; (2) in paragraph (4), by striking the period and inserting ; and ; (3) by inserting after paragraph (4) the following new paragraph: (5) shall be submitted not less frequently than quarterly, on a schedule specified by the Secretary. ; and (4) by adding at the end the following new sentence: The Secretary shall not waive the requirements of this subsection in the case of an infectious disease outbreak (as defined in section 1819(d)(3)(C)). . 5. GAO study and report Not later than one year after the end of the COVID-19 emergency period (as described in section 1135(g)(1)(B) of the Social Security Act ( 42 U.S.C. 1320b–5(g)(1)(B) ), the Comptroller General of the United States shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report analyzing deficiencies during such period in infection control measures and direct care staffing requirements for skilled nursing facilities (as defined in section 1819(a) of the Social Security Act ( 42 U.S.C. 1395i–3(a) )), as reported by the Administrator under section 2(d)(1). 6. Effective date The amendments made by this Act shall apply with respect to skilled nursing facilities and nursing facilities beginning on the date of the enactment of this Act.