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1 FORMAT.—Beginning not later than 2 years
2 after the date of the enactment of this subpara-
3 graph, and after consulting with State long-
4 term care ombudsman programs, consumer ad-
5 vocacy groups, provider stakeholder groups, em-
6 ployees and their representatives, and other
7 parties the Secretary deems appropriate, the
8 Secretary shall require a skilled nursing facility
9 to electronically submit to the Secretary direct
10 care staffing information (including information
11 with respect to agency and contract staff) based
12 on payroll and other verifiable and auditable
13 data in a uniform format (according to speci-
14 fications established by the Secretary in con-
15 sultation with such programs, groups, and par-
16 ties). Such specifications shall require that the
17 information submitted under the preceding sen-
18 tence—
19 ‘‘(i) specify the category of work a
20 certified employee performs (such as
21 whether the employee is a registered nurse,
22 licensed practical nurse, licensed vocational
23 nurse, certified nursing assistant, thera-
24 pist, or other medical personnel);

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1 ‘‘(ii) include resident census data and
2 information on resident case mix;
3 ‘‘(iii) include a regular reporting
4 schedule; and
5 ‘‘(iv) include information on employee
6 turnover and tenure and on the hours of
7 care provided by each category of certified
8 employees referenced in clause (i) per resi-
9 dent per day.
10 Nothing in this subparagraph shall be con-
11 strued as preventing the Secretary from requir-
12 ing submission of such information with respect
13 to specific categories, such as nursing staff, be-
14 fore other categories of certified employees. In-
15 formation under this subparagraph with respect
16 to agency and contract staff shall be kept sepa-
17 rate from information on employee staffing.’’.
18 (b) NURSING FACILITIES.—Section 1919(b)(8) of the
19 Social Security Act (42 U.S.C. 1396r(b)(8)) is amended
20 by adding at the end the following new subparagraph:
21 ‘‘(C) SUBMISSION OF STAFFING INFORMA-

22 TION BASED ON PAYROLL DATA IN A UNIFORM

23 FORMAT.—Beginning not later than 2 years

24 after the date of the enactment of this subpara-
25 graph, and after consulting with State long-

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1 term care ombudsman programs, consumer ad-
2 vocacy groups, provider stakeholder groups, em-
3 ployees and their representatives, and other
4 parties the Secretary deems appropriate, the
5 Secretary shall require a nursing facility to elec-
6 tronically submit to the Secretary direct care
7 staffing information (including information with
8 respect to agency and contract staff) based on
9 payroll and other verifiable and auditable data
10 in a uniform format (according to specifications
11 established by the Secretary in consultation
12 with such programs, groups, and parties). Such
13 specifications shall require that the information
14 submitted under the preceding sentence—
15 ‘‘(i) specify the category of work a
16 certified employee performs (such as
17 whether the employee is a registered nurse,
18 licensed practical nurse, licensed vocational
19 nurse, certified nursing assistant, thera-
20 pist, or other medical personnel);
21 ‘‘(ii) include resident census data and
22 information on resident case mix;
23 ‘‘(iii) include a regular reporting
24 schedule; and

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1 ‘‘(iv) include information on employee
2 turnover and tenure and on the hours of
3 care provided by each category of certified
4 employees referenced in clause (i) per resi-
5 dent per day.
6 Nothing in this subparagraph shall be con-
7 strued as preventing the Secretary from requir-
8 ing submission of such information with respect
9 to specific categories, such as nursing staff, be-
10 fore other categories of certified employees. In-
11 formation under this subparagraph with respect
12 to agency and contract staff shall be kept sepa-
13 rate from information on employee staffing.’’.
14 PART 2—TARGETING ENFORCEMENT

15 SEC. 1421. CIVIL MONEY PENALTIES.

16 (a) SKILLED NURSING FACILITIES.—

17 (1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of
18 the Social Security Act (42 U.S.C. 1395i–
19 3(h)(2)(B)(ii)) is amended to read as follows:
20 ‘‘(ii) AUTHORITY WITH RESPECT TO

21 CIVIL MONEY PENALTIES.—

22 ‘‘(I) AMOUNT.—The Secretary

23 may impose a civil money penalty in
24 the applicable per instance or per day
25 amount (as defined in subclause (II)

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1 and (III)) for each day or instance,
2 respectively, of noncompliance (as de-
3 termined appropriate by the Sec-
4 retary).
5 ‘‘(II) APPLICABLE PER INSTANCE

6 AMOUNT.—In this clause, the term

7 ‘applicable per instance amount’
8 means—
9 ‘‘(aa) in the case where the
10 deficiency is found to be a direct
11 proximate cause of death of a
12 resident of the facility, an
13 amount not to exceed $100,000.
14 ‘‘(bb) in each case of a defi-
15 ciency where the facility is cited
16 for actual harm or immediate
17 jeopardy, an amount not less
18 than $3,050 and not more than
19 $25,000; and
20 ‘‘(cc) in each case of any
21 other deficiency, an amount not
22 less than $250 and not to exceed
23 $3050.

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1 ‘‘(III) APPLICABLE PER DAY

2 AMOUNT.—In this clause, the term

3 ‘applicable per day amount’ means—
4 ‘‘(aa) in each case of a defi-
5 ciency where the facility is cited
6 for actual harm or immediate
7 jeopardy, an amount not less
8 than $3,050 and not more than
9 $25,000 and
10 ‘‘(bb) in each case of any
11 other deficiency, an amount not
12 less than $250 and not to exceed
13 $3,050.
14 ‘‘(IV) REDUCTION OF CIVIL

15 MONEY PENALTIES IN CERTAIN CIR-

16 CUMSTANCES.—Subject to subclauses
17 (V) and (VI), in the case where a fa-
18 cility self-reports and promptly cor-
19 rects a deficiency for which a penalty
20 was imposed under this clause not
21 later than 10 calendar days after the
22 date of such imposition, the Secretary
23 may reduce the amount of the penalty
24 imposed by not more than 50 percent.

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1 ‘‘(V) PROHIBITION ON REDUC-

2 TION FOR CERTAIN DEFICIENCIES.—

3 ‘‘(aa) REPEAT DEFI-

4 CIENCIES.—The Secretary may

5 not reduce under subclause (IV)
6 the amount of a penalty if the
7 deficiency is a repeat deficiency.
8 ‘‘(bb) CERTAIN OTHER DE-

9 FICIENCIES.—The Secretary may

10 not reduce under subclause (IV)
11 the amount of a penalty if the
12 penalty is imposed for a defi-
13 ciency described in subclause
14 (II)(aa) or (III)(aa) and the ac-
15 tual harm or widespread harm
16 immediately jeopardizes the
17 health or safety of a resident or
18 residents of the facility, or if the
19 penalty is imposed for a defi-
20 ciency described in subclause
21 (II)(bb).
22 ‘‘(VI) LIMITATION ON AGGRE-

23 GATE REDUCTIONS.—The aggregate

24 reduction in a penalty under sub-
25 clause (IV) may not exceed 35 percent

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1 on the basis of self-reporting, on the
2 basis of a waiver or an appeal (as pro-
3 vided for under regulations under sec-
4 tion 488.436 of title 42, Code of Fed-
5 eral Regulations), or on the basis of
6 both.
7 ‘‘(VII) COLLECTION OF CIVIL

8 MONEY PENALTIES.—In the case of a

9 civil money penalty imposed under
10 this clause, the Secretary—
11 ‘‘(aa) subject to item (cc),
12 shall, not later than 30 days
13 after the date of imposition of
14 the penalty, provide the oppor-
15 tunity for the facility to partici-
16 pate in an independent informal
17 dispute resolution process which
18 generates a written record prior
19 to the collection of such penalty,
20 but such opportunity shall not af-
21 fect the responsibility of the
22 State survey agency for making
23 final recommendations for such
24 penalties;

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