104 STAT. 1388-218 PUBLIC LAW 101-508 —NOV. 5, 1990 tion (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989."; and (B) by adding at the end the following new subparagraph: "(C) PROHIBITION AGAINST CHARGES. —A State may not impose any charges on a nurse aide relating to the registry established and maintained under subparagraph (A).". (13) CLARIFICATION ON FINDINGS OF NEGLECT. —Section 1919(g)(l)(C) (42 U.S.C. 1396r(g)(l)(C)) is amended by adding at the end the following: "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.". (14) TIMING OF PUBLIC DISCLOSURE OF SURVEY RESULTS. — Section 1919(g)(5)(A)(i) (42 U.S.C. 1396r(g)(5)(A)(i)) is amended by striking "deficiencies and plans" and inserting "deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans". (15) OMBUDSMAN PROGRAM COORDINATION WITH STATE SURVEY AND CERTIFICATION AGENCIES.— SectioD 1919(g)(5)(B) (42 U.S.C. 1396r(g)(5)(B)) is amended by striking "with respect" and inserting "or of any adverse action taken against a nursing facility under paragraphs (1), (2), or (3) of subsection (h), with respect'. (16) DENIAL OF PAYMENT OF LEGAL FEES FOR FRIVOLOUS UTIGA- TION.— (A) IN GENERAL.— Section 1903(i) (42 U.S.C. 1396b(i)), [[as amended by section X???(a)(l)(B) of this Act]], is amended— (i) by striking "or" at the end of paragraph (9); (ii) by striking the period at the end of paragraph (10) and inserting "; or"; and (iii) by inserting after paragraph (10) the following new paragraph: "(11) with respect to any amount expended to reimburse (or otherwise compensate) a nursing facility for payment of legal expenses associated with any action initiated by the facility that is dismissed on the basis that no reasonable legal ground existed for the institution of such action." 42 USC 1396b (B) EFFECTIVE DATE.— The amendments made by subpara- •*<>**• graph (A) shall apply with respect to actions initiated on or after the date of the enactment of this Act. 42 USC 1396r (17) PROVISIONS RELATING TO STAFFING REQUIREMENTS.— "<***• (A) MAINTAINING REGULATORY STANDARDS FOR CERTAIN SERVICES. —Any regulations promulgated and applied by the Secretary of Health and Human Services after the date of the enactment of the Omnibus Budget Reconciliation Act of 1987 with respect to services described in clauses (ii), (iv), and (v) of section 1919(b)(4)(A) of the Social Security Act shall include requirements for providers of such services that are at least as strict as the requirements applicable to providers of such services prior to the enactment of the Omnibus Budget Reconciliation Act of 1987. (B) STUDY ON STAFFING REQUIREMENTS IN NURSING FACILI- TiES. —The Secretary shall conduct a study and report to Congress no later than January 1, 1992, on the appropriateness of establishing minimum caregiver to resident ratios and minimum supervisor to caregiver ratios for skilled nursing facilities serving as providers of services under title
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