I

105TH CONGRESS

2D SESSION H. R. 4804

To amend titles XI, XVIII, and XIX of the Social Security Act to permit

paid staff other than nurse aides and licensed health professionals to

provide feeding and hydration assistance to residents in nursing facilities

participating in the Medicare and Medicaid Programs and to provide

special training requirements for such staff, and to establish a program

to ensure that such facilities do not employ individuals who have a

history of patient or resident abuse or have been convicted of certain

crimes.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 10, 1998

Mr. TOWNS introduced the following bill; which was referred to the Committee

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

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 amend titles XI, XVIII, and XIX of the Social Security

Act to permit paid staff other than nurse aides and

licensed health professionals to provide feeding and hydration assistance to residents in nursing facilities participating in the Medicare and Medicaid Programs and

to provide special training requirements for such staff,

and to establish a program to ensure that such facilities

do not employ individuals who have a history of patient

or resident abuse or have been convicted of certain

crimes.
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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 ‘‘Long-Term Care Pa5 tient Protection Act of 1998’’.

6 SEC. 2. SPECIAL REQUIREMENTS FOR INDIVIDUALS PRO7 VIDING FEEDING AND HYDRATION ASSIST8 ANCE TO NURSING FACILITY RESIDENTS AND

9 SKILLED NURSING FACILITY PATIENTS.

10 (a) MEDICAID PROGRAM.—Section 1919 of the Social

11 Security Act (42 U.S.C. 1396r) is amended—

12 (1) in subsection (b)—

13 (A) in paragraph (5)(F)—

14 (i) by striking ‘‘or’’ at the end of

15 clause (i);

16 (ii) by striking the period at the end

17 of clause (ii) and inserting ‘‘, or’’; and

18 (iii) by adding at the end the follow19 ing new clause:

20 ‘‘(iii) who is a feeding and hydration

21 assistant (as defined in paragraph

22 (8)(B)).’’; and

23 (B) by adding at the end the following new

24 paragraph:
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1 ‘‘(8) REQUIRED TRAINING OF FEEDING AND

2 HYDRATION ASSISTANTS.—

3 ‘‘(A) IN GENERAL.—A nursing facility

4 must not use on a full-time or other paid basis

5 any individual as a feeding and hydration as6 sistant in the facility unless the individual—

7 ‘‘(i) has completed a feeding and hy8 dration assistance training and competency

9 evaluation program approved by the State

10 under subsection (e)(8), and

11 ‘‘(ii) is competent to provide feeding

12 and hydration services.

13 ‘‘(B) FEEDING AND HYDRATION ASSIST14 ANT DEFINED.—In this paragraph, the term

15 ‘feeding and hydration assistant’ means any in16 dividual who assists residents in a nursing facil17 ity to eat or drink but does not otherwise pro18 vide any nursing or nursing-related services to

19 such residents, but does not include an individ20 ual who—

21 ‘‘(i) is a licensed health professional

22 (as defined in paragraph (5)(G)) or a reg23 istered dietitian,

24 ‘‘(ii) volunteers to provide such serv25 ices without monetary compensation, or
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1 ‘‘(iii) is a nurse aide (as defined in

2 paragraph (5)(F), but without applying

3 clause (iii) thereof).’’;

4 (2) in subsection (e), by adding at the end the

5 following new paragraph:

6 ‘‘(8) SPECIFICATION AND REVIEW OF FEEDING

7 AND HYDRATION ASSISTANCE TRAINING AND COM8 PETENCY EVALUATION PROGRAMS.—The State

9 must—

10 ‘‘(A) specify those training and competency

11 evaluation programs that the State approves for

12 purposes of subsection (b)(8) and that meet the

13 requirements established under subsection

14 (f)(10), which shall at a minimum include

15 training concerning—

16 ‘‘(i) recommended amounts of food

17 and hydration,

18 ‘‘(ii) methods of providing food and

19 hydration, and

20 ‘‘(iii) recognition of symptoms of mal21 nutrition and dehydration; and

22 ‘‘(B) provide for the review and reapproval

23 of such programs, at a frequency and using a

24 methodology consistent with the requirements

25 established under subsection (f)(10)(B).
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1 The failure of the Secretary to establish require2 ments under subsection (f)(10) shall not relieve any

3 State of its responsibility under this paragraph.’’;

4 and

5 (3) in subsection (f), by adding at the end the

6 following new paragraph:

7 ‘‘(10) REQUIREMENTS FOR FEEDING AND HY8 DRATION ASSISTANCE TRAINING AND EVALUATION

9 PROGRAMS.—For purposes of subsections (b)(8) and

10 (e)(8), the Secretary shall establish—

11 ‘‘(A) requirements for the approval of feed12 ing and hydration assistance training and com13 petency evaluation programs; and

14 ‘‘(B) requirements respecting the minimum

15 frequency and methodology to be used by a

16 State in reviewing such programs’ compliance

17 with the requirements for such programs.’’.

18 (b) MEDICARE PROGRAM.—Section 1819 of such Act

19 (42 U.S.C. 1395i–3) is amended—

20 (1) in subsection (b)—

21 (A) in paragraph (5)(F)—

22 (i) by striking ‘‘or’’ at the end of

23 clause (i);

24 (ii) by striking the period at the end

25 of clause (ii) and inserting ‘‘, or’’; and
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1 (iii) by adding at the end the follow2 ing new clause:

3 ‘‘(iii) who is a feeding and hydration

4 assistant (as defined in paragraph

5 (8)(B)).’’; and

6 (B) by adding at the end the following new

7 paragraph:

8 ‘‘(8) REQUIRED TRAINING OF FEEDING AND

9 HYDRATION ASSISTANTS.—

10 ‘‘(A) IN GENERAL.—A skilled nursing fa11 cility must not use on a full-time or other paid

12 basis any individual as a feeding and hydration

13 assistant in the facility unless the individual—

14 ‘‘(i) has completed a feeding and hy15 dration assistance training and competency

16 evaluation program approved by the State

17 under subsection (e)(6), and

18 ‘‘(ii) is competent to provide feeding

19 and hydration services.

20 ‘‘(B) FEEDING AND HYDRATION ASSIST21 ANT DEFINED.—In this paragraph, the term

22 ‘feeding and hydration assistant’ means any in23 dividual that assists residents in a skilled nurs24 ing facility to eat or drink but does not other25 wise provide any nursing or nursing-related
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1 services to such residents, but does not include

2 an individual—

3 ‘‘(i) is a licensed health professional

4 (as defined in paragraph (5)(G)) or a reg5 istered dietitian,

6 ‘‘(ii) volunteers to provide such serv7 ices without monetary compensation, or

8 ‘‘(iii) is a nurse aide (as defined in

9 paragraph (5)(F), but without applying

10 clause (iii) thereof).’’;

11 (2) in subsection (e), by adding at the end the

12 following new paragraph:

13 ‘‘(6) SPECIFICATION AND REVIEW OF FEEDING

14 AND HYDRATION ASSISTANCE TRAINING AND COM15 PETENCY EVALUATION PROGRAMS.—The State

16 must—

17 ‘‘(A) specify those training and competency

18 evaluation programs that the State approves for

19 purposes of subsection (b)(8) and that meet the

20 requirements established under subsection

21 (f)(8), which shall, at a minimum, include

22 training concerning—

23 ‘‘(i) recommended amounts of food

24 and hydration,
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1 ‘‘(ii) methods of providing food and

2 hydration, and

3 ‘‘(iii) recognition of symptoms of mal4 nutrition and dehydration; and

5 ‘‘(B) provide for the review and reapproval

6 of such programs, at a frequency and using a

7 methodology consistent with the requirements

8 established under subsection (f)(8)(B).

9 The failure of the Secretary to establish require10 ments under subsection (f)(8) shall not relieve any

11 State of its responsibility under this paragraph.’’;

12 and

13 (3) in subsection (f), by adding at the end the

14 following new paragraph:

15 ‘‘(8) REQUIREMENTS FOR FEEDING AND HY16 DRATION ASSISTANCE TRAINING AND EVALUATION

17 PROGRAMS.—For purposes of subsections (b)(8) and

18 (e)(6), the Secretary shall establish—

19 ‘‘(A) requirements for the approval of feed20 ing and hydration assistance training and com21 petency evaluation programs; and

22 ‘‘(B) requirements respecting the minimum

23 frequency and methodology to be used by a
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1 State in reviewing such programs’ compliance

2 with the requirements for such programs.’’.

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