39–006

105TH CONGRESS REPT. 105–23 " ! HOUSE OF REPRESENTATIVES 1st Session Part 1

WAIVER OF MEDICARE AND MEDICAID NURSING FACILITY

PROHIBITION

MARCH 13, 1997.—Ordered to be printed

Mr. ARCHER, from the Committee on Ways and Means,

submitted the following

REPORT

[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:
2

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.
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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.
4

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 nurs-
5

ing 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

* * * * * * *
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REQUIREMENTS FOR, AND ASSURING QUALITY OF CARE IN, SKILLED

NURSING FACILITIES

SEC. 1819. (a)***

* * * * * * *

(f) RESPONSIBILITIES OF SECRETARY RELATING TO SKILLED NURS- ING 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 require-
7

ments, 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 COM- PETENCY EVALUATION PROGRAMS AND FOR NURSE AIDE COM- PETENCY 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.

* * * * * * *

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