[House Report 105-23]
[From the U.S. Government Publishing Office]
105th Congress Rept. 105-23
HOUSE OF REPRESENTATIVES
1st Session Part 2
_______________________________________________________________________
WAIVER OF MEDICARE AND MEDICAID NURSING FACILITY PROHIBITION
_______
March 18, 1997.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______________________________________________________________________
Mr. Bliley, from the Committee on Commerce, 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 Commerce, 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
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 2
Committee Consideration.......................................... 2
Rollcall Votes................................................... 3
Committee Oversight Findings..................................... 3
Committee on Government Reform and Oversight..................... 3
New Budget Authority and Tax Expenditures........................ 3
Committee Cost Estimate.......................................... 3
Congressional Budget Office Estimate............................. 3
Federal Mandates Statement....................................... 4
Advisory Committee Statement..................................... 4
Constitutional Authority Statement............................... 4
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 5
Changes in Existing Law Made by the Bill, as Reported............ 5
Amendment
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''.
Purpose and Summary
H.R. 968 amends Title XVIII and Title XIX of the Social
Security Act to permit a waiver of the prohibition of offering
nurse aide training and competency evaluation programs in
certain facilities. This measure permits a State to waive the
current prohibition if the State: (1) determines that there is
no other such 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.
Background and Need for Legislation
Under existing Federal law, a nursing facility may lose its
ability to offer facility-based nurse aide training and
competency evaluation programs for reasons that are unrelated
to the quality of the program itself. This unintended
consequence of current law arises from instances where some
form of operational deficiency may exist, even though such
deficiency is 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, are prevented from conducting the training and
evaluation that is integral to the provision of quality nursing
care and the prevention of a staffing void.
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 it 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.
Hearings
The Committee on Commerce has not held hearings on the
legislation.
Committee Consideration
On March 12, 1997, the Subcommittee on Health and
Environment met in open markup session and, by unanimous
consent, a quorum being present, approved H.R. 968 for Full
Committee consideration, without amendment.
On March 13, 1997, the Full Committee met in open markup
session and ordered H.R. 968 reported to the House, without
amendment, by a voice vote.
Rollcall Votes
Clause 2(l)(2)(B) of rule XI of the Rules of the House
requires the Committee to list the recorded votes on the motion
to report legislation and on amendments thereto. There were no
recorded votes taken in connection with ordering H.R. 968
reported. A motion by Mr. Bliley to order H.R. 968 reported to
the House, without amendment, was agreed to by a voice vote, a
quorum being present.
Committee Oversight Findings
Pursuant to clause 2(l)(3)(A) of rule XI of the Rules of
the House of Representatives, the Committee has not held
oversight or legislative hearings on this legislation.
Committee on Government Reform and Oversight
Pursuant to clause 2(l)(3)(D) of rule XI of the Rules of
the House of Representatives, no oversight findings have been
submitted to the Committee by the Committee on Government
Reform and Oversight.
New Budget Authority and Tax Expenditures
In compliance with clause 2(l)(3)(B) of rule XI of the
Rules of the House of Representatives, the Committee finds that
H.R. 968, a bill to amend the Social Security Act to permit a
waiver of the prohibition of offering nurse aide training and
competency evaluation programs in certain facilities, would
result in no new or increased budget authority or tax
expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 403 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 2(l)(3)(C) of rule XI of the Rules of
the House of Representatives, the following is the cost
estimate provided by the Congressional Budget Office pursuant
to section 403 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 14, 1997.
Hon. Tom Bliley,
Chairman, Committee on Commerce,
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 aide 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.
Previous CBO estimate
An essentially similar version of H.R. 968 was ordered
reported by the Committee on Ways and Means on March 12, 1997.
CBO estimated that enactment of the bill would have no
budgetary impact.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 2(l)(4) of rule XI of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Permitting Waiver of Prohibition of Offering Nurse Aide
Training and Competency Evaluation Programs in Certain Facilities
Section 1 of the bill amends section 1819(f)(2) and section
1919(f)(2) of the Social Security Act to authorize a waiver of
the prohibition of offering nurse aide training and competency
evaluation programs in certain facilities upon a State
determination that no similar program is in existence within a
reasonable distance of the facility, an adequate environment
exists for operating the program in the facility, and the State
long-term care ombudsman has been notified of the above.
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.
* * * * * * *