; and and inserting a period; (iii) by striking clause (iii); and (iv) by striking A State may not delegate (through subcontract or otherwise) its responsibility under clause (iii)(II) to the nursing facility. ; (C) by striking subparagraphs (C) and (D); and (D) 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 may, in consultation with such State, disapprove 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 $10,483 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 facility that all deficiencies for which the civil monetary penalty described in clause (i)(I) was assessed have been remedied.