; and (B) by adding at the end the following new subparagraphs: (C) Distinctions for high-rated and low-rated facilities On and after the date the Secretary implements the high-rated facility program under subsection (f)(12) and makes the conversion under subsection (f)(10)(D), the Secretary shall ensure that graphics, including an appropriate explanation of such graphics, are prominently displayed on the website described in subparagraph (A) in order to distinguish each of the following: (i) Nursing facilities that are designated as high-rated nursing facilities under subsection (f)(12). (ii) Nursing facilities that are participating in the low-rated facility program under subsection (f)(10), with information on facilities that have been placed in such program more than one time over the course of the last 10 years (including the number of times such nursing facilities have been placed in the program). (D) Focus groups and consumer testing In order to help limit confusion, particularly among older adults, individuals with disabilities, and family caregivers, the Secretary shall utilize focus groups and other consumer testing methods prior to including the additional information under subparagraph (A)(vi) and implementing the distinctions under subparagraph (C). . (d) GAO study and report (1) Study The Comptroller General of the United States (in this section referred to as the Comptroller General ) shall conduct a study on the quality of items and services furnished by skilled nursing facilities under title XVIII of the Social Security Act and nursing facilities under title XIX of such Act, and such facilities' compliance with the applicable requirements under such titles. Such study shall include analysis of the following: (A) The effectiveness of the low-rated facility program established under paragraph (8) of section 1819(f) of the Social Security Act ( 42 U.S.C. 1395i–3(f) ), as amended by subsection (b)(2), and under paragraph (10) of section 1919(f) of such Act ( 42 U.S.C. 1396r(f) ), as amended by