, provided that:

“(A)In general.—Except as provided in subparagraph (B), the amendments made by this subsection [amending this section and sections 1396span and 1396r of this title] shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203].

“(B)Exception.—The amendments made by paragraph (3) [amending this section and section 1396r of this title] shall apply to nurse aide training and competency evaluation programs, and nurse aide competency evaluation programs, offered on or after the end of the 90-day period beginning on the date of the enactment of this Act [Dec. 19, 1989], but shall not affect competency evaluations conducted under programs offered before the end of such period.”

Puspan. L. 101–239, title VI, § 6901(d)(6), Dec. 19, 1989, 103 Stat. 2301, provided that:

“(A)In general.—Except as provided in subparagraph (B), the amendments made by this subsection [amending this section and sections 1396i and 1396r of this title] shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203].

“(B)Exception.—The amendment made by paragraph (1) [amending section 1396r of this title] shall take effect on the date of the enactment of this Act [Dec. 19, 1989].”

Effective Date of 1988 Amendment

Amendment by Puspan. L. 100–485 effective as if originally included in the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.

Effective Date

Puspan. L. 100–203, title IV, § 4204, Dec. 22, 1987, 101 Stat. 1330–182, as amended by Puspan. L. 100–360, title IV, § 411(l)(9), July 1, 1988, 102 Stat. 805; Puspan. L. 100–485, title VI, § 608(d)(27)(K), Oct. 13, 1988, 102 Stat. 2423, provided that:

“(a)New Requirements and Survey and Certification Process.—Except as otherwise specifically provided in section 1819 of the Social Security Act [42 U.S.C. 1395i–3], the amendments made by sections 4201 and 4202 [enacting and amending this section and amending sections 1395x, 1395aa, 1395tt, and 1395yy of this title] (relating to skilled nursing facility requirements and survey and certification requirements) shall apply to services furnished on or after October 1, 1990, without regard to whether regulations to implement such amendments are promulgated by such date.

“(span)Enforcement.—

(1) Except as otherwise specifically provided in section 1819 of the Social Security Act [42 U.S.C. 1395i–3], the amendments made by section 4203 of this Act [amending this section and section 1395aa of this title] apply January 1, 1988, without regard to whether regulations to implement such amendments are promulgated by such date.

“(2) In applying the amendments made by section 4203 of this Act for services furnished by a skilled nursing facility before October 1, 1990, any reference to a requirement of subsection (span), (c), or (d), of section 1819 of the Social Security Act is deemed a reference to the provisions of section 1861(j) of such Act [42 U.S.C. 1395x(j)].

“(c)Waiver of Paperwork Reduction.—Chapter 35 of title 44, United States Code, shall not apply to information required for purposes of carrying out this part [part 1 of subtitle C (§§ 4201–4206), enacting this section, amending this section and sections 1395x, 1395aa, 1395tt, and 1395yy of this title, and enacting provisions set out as notes under this section] and implementing the amendments made by this part.”

Guidance to States on Form 2567 State Inspection Reports and Complaint Investigation Reports

Puspan. L. 111–148, title VI, § 6103(d)(1), (3), Mar. 23, 2010, 124 Stat. 710, provided that:

“(1)Guidance.—The Secretary of Health and Human Services (in this subtitle [subtitle B (§§ 6101–6121) of title VI of Puspan. L. 111–148, enacting section 1320a–7j of this title, amending this section and sections 1320a–3, 1320a–7j, 1395yy, 1396a, and 1396r of this title, and enacting provisions set out as notes under this section and sections 1320a–3, 1320a–7j, and 1396r of this title] 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.

“(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)).”

Development of Consumer Rights Information Page on Nursing Home Compare Website

Puspan. L. 111–148, title VI, § 6103(e), Mar. 23, 2010, 124 Stat. 710, provided that: “Not later than 1 year after the date of enactment of this Act [Mar. 23, 2010], the Secretary [of Health and Human Services] shall ensure that the Department of Health and Human Services, as part of the information provided for comparison of nursing facilities on the Nursing Home Compare Medicare website develops and includes a consumer rights information page that contains links to descriptions of, and information with respect to, the following:

“(1) The documentation on nursing facilities that is available to the public.

“(2) General information and tips on choosing a nursing facility that meets the needs of the individual.

“(3) General information on consumer rights with respect to nursing facilities.

“(4) The nursing facility survey process (on a national and State-specific basis).

“(5) On a State-specific basis, the services available through the State long-term care ombudsman for such State.”

National Demonstration Projects on Culture Change and Use of Information Technology in Nursing Homes

Puspan. L. 111–148, title VI, § 6114, Mar. 23, 2010, 124 Stat. 720, provided that:

“(a)In General.—The Secretary [of Health and Human Services] shall conduct 2 demonstration projects, 1 for the development of best practices in skilled nursing facilities and nursing facilities that are involved in the culture change movement (including the development of resources for facilities to find and access funding in order to undertake culture change) and 1 for the development of best practices in skilled nursing facilities and nursing facilities for the use of information technology to improve resident care.

“(span)Conduct of Demonstration Projects.—

“(1)Grant award.—Under each demonstration project conducted under this section, the Secretary shall award 1 or more grants to facility-based settings for the development of best practices described in subsection (a) with respect to the demonstration project involved. Such award shall be made on a competitive basis and may be allocated in 1 lump-sum payment.

“(2)Consideration of special needs of residents.—Each demonstration project conducted under this section shall take into consideration the special needs of residents of skilled nursing facilities and nursing facilities who have cognitive impairment, including dementia.

“(c)Duration and Implementation.—

“(1)Duration.—The demonstration projects shall each be conducted for a period not to exceed 3 years.

“(2)Implementation.—The demonstration projects shall each be implemented not later than 1 year after the date of the enactment of this Act [Mar. 23, 2010].

“(d)Definitions.—In this section:

“(1)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)).

“(2)Secretary.—The term ‘Secretary’ means the Secretary of Health and Human Services.

“(3)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) [1395i–3(a)]).

“(e)Authorization of Appropriations.—There are authorized to be appropriated such sums as may be necessary to carry out this section.

“(f)Report.—Not later than 9 months after the completion of the demonstration project, the Secretary shall submit to Congress a report on such project, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.”

Review and Report on Current Standards of Practice for Pharmacy Services Provided to Patients in Nursing Facilities

Puspan. L. 108–173, title I, § 107(span), Dec. 8, 2003, 117 Stat. 2169, provided that:

“(1)Review.—

“(A)In general.—Not later than 12 months after the date of the enactment of this Act [Dec. 8, 2003], the Secretary [of Health and Human Services] shall conduct a thorough review of the current standards of practice for pharmacy services provided to patients in nursing facilities.

“(B)Specific matters reviewed.—In conducting the review under subparagraph (A), the Secretary shall—

“(i) assess the current standards of practice, clinical services, and other service requirements generally used for pharmacy services in long-term care settings; and

“(ii) evaluate the impact of those standards with respect to patient safety, reduction of medication errors and quality of care.

“(2)Report.—

“(A)In general.—Not later than the date that is 18 months after the date of the enactment of this Act [Dec. 8, 2003], the Secretary shall submit a report to Congress on the study conducted under paragraph (1)(A).

“(B)Contents.—The report submitted under subparagraph (A) shall contain—

“(i) a description of the plans of the Secretary to implement the provisions of this Act [see Tables for classification] in a manner consistent with applicable State and Federal laws designed to protect the safety and quality of care of nursing facility patients; and

“(ii) recommendations regarding necessary actions and appropriate reimbursement to ensure the provision of prescription drugs to medicare beneficiaries residing in nursing facilities in a manner consistent with existing patient safety and quality of care standards under applicable State and Federal laws.”

Study and Report Regarding State Licensure and Certification Standards and Respiratory Therapy Competency Examinations

Puspan. L. 106–113, div. B, § 1000(a)(6) [title I, § 107], Nov. 29, 1999, 113 Stat. 1536, 1501A–328, provided that the Secretary of Health and Human Services would conduct a study that identifies variations in State licensure and certification standards for health care providers and other individuals providing respiratory therapy in skilled nursing facilities, examines State requirements relating to respiratory therapy competency examinations for such providers and individuals and determines whether regular respiratory therapy competency examinations or certifications should be required under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and submit a report of the results of the study and any recommendations by 18 months after Nov. 29, 1999.

Retroactive Review

Puspan. L. 105–33, title IV, § 4755(c), Aug. 5, 1997, 111 Stat. 527, provided that: “The procedures developed by a State under the amendments made by subsection[s] (a) and (span) [amending this section and section 1396r of this title] shall permit an individual to petition for a review of any finding made by a State under section 1819(g)(1)(C) or 1919(g)(1)(C) of the Social Security Act (42 U.S.C. 1395i-3(g)(1)(C) or 1396r(g)(1)(C)) after January 1, 1995.”

Study and Report on Deeming for Nursing Facilities and Renal Dialysis Facilities

Puspan. L. 104–134, title I, § 101(d) [title V, § 516(d)], Apr. 26, 1996, 110 Stat. 1321–211, 1321–248; renumbered title I, Puspan. L. 104–140, § 1(a), May 2, 1996, 110 Stat. 1327, provided that:

“(1)Study.—The Secretary of Health and Human Services shall provide for—

“(A) a study concerning the effectiveness and appropriateness of the current mechanisms for surveying and certifying skilled nursing facilities for compliance with the conditions and requirements of sections 1819 and 1861(j) of the Social Security Act [42 U.S.C. 1395i–3, 1395x(j)] and nursing facilities for compliance with the conditions of section 1919 of such Act [42 U.S.C. 1396r], and

“(B) a study concerning the effectiveness and appropriateness of the current mechanisms for surveying and certifying renal dialysis facilities for compliance with the conditions and requirements of section 1881(span) of the Social Security Act [42 U.S.C. 1395rr(span)].

“(2)Report.—Not later than July 1, 1997, the Secretary shall transmit to Congress a report on each of the studies provided for under paragraph (1). The report on the study under paragraph (1)(A) shall include (and the report on the study under paragraph (1)(B) may include) a specific framework, where appropriate, for implementing a process under which facilities covered under the respective study may be deemed to meet applicable medicare conditions and requirements if they are accredited by a national accreditation body.”

Maintaining Regulatory Standards for Certain Services

Puspan. L. 101–508, title IV, § 4008(h)(2)(O), Nov. 5, 1990, 104 Stat. 1388–50, provided that: “Any regulations promulgated and applied by the Secretary of Health and Human Services after the date of the enactment of the Omnibus Budget Reconciliation Act of 1987 [Dec. 22, 1987] with respect to services described in clauses (ii), (iv), and (v) of section 1819(span)(4)(A) of the Social Security Act [42 U.S.C. 1395i–3(span)(4)(A)(ii), (iv), and (v)] shall include requirements for providers of such services that are at least as strict as the requirements applicable to providers of such services prior to the enactment of the Omnibus Budget Reconciliation Act of 1987.”

Nurse Aide Training and Competency Evaluation Programs; Publication of Proposed Regulations

Puspan. L. 101–239, title VI, § 6901(span)(2), Dec. 19, 1989, 103 Stat. 2298, provided that: “The Secretary of Health and Human Services shall issue proposed regulations to establish the requirements described in sections 1819(f)(2) and 1919(f)(2) of the Social Security Act [42 U.S.C. 1395i–3(f)(2), 1396r(f)(2)] by not later than 90 days after the date of the enactment of this Act [Dec. 19, 1989].”

Nurse Aide Training and Competency Evaluation; Satisfaction of Requirements; Waiver

Puspan. L. 101–239, title VI, § 6901(span)(4)(B)–(D), Dec. 19, 1989, 103 Stat. 2299, provided that:

“(B) A nurse aide shall be considered to satisfy the requirement of sections 1819(span)(5)(A) and 1919(span)(5)(A) of the Social Security Act [42 U.S.C. 1395i–3(span)(5)(A), 1396r(span)(5)(A)] (of having completed a training and competency evaluation program approved by a State under section 1819(e)(1)(A) or 1919(e)(1)(A) of such Act [42 U.S.C. 1395i–3(e)(1)(A), 1396r(e)(1)(A)]), if such aide would have satisfied such requirement as of July 1, 1989, if a number of hours (not less than 60 hours) were substituted for ‘75 hours’ in sections 1819(f)(2) and 1919(f)(2) of such Act [42 U.S.C. 1395i–3(f)(2), 1396r(f)(2)], respectively, and if such aide had received, before July 1, 1989, at least the difference in the number of such hours in supervised practical nurse aide training or in regular in-service nurse aide education.

“(C) A nurse aide shall be considered to satisfy the requirement of sections 1819(span)(5)(A) and 1919(span)(5)(A) of the Social Security Act (of having completed a training and competency evaluation program approved by a State under section 1819(e)(1)(A) or 1919(e)(1)(A) of such Act), if such aide was found competent (whether or not by the State), before July 1, 1989, after the completion of a course of nurse aide training of at least 100 hours duration.

“(D) With respect to the nurse aide competency evaluation requirements described in sections 1819(span)(5)(A) and 1919(span)(5)(A) of the Social Security Act, a State may waive such requirements with respect to an individual who can demonstrate to the satisfaction of the State that such individual has served as a nurse aide at one or more facilities of the same employer in the State for at least 24 consecutive months before the date of the enactment of this Act [Dec. 19, 1989].”

Evaluation and Report on Implementation of Resident Assessment Process

Puspan. L. 100–203, title IV, § 4201(c), Dec. 22, 1987, 101 Stat. 1330–174, provided that: “The Secretary of Health and Human Services shall evaluate, and report to Congress by not later than January 1, 1992, on the implementation of the resident assessment process for residents of skilled nursing facilities under the amendments made by this section [enacting this section and amending sections 1395x, 1395aa, 1395tt, and 1395yy of this title].”

Annual Report on Statutory Compliance and Enforcement Actions

Puspan. L. 100–203, title IV, § 4205, Dec. 22, 1987, 101 Stat. 1330–182, provided that: “The Secretary of Health and Human Services shall report to the Congress annually on the extent to which skilled nursing facilities are complying with the requirements of subsections (span), (c), and (d) of section 1819 of the Social Security Act [42 U.S.C. 1395i–3(span), (c), (d)] (as added by the amendments made by this part) and the number and type of enforcement actions taken by States and the Secretary under section 1819(h) of such Act (as added by section 4203 of this Act).”