I

106TH CONGRESS

2D SESSION H. R. 5282

To establish a demonstration project to waive certain nurse training requirements for specially trained individuals who perform certain specific nursing-related tasks in Medicare and Medicaid nursing facilities.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 25, 2000

Mr. RYAN of Wisconsin introduced the following bill; which was referred to

the Committee on Ways and Means, and in addition to the Committee

on Commerce, for a period to be subsequently determined by the Speaker,

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To establish a demonstration project to waive certain nurse

training requirements for specially trained individuals

who perform certain specific nursing-related tasks in

Medicare and Medicaid nursing facilities.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Medicare and Medicaid

5 Nursing Services Quality Improvement Demonstration Act

6 of 2000’’.
2

•HR 5282 IH

1 SEC. 2. DEMONSTRATION PROJECT TO WAIVE CERTAIN

2 NURSE TRAINING REQUIREMENTS FOR SPE3 CIALLY TRAINED INDIVIDUALS WHO PER4 FORM NURSING-RELATED TASKS IN MEDI5 CARE AND MEDICAID NURSING FACILITIES.

6 (a) ESTABLISHMENT.—The Secretary of Health and

7 Human Services shall establish a five-year demonstration

8 project under which, pursuant to subsection (c), nurse

9 aide training requirements (as defined in subsection

10 (g)(1)) are waived in up to five States in the case of spe11 cially trained individuals with respect to specific nursing

12 tasks (as defined in subsection (g)(2)).

13 (b) STATE PARTICIPATION.—

14 (1) ELIGIBILITY.—No State shall be eligible to

15 participate in the project unless the State—

16 (A) submits, in a form and manner speci17 fied by the Secretary, an application to partici18 pate in the project; and

19 (B) agrees to collect, maintain, and submit

20 such data as the Secretary deems necessary to

21 complete the reports required by subsection (e).

22 (2) PRIORITY STATES.—The Secretary shall

23 give priority for participation in the project—

24 (A) first, to any priority State described in

25 subsection (g)(3)(A) that notifies the Secretary

26 (not later than 90 days after the date of enact-
3

•HR 5282 IH

1 ment of this Act) of its intention to seek to par2 ticipate in the project and submits a timely ap3 plication to participate in the project; and

4 (B) second, to any other priority State

5 that so notifies the Secretary and submits such

6 a timely application.

7 (c) TRAINING AND COMPETENCY REQUIREMENTS.—

8 Under the project, an individual who does not meet nurse

9 aide training requirements may perform a specific nursing

10 task for a resident of a skilled nursing facility or a nursing

11 facility covered under the medicare or medicaid program

12 under title XVIII or XIX of the Social Security Act in

13 a participating State if—

14 (1) the individual has successfully completed a

15 training and competency evaluation program, devel16 oped or approved by the State in which such facility

17 operates in consultation with the Secretary, relating

18 to the performance of such task;

19 (2) the individual is performing the task under

20 the supervision of a registered professional nurse, li21 censed practical nurse, or licensed vocational nurse;

22 (3) the resident does not have special needs re23 lating to the performance of such task for which

24 needs the individual has not received specific train25 ing; and
4

•HR 5282 IH

1 (4) the individual complies with any limitations

2 on performance of duties which may be established

3 by the State in which such facility operates.

4 (d) MINIMUM STAFFING REQUIREMENTS NOT AF5 FECTED.—Individuals performing a specific nursing task

6 under the project shall not count toward any minimum

7 nursing staffing requirements of section 1818 or 1919 of

8 the Social Security Act (42 U.S.C. 1395i–3, 1396r).

9 (e) ANNUAL REPORT TO CONGRESS.—During the pe10 riod of the project, the Secretary of Health and Human

11 Services shall submit an annual report to the Congress

12 providing an analysis comparing the well-being of resi13 dents receiving specific nursing services performed by indi14 viduals under the project with those receiving such serv15 ices performed by nurse aides. Such analysis shall employ

16 quality indicators determined by the Secretary, including

17 (with regard to specific nursing tasks related to providing

18 nutrition and hydration) nutrition and hydration levels,

19 unplanned weight loss or gain, and number of citations

20 for nutrition-related violations relating to such residents.

21 (f) TRANSITIONAL WAIVER.—The Secretary shall

22 waive nurse aide training requirements for nursing facili23 ties in a priority State in the same manner as under the

24 project during the period beginning on the date of enact25 ment of this Act and ending—
5

•HR 5282 IH

1 (1) in the case of a State which fails to submit

2 a timely application for participation in the project,

3 on the date such application is due; or

4 (2) in the case of a State which submits a time5 ly application for participation in the project, the

6 date on which the Secretary makes a final decision

7 on the application.

8 (g) DEFINITIONS.—In this section:

9 (1) The term ‘‘nurse aide training require10 ments’’ means the requirements of sections

11 1819(b)(5)(F) and 1919(b)(5)(F) of the Social Se12 curity Act (42 U.S.C. 1395i–3(b)(5)(F) and

13 1396r(b)(5)(F)) relating to nurse aides.

14 (2) The term ‘‘nursing task’’ means a nursing

15 or nursing-related service described in section

16 1819(b)(5)(F) or 1919(b)(5)(F) of the Social Secu17 rity Act (42 U.S.C. 1395i–3(b)(5)(F),

18 1396r(b)(5)(F)).

19 (3) The term ‘‘priority State’’ means—

20 (A) Wisconsin, New York, North Dakota,

21 Minnesota, and Delaware; and

22 (B) any other State which, as of the date

23 of enactment of this Act, has established a

24 project, program, or policy to permit individuals

25 who do not meet nurse aide training require-
6

•HR 5282 IH

1 ments to perform one or more specific nursing

2 tasks.

3 (4) The term ‘‘project’’ means the demonstra4 tion project established in this section.

5 (5) The term ‘‘Secretary’’ means the Secretary

6 of Health and Human Services.

7 (6) The term ‘‘State’’ has the meaning given

8 such term for purposes of title XIX of the Social Se9 curity Act.

Æ