II

Calendar No. 36

106TH CONGRESS

1ST SESSION S. 494

[Report No. 106–13]

To amend title XIX of the Social Security Act to prohibit transfers or

discharges of residents of nursing facilities as a result of a voluntary

withdrawal from participation in the medicaid program.

IN THE SENATE OF THE UNITED STATES

MARCH 2, 1999

Mr. GRAHAM (for himself, Mr. GRASSLEY, Mr. ROTH, Mr. MOYNIHAN, Mr.

CHAFEE, Mr. ROCKEFELLER, Mr. MACK, Mr. BREAUX, Mr. KERREY, Ms.

MIKULSKI, Mr. BRYAN, Mr. HOLLINGS, Mr. INOUYE, Mr. HARKIN, Mr.

BAYH, Mr. ROBB, Mr. MURKOWSKI, Mr. BAUCUS, Mr. CONRAD, and Mr.

SANTORUM) introduced the following bill; which was read twice and referred to the Committee on Finance

MARCH 10, 1999

Reported by Mr. ROTH, without amendment

A BILL

To amend title XIX of the Social Security Act to prohibit

transfers or discharges of residents of nursing facilities

as a result of a voluntary withdrawal from participation

in the medicaid program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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•S 494 RS

1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Nursing Home Resi3 dential Security Act of 1999’’.

4 SEC. 2. RESTRICTIONS ON TRANSFERS OR DISCHARGES OF

5 NURSING FACILITY RESIDENTS IN THE CASE

6 OF VOLUNTARY WITHDRAWAL FROM PAR7 TICIPATION UNDER THE MEDICAID PRO8 GRAM.

9 (a) IN GENERAL.—Section 1919(c)(2) of the Social

10 Security Act (42 U.S.C. 1396r(c)(2)) is amended by add11 ing at the end the following new subparagraph:

12 ‘‘(F) CONTINUING RIGHTS IN CASE OF

13 VOLUNTARY WITHDRAWAL FROM PARTICIPA14 TION.—

15 ‘‘(i) IN GENERAL.—In the case of a

16 nursing facility that voluntarily withdraws

17 from participation in a State plan under

18 this title but continues to provide services

19 of the type provided by nursing facilities—

20 ‘‘(I) the facility’s voluntary with21 drawal from participation is not an

22 acceptable basis for the transfer or

23 discharge of residents of the facility

24 who were residing in the facility on

25 the day before the effective date of the

26 withdrawal (including those residents
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•S 494 RS

1 who were not entitled to medical as2 sistance as of such day);

3 ‘‘(II) the provisions of this sec4 tion continue to apply to such resi5 dents until the date of their discharge

6 from the facility; and

7 ‘‘(III) in the case of each individ8 ual who begins residence in the facil9 ity after the effective date of such

10 withdrawal, the facility shall provide

11 notice orally and in a prominent man12 ner in writing on a separate page at

13 the time the individual begins resi14 dence of the information described in

15 clause (ii) and shall obtain from each

16 such individual at such time an ac17 knowledgment of receipt of such infor18 mation that is in writing, signed by

19 the individual, and separate from

20 other documents signed by such indi21 vidual.

22 Nothing in this subparagraph shall be con23 strued as affecting any requirement of a

24 participation agreement that a nursing fa25 cility provide advance notice to the State
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•S 494 RS

1 or the Secretary, or both, of its intention

2 to terminate the agreement.

3 ‘‘(ii) INFORMATION FOR NEW RESI4 DENTS.—The information described in this

5 clause for a resident is the following:

6 ‘‘(I) The facility is not participat7 ing in the program under this title

8 with respect to that resident.

9 ‘‘(II) The facility may transfer or

10 discharge the resident from the facil11 ity at such time as the resident is un12 able to pay the charges of the facility,

13 even though the resident may have be14 come eligible for medical assistance

15 for nursing facility services under this

16 title.

17 ‘‘(iii) CONTINUATION OF PAYMENTS

18 AND OVERSIGHT AUTHORITY.—Notwith19 standing any other provision of this title,

20 with respect to the residents described in

21 clause (i)(I), a participation agreement of

22 a facility described in clause (i) is deemed

23 to continue in effect under such plan after

24 the effective date of the facility’s voluntary
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•S 494 RS

1 withdrawal from participation under the

2 State plan for purposes of—

3 ‘‘(I) receiving payments under

4 the State plan for nursing facility

5 services provided to such residents;

6 ‘‘(II) maintaining compliance

7 with all applicable requirements of

8 this title; and

9 ‘‘(III) continuing to apply the

10 survey, certification, and enforcement

11 authority provided under subsections

12 (g) and (h) (including involuntary ter13 mination of a participation agreement

14 deemed continued under this clause).

15 ‘‘(iv) NO APPLICATION TO NEW RESI16 DENTS.—This paragraph (other than sub17 clause (III) of clause (i)) shall not apply to

18 an individual who begins residence in a fa19 cility on or after the effective date of the

20 withdrawal from participation under this

21 subparagraph.’’.

22 (b) EFFECTIVE DATE.—The amendment made by

23 subsection (a) applies to voluntary withdrawals from par24 ticipation occurring on or after the date of the enactment

25 of this Act.
Calendar No. 36

106TH CONGRESS

1ST SESSION S. 494

[Report No. 106–13]

A BILL

To amend title XIX of the Social Security Act to

gram.drawal from participation in the medicaid pronursing facilities as a result of a voluntary withprohibit transfers or discharges of residents of

MARCH 10, 1999

Reported without amendment