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United States Code (Last Updated: May 24, 2014) |
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Title 42. THE PUBLIC HEALTH AND WELFARE |
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Chapter 7. SOCIAL SECURITY |
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SubChapter XVIII. HEALTH INSURANCE FOR AGED AND DISABLED |
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Part A. Hospital Insurance Benefits for Aged and Disabled |
§ 1395i–3. Requirements for, and assuring quality of care in, skilled nursing facilities
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(a) “Skilled nursing facility” defined In this subchapter, the term “skilled nursing facility” means an institution (or a distinct part of an institution) which— (1) is primarily engaged in providing to residents— (A) skilled nursing care and related services for residents who require medical or nursing care, or (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement (meeting the requirements of section 1395x(l) of this title) with one or more hospitals having agreements in effect under section 1395cc of this title; and (3) meets the requirements for a skilled nursing facility described in subsections (b), (c), and (d) of this section. (b) Requirements relating to provision of services (1) Quality of life (A) In general A skilled nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.
(B) Quality assessment and assurance A skilled nursing facility must maintain a quality assessment and assurance committee, consisting of the director of nursing services, a physician designated by the facility, and at least 3 other members of the facility’s staff, which (i) meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary and (ii) develops and implements appropriate plans of action to correct identified quality deficiencies. 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.
(2) Scope of services and activities under plan of care A skilled nursing facility must provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in accordance with a written plan of care which— (A) describes the medical, nursing, and psychosocial needs of the resident and how such needs will be met; (B) is initially prepared, with the participation to the extent practicable of the resident or the resident’s family or legal representative, by a team which includes the resident’s attending physician and a registered professional nurse with responsibility for the resident; and (C) is periodically reviewed and revised by such team after each assessment under paragraph (3). (3) Residents’ assessment (A) Requirement A skilled nursing facility must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity, which assessment— (i) describes the resident’s capability to perform daily life functions and significant impairments in functional capacity; (ii) is based on a uniform minimum data set specified by the Secretary under subsection (f)(6)(A) of this section; (iii) uses an instrument which is specified by the State under subsection (e)(5) of this section; and (iv) includes the identification of medical problems. (B) Certification (i) In general Each such assessment must be conducted or coordinated (with the appropriate participation of health professionals) by a registered professional nurse who signs and certifies the completion of the assessment. Each individual who completes a portion of such an assessment shall sign and certify as to the accuracy of that portion of the assessment.
(ii) Penalty for falsification (I) An individual who willfully and knowingly certifies under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than $1,000 with respect to each assessment. (II) An individual who willfully and knowingly causes another individual to certify under clause (i) a material and false statement in a resident assessment is subject to a civil money penalty of not more than $5,000 with respect to each assessment. (III) The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) 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 1320a–7a(a) of this title. (iii) Use of independent assessors If a State determines, under a survey under subsection (g) of this section or otherwise, that there has been a knowing and willful certification of false assessments under this paragraph, the State may require (for a period specified by the State) that resident assessments under this paragraph be conducted and certified by individuals who are independent of the facility and who are approved by the State.
(C) Frequency (i) In general Subject to the timeframes prescribed by the Secretary under section 1395yy(e)(6) of this title, such an assessment must be conducted— (I) promptly upon (but no later than 14 days after the date of) admission for each individual admitted on or after October 1, 1990 , and by not later thanJanuary 1, 1991 , for each resident of the facility on that date;(II) promptly after a significant change in the resident’s physical or mental condition; and (III) in no case less often than once every 12 months. (ii) Resident review The skilled nursing facility must examine each resident no less frequently than once every 3 months and, as appropriate, revise the resident’s assessment to assure the continuing accuracy of the assessment.
(D) Use The results of such an assessment shall be used in developing, reviewing, and revising the resident’s plan of care under paragraph (2).
(E) Coordination Such assessments shall be coordinated with any State-required preadmission screening program to the maximum extent practicable in order to avoid duplicative testing and effort.
(4) Provision of services and activities (A) In general To the extent needed to fulfill all plans of care described in paragraph (2), a skilled nursing facility must provide, directly or under arrangements (or, with respect to dental services, under agreements) with others for the provision of— (i) nursing services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident; (ii) medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident; (iii) pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident; (iv) dietary services that assure that the meals meet the daily nutritional and special dietary needs of each resident; (v) an on-going program, directed by a qualified professional, of activities designed to meet the interests and the physical, mental, and psychosocial well-being of each resident; (vi) routine and emergency dental services to meet the needs of each resident; and (vii) treatment and services required by mentally ill and mentally retarded residents not otherwise provided or arranged for (or required to be provided or arranged for) by the State. The services provided or arranged by the facility must meet professional standards of quality. Nothing in clause (vi) shall be construed as requiring a facility to provide or arrange for dental services described in that clause without additional charge. (B) Qualified persons providing services Services described in clauses (i), (ii), (iii), (iv), and (vi) of subparagraph (A) must be provided by qualified persons in accordance with each resident’s written plan of care.
(C) Required nursing care (i) In general Except as provided in clause (ii), a skilled nursing facility must provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, 7 days a week.
(ii) Exception To the extent that clause (i) may be deemed to require that a skilled nursing facility engage the services of a registered professional nurse for more than 40 hours a week, the Secretary is authorized to waive such requirement if the Secretary finds that— (I) the facility is located in a rural area and the supply of skilled nursing facility services in such area is not sufficient to meet the needs of individuals residing therein, (II) the facility has one full-time registered professional nurse who is regularly on duty at such facility 40 hours a week, (III) the facility either has only patients whose physicians have indicated (through physicians’ orders or admission notes) that each such patient does not require the services of a registered nurse or a physician for a 48-hour period, or has made arrangements for a registered professional nurse or a physician to spend such time at such facility as may be indicated as necessary by the physician to provide necessary skilled nursing services on days when the regular full-time registered professional nurse is not on duty, (IV) the Secretary provides notice of the waiver to the State long-term care ombudsman (established under section 307(a)(12) the number of civil monetary penalties levied against the facility, employees, contractors, and other agents. (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
March 23, 2010 .(ii) Exception The Secretary shall ensure that the information described in subparagraph (A)(i) is included on such website (or a successor website) not later than the date on which the requirements under section 1320a–7j(g) of this title are implemented.
(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 March 23, 2010 ; and(ii) not later than 1 year after March 23, 2010 , 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. (j) Construction Where requirements or obligations under this section are identical to those provided under section 1396r of this title, the fulfillment of those requirements or obligations under section 1396r of this title shall be considered to be the fulfillment of the corresponding requirements or obligations under this section.
Prospective Amendment
Pub. L. 111–148, title VI, § 6103(c)(1), (3),
(C) 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.
See 2010 Amendment note below.
Pub. L. 111–148, title VI, § 6101(c)(1)(A), (2),
References In Text
The Older Americans Act of 1965, referred to in subsecs. (b)(4)(C)(ii)(IV), (c)(2)(B)(iii)(II), and (g)(5)(B), is Pub. L. 89–73,
Subparagraphs (B), (C), and (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989 [Pub. L. 101–239], referred to in subsec. (e)(2)(A), are set out below.
Section 21(b) of the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977, referred to in subsec. (f)(7)(A), probably means section 21(b) of the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Pub. L. 95–142, which is set out as a note under section 1395x of this title.
Amendments
2010—Subsec. (b)(5)(F). Pub. L. 111–148, § 6121(a)(2), inserted concluding provisions.
Subsec. (d)(1)(B). Pub. 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). Pub. L. 111–148, § 6103(c)(1), added subpar. (C). Former subpar. (C) redesignated (B).
Subsec. (f)(2)(A)(i)(I). Pub. 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). Pub. L. 111–148, § 6103(a)(3), added par. (8).
Subsec. (g)(5)(E). Pub. L. 111–148, § 6103(a)(2)(A), added subpar. (E).
Subsec. (h)(2)(B)(ii). Pub. L. 111–148, § 6111(a)(1), designated existing provisions as subcl. (I), inserted heading, substituted “Subject to subclause (II), the Secretary” for “The Secretary”, and added subcls. (II) to (IV).
Subsec. (h)(4). Pub. L. 111–148, § 6113(b), 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). Pub. L. 111–148, § 6111(a)(2), inserted “(ii)(IV),” after “(i),”.
Subsecs. (i), (j). Pub. L. 111–148, § 6103(a)(1), added subsec. (i) and redesignated former subsec. (i) as (j).
2003—Subsec. (b)(4)(C)(i). Pub. L. 108–173, § 736(a)(8)(A), substituted “at least” for “at least at least”.
Subsec. (d)(1)(A). Pub. L. 108–173, § 736(a)(8)(B), substituted “physical, mental” for “physical mental”.
Subsec. (f)(2)(B)(iii). Pub. L. 108–173, § 932(c)(2)(A), substituted “subparagraphs (C) and (D)” for “subparagraph (C)” in introductory provisions.
Pub. L. 108–173, § 736(a)(8)(C), realigned margins of concluding provisions.
Subsec. (f)(2)(D). Pub. L. 108–173, § 932(c)(2)(B), added subpar. (D).
2000–Subsec. (b)(8). Pub. L. 106–554 added par. (8).
1997—Subsec. (b)(3)(C)(i). Pub. L. 105–33, § 4432(b)(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). Pub. L. 105–15, § 1(1), inserted “subject to subparagraph (C),” after “(iii)”.
Subsec. (f)(2)(C). Pub. L. 105–15, § 1(2), added subpar. (C).
Subsec. (g)(1)(D), (E). Pub. L. 105–33, § 4755(a), added subpar. (D) and redesignated former subpar. (D) as (E).
1994—Subsec. (b)(3)(C)(i)(I). Pub. L. 103–432, § 110(b), substituted “but no later than 14 days” for “but no later than not later than 14 days”.
Subsec. (b)(5)(D). Pub. L. 103–432, § 106(d)(1), struck out comma before “or a new competency evaluation program”.
Subsec. (b)(5)(G). Pub. 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). Pub. 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). Pub. L. 103–432, § 106(c)(3)(A), substituted “$100” for “$50”.
Subsec. (e)(2)(B). Pub. 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). Pub. L. 103–432, § 106(d)(3), substituted “facilities (subject to clause (iii)),” for “facilities,”.
Subsec. (f)(2)(B)(iii)(I)(b). Pub. 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 (b), (c), and (d) of this section”.
Subsec. (f)(2)(B)(iii)(I)(c). Pub. L. 103–432, § 106(d)(4), substituted “clause” for “clauses” in two places.
Subsec. (g)(1)(C). Pub. 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). Pub. 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). Pub. 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. (b)(1)(B). Pub. 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. (b)(3)(C)(i)(I). Pub. L. 101–508, § 4008(h)(2)(C), substituted “not later than 14 days” for “4 days”.
Subsec. (b)(4)(A)(vii). Pub. L. 101–508, § 4008(h)(2)(D), added cl. (vii).
Subsec. (b)(4)(C)(ii)(IV), (V). Pub. L. 101–508, § 4008(h)(2)(E), added subcls. (IV) and (V).
Subsec. (b)(5)(A). Pub. 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. (b)(5)(C). Pub. L. 101–508, § 4008(h)(1)(C), substituted “any State registry established under subsection (e)(2)(A) of this section that the facility believes will include information” for “the State registry established under subsection (e)(2)(A) of this section as to information in the registry”.
Subsec. (b)(5)(D). Pub. L. 101–508, § 4008(h)(1)(D), inserted before period at end “, or a new competency evaluation program” after “and competency evaluation program”.
Subsec. (b)(5)(F)(i). Pub. L. 101–508, § 4008(h)(2)(F), substituted “(G)) or a registered dietician,” for “(G)),”.
Subsec. (c)(1)(A). Pub. 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). Pub. 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). Pub. L. 101–508, § 4008(h)(2)(G)(i), added cl. (x) and redesignated former cl. (x) as (xi).
Subsec. (c)(1)(B)(ii). Pub. 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). Pub. L. 101–508, § 4206(d)(1), added subpar. (E).
Subsec. (e)(1)(A). Pub. L. 101–508, § 4008(h)(2)(J), substituted “subsection (f)(2) of this section” for “clause (i) or (ii) of subsection (f)(2)(A) of this section”.
Subsec. (e)(2)(A). Pub. L. 101–508, § 4008(h)(2)(K)(i), inserted before period at end “, or any individual described in subsection (f)(2)(B)(ii) of this section or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989”.
Subsec. (e)(2)(C). Pub. L. 101–508, § 4008(h)(2)(K)(ii), added subpar. (C).
Subsec. (f)(2)(A)(ii). Pub. L. 101–508, § 4008(m)(3)(F)[(E)], struck out “and” after semicolon at end.
Subsec. (f)(2)(A)(iv). Pub. 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). Pub. 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). Pub. 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 (b), (c), or (d) of this section, within the previous 2 years, or”.
Subsec. (g)(1)(C). Pub. 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). Pub. 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). Pub. 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) of this section, with respect” for “with respect”.
1989—Subsec. (b)(5)(A). Pub. L. 101–239, § 6901(b)(1)(A), substituted “
Subsec. (b)(5)(B). Pub. L. 101–239, § 6901(b)(1)(B), substituted “
Subsec. (c)(1)(A)(ii)(II). Pub. 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). Pub. L. 101–239, § 6901(d)(4)(B), substituted “accommodation” for “accommodations”.
Subsec. (f)(2)(A)(i)(I). Pub. L. 101–239, § 6901(d)(4)(C), substituted “and content of the curriculum” for “, content of the curriculum”.
Pub. L. 101–239, § 6901(b)(3)(A), inserted “care of cognitively impaired residents,” after “social service needs,”.
Subsec. (f)(2)(A)(ii). Pub. L. 101–239, § 6901(b)(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). Pub. L. 101–239, § 6901(b)(3)(C), (D), added cl. (iv).
Subsec. (h)(2)(C). Pub. L. 101–239, § 6901(d)(4)(D), inserted “after the effective date of the findings” after “6 months” in introductory provisions.
1988—Subsec. (b)(3)(A)(iii). Pub. 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. (b)(3)(A)(iv). Pub. L. 100–360, § 411(l)(2)(A), as amended by Pub. 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. (b)(3)(B)(ii)(III). Pub. 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. (b)(3)(C)(i)(I). Pub. L. 100–360, § 411(l)(1)(A)(i), substituted “than
Subsec. (b)(4)(C)(i). Pub. 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. (b)(5)(A). Pub. L. 100–360, § 411(l)(2)(D)(i), as amended by Pub. L. 100–485, § 608(d)(27)(D), struck out “, who is not a licensed health professional (as defined in subparagraph (E)),” after “any individual”.
Pub. L. 100–360, § 411(l)(1)(A)(iii), substituted “
Subsec. (b)(5)(A)(ii). Pub. L. 100–360, § 411(l)(2)(D)(ii), substituted “nursing or nursing-related services” for “such services”.
Subsec. (b)(5)(G). Pub. L. 100–360, § 411(l)(2)(D)(iii), inserted “physical or occupational therapy assistant,” after “occupational therapist,”.
Subsec. (c)(1)(D). Pub. L. 100–360, § 411(l)(1)(A)(iv), as added by Pub. L. 100–485, § 608(d)(27)(A), added subpar. (D).
Subsec. (c)(2)(A)(v). Pub. 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). Pub. 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). Pub. L. 100–360, § 411(l)(1)(A)(v), formerly § 411(l)(1)(A)(iv), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.
Subsec. (e)(1)(B). Pub. L. 100–360, § 411(l)(1)(A)(vi), formerly § 411(l)(1)(A)(v), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.
Subsec. (e)(2)(A). Pub. L. 100–360, § 411(l)(1)(A)(vii), formerly § 411(l)(1)(A)(vi), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “January” for “March”.
Subsec. (e)(2)(B). Pub. 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). Pub. L. 100–360, § 411(l)(2)(I), inserted “and discharges” after “transfers” in heading and in two places in text.
Pub. L. 100–360, § 411(l)(1)(A)(viii), formerly § 411(l)(1)(A)(vii), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “1989” for “1990”.
Subsec. (e)(5). Pub. L. 100–360, § 411(l)(1)(A)(ix), formerly § 411(l)(1)(A)(viii), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “1990” for “1989” in introductory provisions.
Subsec. (f)(2)(A)(i)(I). Pub. 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). Pub. L. 100–360, § 411(l)(2)(I), inserted “and discharges” after “transfers” in heading and in text.
Pub. L. 100–360, § 411(l)(1)(A)(x), formerly § 411(l)(1)(A)(ix), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “1988” for “1989”.
Subsec. (f)(6)(A). Pub. L. 100–360, § 411(l)(1)(A)(xi), formerly § 411(l)(1)(A)(x), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “January” for “July”.
Subsec. (f)(6)(B). Pub. L. 100–360, § 411(l)(1)(A)(xii), formerly § 411(l)(1)(A)(xi), as redesignated by Pub. L. 100–485, § 608(d)(27)(A), substituted “April” for “October”.
Subsec. (f)(7)(A). Pub. L. 100–360, § 411(l)(2)(K), substituted “residents” for “patients”.
Subsec. (f)(7)(B). Pub. L. 100–360, § 411(l)(2)(L)(i), substituted “shall include” for “shall not include”.
Subsec. (g)(1)(C). Pub. 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). Pub. 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). Pub. 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). Pub. L. 100–360, § 411(l)(5)(F), as added by Pub. L. 100–485, § 608(d)(27)(I), substituted “practicable” for “practical”.
Subsec. (g)(2)(C)(i). Pub. L. 100–360, § 411(l)(4), substituted “January” for “October”.
Subsec. (g)(3)(D). Pub. L. 100–360, § 411(l)(5)(G), formerly § 411(l)(5)(F), as redesignated by Pub. L. 100–485, § 608(d)(27)(I), substituted “on the basis of that survey” for “on that basis”.
Subsec. (g)(4). Pub. L. 100–360, § 411(l)(5)(H), formerly § 411(l)(5)(G), as redesignated by Pub. L. 100–485, § 608(d)(27)(I), struck out “chronically” after “enforcement actions against” in last sentence.
Subsec. (h)(2)(B)(ii). Pub. L. 100–360, § 411(l)(7)(A), substituted “. The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) 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). Pub. L. 100–360, § 411(l)(11), as added by Pub. 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). Pub. L. 100–360, § 411(l)(7)(B), inserted “by such facilities” after “be made available”.
1987—Subsecs. (g) to (i). Pub. L. 100–203, §§ 4202(a)(2), 4203(a)(2), 4206, added subsecs. (g), (h), and (i), respectively.
Effective Date Of Amendment
Pub. L. 111–148, title VI, § 6101(c)(2),
Pub. L. 111–148, title VI, § 6103(a)(2)(B),
Pub. L. 111–148, title VI, § 6103(c)(3),
Pub. L. 111–148, title VI, § 6111(c),
Amendment by section 6113(b) of Pub. L. 111–148 effective 1 year after
Pub. L. 111–148, title VI, § 6121(c),
Pub. L. 108–173, title IX, § 932(d),
Pub. L. 106–554, § 1(a)(6) [title IX, § 941(c)],
Pub. L. 105–33, title IV, § 4432(d),
Pub. L. 103–432, title I, § 106(c)(1)(B),
Pub. L. 103–432, title I, § 106(c)(2)(B),
Pub. L. 103–432, title I, § 106(c)(3)(B),
Pub. L. 103–432, title I, § 106(c)(4)(C),
Pub. L. 103–432, title I, § 106(d)(7),
Amendment by Pub. L. 102–375 inapplicable with respect to fiscal year 1993, see section 4(b) of Pub. L. 103–171, set out as a note under section 3001 of this title.
Amendment by Pub. L. 102–375 inapplicable with respect to fiscal year 1992, see section 905(b)(6) of Pub. L. 102–375, set out as a note under section 3001 of this title.
Pub. L. 101–508, title IV, § 4008(h)(1)(F)(ii),
Pub. L. 101–508, title IV, § 4008(h)(1)(H),
Pub. L. 101–508, title IV, § 4008(h)(2)(P),
Pub. L. 101–508, title IV, § 4206(e)(1),
Pub. L. 101–239, title VI, § 6901(b)(6),
Pub. L. 101–239, title VI, § 6901(d)(6),
Amendment by Pub. L. 100–485 effective as if originally included in the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Pub. L. 100–485, set out as a note under section 704 of this title.
Except as specifically provided in section 411 of Pub. L. 100–360, amendment by Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.
Effective Date
Pub. L. 100–203, title IV, § 4204,
Miscellaneous
Pub. L. 111–148, title VI, § 6103(d)(1), (3),
Pub. L. 111–148, title VI, § 6103(e),
Pub. L. 111–148, title VI, § 6114,
Pub. L. 108–173, title I, § 107(b),
Pub. L. 106–113, div. B, § 1000(a)(6) [title I, § 107],
Pub. L. 105–33, title IV, § 4755(c),
Pub. L. 104–134, title I, § 101(d) [title V, § 516(d)],
Pub. L. 101–508, title IV, § 4008(h)(2)(O),
Pub. L. 101–239, title VI, § 6901(b)(2),
Pub. L. 101–239, title VI, § 6901(b)(4)(B)–(D),
Pub. L. 100–203, title IV, § 4201(c),
Pub. L. 100–203, title IV, § 4205,