[House Report 105-23]
[From the U.S. Government Publishing Office]
105th Congress Rept. 105-23
HOUSE OF REPRESENTATIVES
1st Session Part 1
_______________________________________________________________________
WAIVER OF MEDICARE AND MEDICAID NURSING FACILITY PROHIBITION
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March 13, 1997.--Ordered to be printed
_______________________________________________________________________
Mr. Archer, from the Committee on Ways and Means, submitted the
following
R E P O R T
[To accompany H.R. 968]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 968) to amend title XVIII and XIX of the Social
Security Act to permit a waiver of the prohibition of offering
nurse aide training and competency evaluation programs in
certain nursing facilities, having considered the same, report
favorably thereon with amendments and recommend that the bill
as amended do pass.
CONTENTS
Page
I. Introduction......................................................2
A. Purpose and Summary................................... 2
B. Background and Need for Legislation................... 2
C. Legislative History................................... 2
II. Explanation of the Bill...........................................3
III.Vote of the Committee.............................................3
IV. Budgets Effects of the Bill.......................................4
A. Committee Estimate of Budgetary Effects............... 4
B. Statement Regarding New Budget Authority and Tax
Expenditures........................................... 4
C. Cost Estimate Prepared by the Congressional Budget
Office................................................. 4
V. Other Matters To Be Discussed Under the Rules of the House........5
A. Committee Oversight Findings and Recommendations...... 5
B. Summary of Findings and Recommendations of the
Government Operations Committee........................ 5
C. Constitutional Authority.............................. 5
VI. Changes in Existing Law Made by the Bill, as Reported.............5
The amendments (stated in terms of the page and line
numbers of the introduced bill) are as follows:
Page 2, line 12, strike ``(iii)'' and insert ``(iii)(I)''.
Page 2, line 14, insert ``(or skilled nursing facility for
purposes of title XVIII)'' after ``nursing facility''.
I. Introduction
a. purpose and summary
H.R. 968 amends title XVIII and title XIX of the Social
Security Act to permit a waiver of the prohibition on offering
nurse aide training and competency evaluation programs in
certain nursing facilities. This measure permits a State to
waive the current prohibition if the State: (1) determines that
there is no other program offered within a reasonable distance
of the facility; (2) assures, through an oversight effort, that
an adequate environment exists for operating the program in the
facility; and, (3) provides notice of such determination to the
State long-term care ombudsman.
b. background and need for legislation
Under current law, a nursing facility may lose its ability
to offer facility-based nurse aide training and competency
evaluation programs for reasons that may be unrelated to the
quality of its training activities. This unintended consequence
of current law arises from instances in which a deficiency may
exist, but may be unrelated to the nurse aide training and
evaluation programs, and is being or has been corrected. As a
result, nursing facilities, particularly those in rural
communities, face difficulties filling staff positions because
they are prevented from conducting on-site nurse aide training
and evaluation programs.
This measure would revise current law to permit the
continuation of nurse aide training and competency evaluation
programs in affected facilities under certain circumstances. In
order for a facility to continue its training and evaluation
programs, the State in which the facility is located would have
to make a determination that no similar program is in existence
within a reasonable distance of the facility, conduct oversight
activities to ensure that an adequate environment exists for
operating the program in the facility, and provide notice of
such determination to the State long-term care ombudsman. The
Committee and the Administration agree that these training
programs should continue under certain circumstances.
c. legislative history
Committee bill
H.R. 968 was introduced March 6, 1997 by Mr. Ehrlich of
Maryland, et al., and referred to the Committee on Ways and
Means, and in addition, to the Committee on Commerce. The bill,
as introduced, contained a provision to permit a waiver of the
prohibition of offering nurse aide training and competency
evaluation programs in certain nursing facilities. The
Committee on Ways and Means considered the bill on March 12,
1997, and ordered the bill favorably reported, without
amendment, by voice vote, with a quorum present.
Legislative hearing
The Committee of Ways and Means held a hearing on Medicare
payment and policy issues related to skilled nursing facilities
on March 4, 1997.
II. Explanation of the Bill
permit a waiver of the prohibition of offering nurse aide training and
competency evaluation programs in certain nursing facilities (sec. 1 of
the bill and sec. 4201(f)(1) of obra 1987)
Present law
Under Medicare and Medicaid, nursing facilities must comply
with federal and state laws regarding nurse aide training and
competency evaluation programs. OBRA 1987 required the
Secretary of Health and Human Services to establish and enforce
such requirements. As such, if a nursing facility has been
subject to an extended (or partial extended) survey, it is
prohibited from operating a nurse aide training and competency
evaluation program.
Explanation of provision
The provision would permit a waiver of the prohibition of
offering nurse aide training and competency evaluation programs
in certain nursing facilities if the State: (1) determines
there is no other training program within a reasonable distance
of the facility; (2) assures that an adequate environment
exists for operating the program in the facility; and, (3)
provides notice to the State long-term care ombudsman.
Reasons for change
Nursing facilities in rural areas face difficulties
recruiting nurse aides; many rural areas have no such training
facilities, making it difficult to recruit nurse aides which
may affect patient care. Nursing home providers, particularly
those located in rural communities, have raised concerns about
the prohibition on nurse aide training and competency
evaluation programs in a facility as the result of being
subject to an extended (or partial extended) survey.
Effective date
The provision is effective upon enactment.
III. Vote of the Committee
In compliance with clause 2(l)(2)(B) of rule XI of the
Rules of the House of Representatives, the following statement
is made concerning the vote of the Committee in its
consideration of the bill, H.R. 968:
MOTION TO REPORT THE BILL
The bill, H.R. 968, was ordered favorably reported by voice
vote on March 12, 1997, with a quorum present.
IV. Budget Effects of the Bill
A. Committee Estimate of Budgetary Effects
In compliance with clause 7(a) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of this bill, H.R. 968, as
reported: The Committee agrees with the estimate prepared by
CBO which is included below.
B. STATEMENT REGARDING NEW BUDGET AUTHORITY AND TAX EXPENDITURES
In compliance with subdivision (B) of clause 2(l)(3) rule
XI of the Rules of the House of Representatives, the Committee
states that the provisions of H.R. 968 do not involve any new
budget authority, or any increase or decrease in revenues or
tax expenditures.
C. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET OFFICE
In compliance with subdivision (C) of clause 2(l)(3) of
rule XI of the Rules of the House of Representatives, requiring
a cost estimate prepared by the Congressional Budget Office,
the following report prepared by CBO is provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 13, 1997.
Hon. Bill Archer,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 968, a bill to
permit a waiver of the prohibition of offering nurse aide
training and competency evaluation programs in certain nursing
facilities.
If you wish for further details on this estimate, we will
be pleased to provide them. The CBO staff contact is Robin
Rudowitz.
Sincerely,
June E. O'Neill, Director.
Enclosure.
H.R. 968--A bill to permit a waiver of the prohibition of offering
nurse aide training and competency evaluation programs in
certain nursing facilities
CBO estimates that enactment of this bill would have no
budgetary impact.
Nursing facilities must meet certain requirements to be
certified for payment by the Medicare and Medicaid programs.
Among these are provisions included in the Omnibus Budget
Reconciliation Act of 1987 that require nursing facilities to
conduct nurse aid training and competency evaluation programs.
However, the Secretary can approve such programs at nursing
facilities only under certain conditions. In rural areas where
there are no nearby training programs, the bill would allow the
Secretary to waive some of the restrictions so that a training
program could be conducted at a nursing facility as long as the
program was not conducted by the nursing facility.
This bill contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act of 1995
(UMRA) and would impose no costs on state, local, or tribal
governments.
The CBO staff contact for the estimate is Robin Rudowitz.
This estimate was approved by Paul N. Van de Water, Assistant
Director for Budget Analysis.
V. Other Matters To Be Discussed Under the Rules of the House
A. COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS
With respect to subdivision (A) of clause 2(l)(3) of rule
XI of the Rules of the House of Representatives (relating to
oversight findings), the Committee advises that it was as a
result of its oversight activities with respect to the Medicare
program that the Committee concluded that it is appropriate to
enact the provision contained in the bill as reported.
B. SUMMARY OF FINDINGS AND RECOMMENDATIONS OF THE COMMITTEE ON
GOVERNMENT REFORM AND OVERSIGHT
With respect to subdivision (D) of clause 2(l)(3) of rule
XI of the Rules of the House of Representatives (relating to
oversight findings), the Committee advises that no oversight
findings or recommendations have been submitted to this
Committee by the Committee on Government Reform and Oversight
with respect to the provisions contained in this bill.
C. CONSTITUTIONAL AUTHORITY STATEMENT
With respect to clause 2(l)(4) of rule XI of the Rules of
the House of Representatives, relating to Constitutional
Authority, the Committee states that the Committee's action in
reporting the bill is derived from Article I of the
Constitution, Section 8 (``The Congress shall have power to lay
and collect taxes, duties, imposts and excises, to pay the
debts and to provide for * * * the general Welfare of the
United States * * *'').
VI. Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3 of rule XIII of the Rules of the
House of Representatives, changes in existing law made by the
bill, as reported, are shown as follows (new matter is printed
in italic and existing law in which no change is proposed is
shown in roman):
THE SOCIAL SECURITY ACT
* * * * * * *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED
* * * * * * *
requirements for, and assuring quality of care in, skilled nursing
facilities
Sec. 1819. (a) * * *
* * * * * * *
(f) Responsibilities of Secretary Relating to Skilled Nursing
Facility Requirements.--
(1) General responsibility.--It is the duty and
responsibility of the Secretary to assure that
requirements which govern the provision of care in
skilled nursing facilities under this title, and the
enforcement of such requirements, are adequate to
protect the health, safety, welfare, and rights of
residents and to promote the effective and efficient
use of public moneys.
(2) Requirements for nurse aide training and
competency evaluation programs and for nurse aide
competency evaluation programs.--
(A) * * *
(B) Approval of certain programs.--Such
requirements--
(i) * * *
* * * * * * *
(iii) subject to subparagraph (C),
shall prohibit approval of such a
program--
(I) * * *
* * * * * * *
(C) Waiver authorized.--Clause (iii)(I) of
subparagraph (B) shall not apply to a program
offered in (but not by) a nursing facility (or
skilled nursing facility for purposes of title
XVIII) in a State if the State--
(i) determines that there is no other
such program offered within a
reasonable distance of the facility,
(ii) assures, through an oversight
effort, that an adequate environment
exists for operating the program in the
facility, and
(iii) provides notice of such
determination and assurances to the
State long-term care ombudsman.
* * * * * * *
TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
* * * * * * *
requirements for nursing facilities
Sec. 1919. (a) * * *
* * * * * * *
(f) Responsibilities of Secretary Relating to Nursing
Facility Requirements.--
(1) General responsibility.--It is the duty and
responsibility of the Secretary to assure that
requirements which govern the provision of care in
nursing facilities under State plans approved under
this title, and the enforcement of such requirements,
are adequate to protect the health, safety, welfare,
and rights of residents and to promote the effective
and efficient use of public moneys.
(2) Requirements for nurse aide training and
competency evaluation programs and for nurse aide
competency evaluation programs.--
(A) * * *
(B) Approval of certain programs.--Such
requirements--
(i) * * *
* * * * * * *
(iii) subject to subparagraph (C),
shall prohibit approval of such a
program--
(I) * * *
* * * * * * *
(C) Waiver authorized.--Clause (iii)(I) of
subparagraph (B) shall not apply to a program
offered in (but not by) a nursing facility (or
skilled nursing facility for purposes of title
XVIII) in a State if the State--
(i) determines that there is no other
such program offered within a
reasonable distance of the facility,
(ii) assures, through an oversight
effort, that an adequate environment
exists for operating the program in the
facility, and
(iii) provides notice of such
determination and assurances to the
State long-term care ombudsman.
* * * * * * *