National Independent Monitor Demonstration Project

Pub. L. 111–148, title VI, § 6112, Mar. 23, 2010, 124 Stat. 716, provided that:

“(a)

Establishment.—

“(1)

In general.—

The Secretary [of Health and Human Services], in consultation with the Inspector General of the Department of Health and Human Services, shall conduct a demonstration project to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.

“(2)

Selection.—

The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the demonstration project under this section from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

“(3)

Duration.—

The Secretary shall conduct the demonstration project under this section for a 2-year period.

“(4)

Implementation.—

The Secretary shall implement the demonstration project under this section not later than 1 year after the date of the enactment of this Act [Mar. 23, 2010].

“(b)

Requirements.—

The Secretary shall evaluate chains selected to participate in the demonstration project under this section based on criteria selected by the Secretary, including where evidence suggests that a number of the facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes a number of facilities participating in the ‘Special Focus Facility’ program (or a successor program) or multiple facilities with a record of repeated serious safety and quality of care deficiencies.

“(c)

Responsibilities.—

An independent monitor that enters into a contract with the Secretary to participate in the conduct of the demonstration project under this section shall—

“(1)

conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with State and Federal laws and regulations applicable to the facilities;

“(2)

conduct sustained oversight of the efforts of the chain, whether publicly or privately held, to achieve compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;

“(3)

analyze the management structure, distribution of expenditures, and nurse staffing levels of facilities of the chain in relation to resident census, staff turnover rates, and tenure;

“(4)

report findings and recommendations with respect to such reviews, analyses, and oversight to the chain and facilities of the chain, to the Secretary, and to relevant States; and

“(5)

publish the results of such reviews, analyses, and oversight.

“(d)

Implementation of Recommendations.—

“(1)

Receipt of finding by chain.—

Not later than 10 days after receipt of a finding of an independent monitor under subsection (c)(4), a chain participating in the demonstration project shall submit to the independent monitor a report—

“(A)

outlining corrective actions the chain will take to implement the recommendations in such report; or

“(B)

indicating that the chain will not implement such recommendations, and why it will not do so.

“(2)

Receipt of report by independent monitor.—

Not later than 10 days after receipt of a report submitted by a chain under paragraph (1), an independent monitor shall finalize its recommendations and submit a report to the chain and facilities of the chain, the Secretary, and the State or States, as appropriate, containing such final recommendations.

“(e)

Cost of Appointment.—

A chain shall be responsible for a portion of the costs associated with the appointment of independent monitors under the demonstration project under this section. The chain shall pay such portion to the Secretary (in an amount and in accordance with procedures established by the Secretary).

“(f)

Waiver Authority.—

The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary for the purpose of carrying out the demonstration project under this section.

“(g)

Authorization of Appropriations.—

There are authorized to be appropriated such sums as may be necessary to carry out this section.

“(h)

Definitions.—

In this section:

“(1)

Additional disclosable party.—

The term ‘additional disclosable party’ has the meaning given such term in section 1124(c)(5)(A) of the Social Security Act [42 U.S.C. 1320a–3(c)(5)(A)], as added by section 4201(a) [probably should be “6101(a)”].

“(2)

Facility.—

The term ‘facility’ means a skilled nursing facility or a nursing facility.

“(3)

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)).

“(4)

Secretary.—

The term ‘Secretary’ means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation.

“(5)

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)]).

“(i)

Evaluation and Report.—

“(1)

Evaluation.—

The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall evaluate the demonstration project conducted under this section.

“(2)

Report.—

Not later than 180 days after the completion of the demonstration project under this section, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations—

“(A)

as to whether the independent monitor program should be established on a permanent basis;

“(B)

if the Secretary recommends that such program be so established, on appropriate procedures and mechanisms for such establishment; and

“(C)

for such legislation and administrative action as the Secretary determines appropriate.”