S. 4467

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4467 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4467

To amend titles XVIII and XIX of the Social Security Act with respect 
to nursing facility requirements, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

April 30, 2026

Mr. Warner (for himself, Mr. Scott of South Carolina, Mr. Kelly, and 
Mr. Barrasso) introduced the following bill; which was read twice and 
referred to the Committee on Finance

_______________________________________________________________________

A BILL

To amend titles XVIII and XIX of the Social Security Act with respect 
to nursing facility requirements, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Ensuring Seniors' Access to Quality 
Care Act''.

SEC. 2. TRAINING AND COMPETENCY EVALUATION PROGRAMS.

(a) Medicare.--Section 1819(f)(2) of the Social Security Act (42 
U.S.C. 1395i-3(f)(2)) is amended--
(1) in subparagraph (A)(iv)(I), by striking ``(unless the 
facility is described in subparagraph (B)(iii)(I))'';
(2) in subparagraph (B)--
(A) in clause (i)--
(i) by striking ``(subject to clause 
(iii))''; and
(ii) by inserting ``and'' after the 
semicolon;
(B) in clause (ii), by striking ``; and'' and 
inserting a period; and
(C) by striking clause (iii);
(3) by striking ``A State may not delegate (through 
subcontract or otherwise) its responsibility under clause 
(iii)(II) to the skilled nursing facility.'';
(4) by striking subparagraphs (C) and (D); and
(5) by adding at the end the following:
``(C) Disapproval of nurse aide training and 
competency evaluation programs and nurse aide 
competency evaluation programs.--
``(i) In general.--With respect to a State, 
the Secretary shall, in consultation with such 
State, disapprove, for a period not to exceed 2 
years, a nurse aide training and competency 
evaluation program or a nurse aide competency 
evaluation program offered by or in a skilled 
nursing facility if such facility--
``(I) has been assessed a civil 
monetary penalty under subsection 
(h)(2)(B)(ii) or section 
1919(h)(2)(A)(ii) of not less than 
$10,697 for providing substandard 
quality of care; and
``(II) has not, in the 
determination of the Secretary, 
corrected the deficiencies in quality 
of care for which such civil monetary 
penalty was assessed.
``(ii) Rescission of disapproval.--The 
Secretary shall rescind a disapproval under 
clause (i) upon demonstration by a skilled 
nursing facility that--
``(I) all deficiencies for which 
the civil monetary penalty described in 
clause (i)(I) was assessed have been 
remedied;
``(II) the facility has not 
received deficiencies related to direct 
patient harm for substandard quality of 
care deficiencies in the prior 2 years; 
and
``(III) the Secretary certifies 
that the civil monetary penalty 
assessed under clause (i)(I) did not 
result in immediate jeopardy for direct 
patient harm or injury related to an 
abuse or neglect deficiency.
For purposes of rescinding disapproval under 
this clause, the Secretary may require 
additional oversight of the skilled nursing 
facility for a period not to exceed the period 
of disapproval imposed under clause (i) with 
respect to such facility.''.
(b) Medicaid.--Section 1919(f)(2) of the Social Security Act (42 
U.S.C. 1396r(f)(2)) is amended--
(1) in subparagraph (A)(iv)(I), by striking ``(unless the 
facility is described in subparagraph (B)(iii)(I))'';
(2) in subparagraph (B)--
(A) in clause (i), by inserting ``and'' after the 
semicolon;
(B) in clause (ii), by striking ``; and'' and 
inserting a period;
(C) by striking clause (iii); and
(D) by striking ``A State may not delegate (through 
subcontract or otherwise) its responsibility under 
clause (iii)(II) to the nursing facility.'';
(3) by striking subparagraphs (C) and (D); and
(4) by adding at the end the following:
``(C) Disapproval of nurse aide training and 
competency evaluation programs and nurse aide 
competency evaluation programs.--
``(i) In general.--With respect to a State, 
the Secretary shall, in consultation with such 
State, disapprove, for a period not to exceed 2 
years, a nurse aide training and competency 
evaluation program or a nurse aide competency 
evaluation program offered by or in a nursing 
facility if such facility--
``(I) has been assessed a civil 
monetary penalty under section 
1819(h)(2)(B)(ii) or subsection 
(h)(2)(A)(ii) of not less than $10,697 
for providing substandard quality of 
care; and
``(II) has not, in the 
determination of the Secretary, 
corrected the deficiencies in quality 
of care for which such civil monetary 
penalty was assessed.
``(ii) Rescission of disapproval.--The 
Secretary shall rescind a disapproval under 
clause (i) upon demonstration by a nursing 
facility that--
``(I) all deficiencies for which 
the civil monetary penalty described in 
clause (i)(I) was assessed have been 
remedied;
``(II) the facility has not 
received deficiencies related to direct 
patient harm for substandard quality of 
care deficiencies in the prior 2 years; 
and
``(III) the Secretary certifies 
that the civil monetary penalty 
assessed under clause (i)(I) did not 
result in immediate jeopardy for direct 
patient harm or injury related to an 
abuse or neglect deficiency.
For purposes of rescinding disapproval under 
this clause, the Secretary may require 
additional oversight of the nursing facility 
for a period not to exceed the period of 
disapproval imposed under clause (i) with 
respect to such facility.''.
(c) Regulations.--Not later than 180 days after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
promulgate regulations as necessary to implement the amendments made by 
this section.
(d) Applicability.--
(1) In general.--
(A) Timing of determinations.--The amendments made 
by subsections (a)(4) and (b)(4) of this section shall 
apply only to a civil monetary penalty if the relevant 
covered determination was made on or after the date of 
enactment of this Act.
(B) Covered determination defined.--The term 
``covered determination'' means, with respect to a 
skilled nursing facility or a nursing facility in a 
State, a determination by the State or the Secretary of 
Health and Human Services that the facility has 
provided a substandard quality of care for which a 
civil monetary penalty described in section 
1819(f)(2)(C)(i)(I) or 1919(f)(2)(C)(i)(I) of the 
Social Security Act (as such sections have been amended 
by this Act) may be assessed.
(2) Previously prohibited programs.--
(A) Waiver.--With respect to a skilled nursing 
facility or a nursing facility subject, on the day 
before the date of enactment of this Act, to a 
prohibition under item (a) of either section 
1819(f)(2)(B)(iii)(I) or section 1919(f)(2)(B)(iii)(I) 
of the Social Security Act (as in effect on the day 
before such date of enactment), such prohibition shall 
no longer apply to the facility on or after such date 
of enactment.
(B) Survey or civil monetary penalty.--With respect 
to a skilled nursing facility or a nursing facility 
subject, on the day before the date of enactment of 
this Act, to a prohibition under item (b) or (c) of 
either section 1819(f)(2)(B)(iii)(I) or section 
1919(f)(2)(B)(iii)(I) of the Social Security Act (as in 
effect on the day before such date of enactment), such 
prohibition shall no longer apply to the facility on or 
after such date of enactment upon a determination by 
the Secretary of Health and Human Services that the 
facility has corrected the issue that resulted in such 
prohibition.

SEC. 3. PERMITTING MEDICARE AND MEDICAID PROVIDERS TO ACCESS THE 
NATIONAL PRACTITIONER DATA BANK TO CONDUCT EMPLOYEE 
BACKGROUND CHECKS.

Section 1921(b)(6) of the Social Security Act (42 U.S.C. 1396r-
2(b)(6)) is amended--
(1) by striking ``and other health care entities (as 
defined in section 431 of the Health Care Quality Improvement 
Act of 1986)'' and inserting ``, other health care entities (as 
defined in section 431 of the Health Care Quality Improvement 
Act of 1986), providers of services (as defined in section 
1861(u)), suppliers (as defined in section 1861(d)), and 
providers of items or services under a State plan under this 
title (or a waiver of such a plan)''; and
(2) by striking ``such hospitals or other health care 
entities'' and inserting ``such hospitals, health care 
entities, providers, or suppliers''.
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