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1 hardship to the facility's patients or if he finds it impracti2 cable within the twelve-month period to determine whether 3 the facility is complying with the provisions of this title and 4 applicable regulations. The State agency may upon approval 5 of the Secretary enter into an agreement with any skilled 6 nursing or intermediate care facility for the specified approval 7 period.


"(c) The Secretary may cancel approval of any skilled 9 nursing or intermediate care facility at any time if he finds 10 that a facility fails to meet the requirements contained in 11 section 1902 (a) (28) or section 1905 (c), or if he finds 12 grounds for termination of his agreement with the facility 13 pursuant to section 1866 (b). In that event the Secretary 14 shall notify the State agency and the skilled nursing or inter15 mediate care facility that approval of eligibility of the facility 16 to participate in the programs established by this title and 17 title XVIII shall be terminated at a time specified by the 18 Secretary. The approval of eligibility of any such facility to 19 participate in the programs may not be reinstated unless the 20 Secretary finds that the reason for termination has been re

21 moved and there is reasonable assurance that it will not

22 23




“(d) Effective July 1, 1978, no payment may be made

24 to any State under this title for skilled nursing or intermedi25 ate care facility services furnished by any facility—









"(1) which does not have in effect an agreement with the State agency pursuant to subsection (b), or


'(2) whose approval of eligibility to participate in

the programs established by this title or title XVIII has been terminated by the Secretary and has not been reinstated, except that payment may be made for up to

thirty days for skilled nursing or intermediate care fa

8 cility services furnished to any eligible individual who




was admitted to the facility prior to the effective date of the termination.".

"(e) Any skilled nursing facility or intermediate care 12 facility which is dissatisfied with any determination by the 13 Secretary that it no longer qualifies as a skilled nursing 14 facility or intermediate care facility for purposes of this 15 title shall be entitled to a hearing by the Secretary to the 16 same extent as is provided in section 205 (b) and to judicial 17 review of the Secretary's final decision after such hearing as 18 is provided in section 205 (g). Any agreement between such 19 facility and the State agency shall remain in effect until the 20 period for filing a request for a hearing has expired or, if a 21 request has been filed, until a decision has been made by the 22 Secretary: Provided, however, That the agreement shall 23 not be extended if the Secretary makes a written determina24 tion, specifying the reasons therefor, that the continuation 25 of provider status constitutes an immediate and serious


1 threat to the health and safety of patients, and if the Secre

2 tary certifies that the facility has been notified of its defi

3 ciencies and has failed to correct them.”.


(b) Section 1869 (c) of the Social Security Act is 5 amended by adding at the end the following sentence: "If 6 the Secretary's determination terminates a provider with an 7 existing agreement pursuant to section 1866 (b) (2), or if 8 that determination consists of a refusal to renew an existing 9 provider agreement, the provider's agreement shall remain in 10 effect until the period for filing a request for a hearing has 11 expired or, if a request has been filed, until a final decision 12 has been made by the Secretary: Provided, however, That 13 the agreement shall not be extended if the Secretary makes a 14 written determination, specifying the reasons therefor, that 15 the continuation of provider status constitutes an immediate 16 and serious threat to the health and safety of patients and if 17 the Secretary certifies that the provider has been notified 18 of such deficiencies and has failed to correct them.".


(c) The amendments made by this section shall be20 come effective on the date on which final regulations, promul21 gated by the Secretary to implement the amendments, are 22 issued; and those regulations shall be issued not later than


1 the first day of the sixth calendar month following the month

2 in which this Act is enacted.





SEC. 23. Section 1903 of the Social Security Act is 6 amended by adding:


"(1) In the administration of this title, the fact that an 8 individual who is an inpatient of a skilled nursing or inter9 mediate care facility leaves to make visits outside the facility 10 shall not conclusively indicate that he does not need services 11 which the facility is designed to provide; however, the fre12 quency and length of visits away shall be considered, to13 gether with other evidence, in determining whether the in14 dividual is in need of the facility's services.".






SEC. 30. (a) Section 702 of the Social Security Act is

18 amended





(1) by inserting "(a)" immediately after "SEC. 702.", and

(2) by adding at the end the following subsection: 22 "(b) The Secretary shall establish, within the De23 partment of Health, Education, and Welfare, a separate 24 organization to be known as the Health Care Financing 25 Administration (which shall include the functions and per


1 sonnel of administrative entities known as of January 1, 1977 2 as the 'Bureau of Health Insurance', the 'Medical Services 3 Administration', the 'Bureau of Quality Assurance' (includ4 ing the National Professional Standards Review Council), 5 and the 'Office of Long-Term Care' and related research 6 and statistical units (including the Division of Health In7 surance Studies of the Social Security Administration) 8 which shall be under the direction of the Assistant Secre9 tary for Health Care Financing, who shall report directly 10 to the Secretary and who shall have policy and adminis11 trative responsibility (including policy and administrative 12 responsibility with respect to health care standards and certi13 fication requirements as they apply to practitioners and in14 stitutions) for the programs established by titles XVIII 15 and XIX, part B of title XI, for the renal disease program 16 established by section 226 and any other health care financ17 ing programs as may be established under this Act. The 18 Assistant Secretary may not have any other duties or func19 tions assigned to him which would prevent him from carrying 20 out the duties required under the preceding sentence on a full21 time basis.

22 (b) (1) There shall be in the Department of Health, 28 Education, and Welfare an Assistant Secretary for Health 24 Care Financing, who shall be appointed by the President, 25 by and with the advice and consent of the Senate.

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