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 hy-
dration assistance to residents in nursing facilities par-
ticipating 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Long-Term Care Pa-
tient Protection Act of 1998’’.
SEC. 2. SPECIAL REQUIREMENTS FOR INDIVIDUALS PRO-
VIDING FEEDING AND HYDRATION ASSIST-
ANCE TO NURSING FACILITY RESIDENTS AND
SKILLED NURSING FACILITY PATIENTS.
(a) MEDICAID PROGRAM.—Section 1919 of the Social
Security Act (42 U.S.C. 1396r) is amended—
(1) in subsection (b)—
(A) in paragraph (5)(F)—
(i) by striking ‘‘or’’ at the end of
clause (i);
(ii) by striking the period at the end
of clause (ii) and inserting ‘‘, or’’; and
(iii) by adding at the end the follow-
ing new clause:
‘‘(iii) who is a feeding and hydration
assistant 
(as 
defined 
in 
paragraph
(8)(B)).’’; and
(B) by adding at the end the following new
paragraph:
‘‘(8) REQUIRED
TRAINING
OF
FEEDING
AND
HYDRATION ASSISTANTS.—
‘‘(A) IN
GENERAL.—A nursing facility
must not use on a full-time or other paid basis
any individual as a feeding and hydration as-
sistant in the facility unless the individual—
‘‘(i) has completed a feeding and hy-
dration assistance training and competency
evaluation program approved by the State
under subsection (e)(8), and
‘‘(ii) is competent to provide feeding
and hydration services.
‘‘(B) FEEDING
AND
HYDRATION
ASSIST-
ANT
DEFINED.—In this paragraph, the term
‘feeding and hydration assistant’ means any in-
dividual who assists residents in a nursing facil-
ity to eat or drink but does not otherwise pro-
vide any nursing or nursing-related services to
such residents, but does not include an individ-
ual who—
‘‘(i) is a licensed health professional
(as defined in paragraph (5)(G)) or a reg-
istered dietitian,
‘‘(ii) volunteers to provide such serv-
ices without monetary compensation, or
‘‘(iii) is a nurse aide (as defined in
paragraph (5)(F), but without applying
clause (iii) thereof).’’;
(2) in subsection (e), by adding at the end the
following new paragraph:
‘‘(8) SPECIFICATION AND REVIEW OF FEEDING
AND HYDRATION ASSISTANCE TRAINING AND COM-
PETENCY
EVALUATION
PROGRAMS.—The 
State
must—
‘‘(A) specify those training and competency
evaluation programs that the State approves for
purposes of subsection (b)(8) and that meet the
requirements 
established 
under 
subsection
(f)(10), which shall at a minimum include
training concerning—
‘‘(i) recommended amounts of food
and hydration,
‘‘(ii) methods of providing food and
hydration, and
‘‘(iii) recognition of symptoms of mal-
nutrition and dehydration; and
‘‘(B) provide for the review and reapproval
of such programs, at a frequency and using a
methodology consistent with the requirements
established under subsection (f)(10)(B).
The failure of the Secretary to establish require-
ments under subsection (f)(10) shall not relieve any
State of its responsibility under this paragraph.’’;
and
(3) in subsection (f), by adding at the end the
following new paragraph:
‘‘(10) REQUIREMENTS FOR FEEDING AND HY-
DRATION ASSISTANCE TRAINING AND EVALUATION
PROGRAMS.—For purposes of subsections (b)(8) and
(e)(8), the Secretary shall establish—
‘‘(A) requirements for the approval of feed-
ing and hydration assistance training and com-
petency evaluation programs; and
‘‘(B) requirements respecting the minimum
frequency and methodology to be used by a
State in reviewing such programs’ compliance
with the requirements for such programs.’’.
(b) MEDICARE PROGRAM.—Section 1819 of such Act
(42 U.S.C. 1395i–3) is amended—
(1) in subsection (b)—
(A) in paragraph (5)(F)—
(i) by striking ‘‘or’’ at the end of
clause (i);
(ii) by striking the period at the end
of clause (ii) and inserting ‘‘, or’’; and