reductions in negative, adverse patient events. Improved patient satisfaction due to appropriate nurse staffing is reflected in hospitals’ patient satisfaction survey results, which are publicly reported, and are a key measure for value-based payment programs. (6) Research indicates that patients who receive care during periods of sub-optimal nurse staffing experience increased rates of medication errors, increased rates of death, increased rates of failure-to-rescue, and worse outcomes. (7) As a payor for inpatient and outpatient hospital services furnished to Medicare beneficiaries, the Federal Government has a compelling interest in promoting the safety of hospitalized patients by requiring any hospital participating in the Medicare program to establish appropriate registered nurse staffing levels. 3. Establishment of safe nurse staffing levels by Medicare participating hospitals (a) Requirement of medicare provider agreement Section 1866(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc(a)(1) ) is amended— (1) by striking and at the end of subparagraph (X)