; (II) the facility has not received deficiencies related to direct patient harm for substandard quality of care deficiencies in the prior 2 years; and (III) the Secretary certifies that the civil monetary penalty assessed under clause (i)(I) did not result in immediate jeopardy for direct patient harm or injury related to an abuse or neglect deficiency. For purposes of rescinding disapproval under this clause, the Secretary may require additional oversight of the skilled nursing facility for a period not to exceed the period of disapproval imposed under clause (i) with respect to such facility. . (b) Medicaid Section 1919(f)(2) of the Social Security Act ( 42 U.S.C. 1396r(f)(2) ) is amended— (1) in subparagraph (A)(iv)(I), by striking (unless the facility is described in subparagraph (B)(iii)(I)) ; (2) in subparagraph (B)— (A) in clause (i), by inserting and after the semicolon; (B) in clause (ii), by striking ; and and inserting a period; (C) by striking clause (iii); and (D) by striking A State may not delegate (through subcontract or otherwise) its responsibility under clause (iii)(II) to the nursing facility. ; (3) by striking subparagraphs (C) and (D); and (4) 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 shall, in consultation with such State, disapprove, for a period not to exceed 2 years, 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 $10,697 for providing substandard quality of care