I
105TH CONGRESS
2D SESSION
H. R. 4046
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 HOUSE OF REPRESENTATIVES
JUNE 11, 1998
Mr. DAVIS of Florida (for himself, Mr. BILIRAKIS, Mr. DINGELL, Mr. SHAW,
Mr. BROWN of Ohio, Mr. CANADY of Florida, Mr. WAXMAN, Mr. YOUNG
of Florida, Mr. DEUTSCH, Mr. FOLEY, Mr. WEXLER, Mrs. FOWLER, Mr.
MARKEY, Mr. DIAZ-BALART, Mr. HASTINGS of Florida, Ms. ROS-
LEHTINEN, Ms. BROWN of Florida, Mr. BOUCHER, Mrs. THURMAN, Mrs.
MEEK of Florida, Mr. BOYD, Mr. MANTON, Mr. TOWNS, Mr. PALLONE,
Ms. FURSE, Mr. RUSH, Ms. ESHOO, Mr. STUPAK, Mr. GREEN, Mr. KEN-
NEDY of Massachusetts, and Mr. BISHOP) introduced the following bill;
which was referred to the Committee on Commerce
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 
1. 
RESTRICTIONS 
ON 
TRANSFERS 
OR 
DIS-
CHARGES OF NURSING FACILITY RESIDENTS
IN THE CASE OF VOLUNTARY WITHDRAWAL
FROM PARTICIPATION UNDER THE MEDICAID
PROGRAM.
(a) IN GENERAL.—Section 1919(c)(2) of the Social
Security Act (42 U.S.C. 1396r(c)(2)) is amended by add-
ing at the end the following new subparagraph:
‘‘(F) CONTINUING
RIGHTS
IN
CASE
OF
VOLUNTARY
WITHDRAWAL
FROM
PARTICIPA-
TION.—
‘‘(i) IN GENERAL.—In the case of a
nursing facility that voluntarily withdraws
from participation in a State plan under
this title but continues to provide services
of the type provided by nursing facilities—
‘‘(I) the facility’s voluntary with-
drawal from participation is not an
acceptable basis for the transfer or
discharge of residents of the facility
who were residing in the facility on
the day before the effective date of the
withdrawal;
‘‘(II) the provisions of this sec-
tion continue to apply to such resi-
dents until the date of their discharge
from the facility; and
‘‘(III) in the case of each individ-
ual who begins residence in the facil-
ity after the effective date of such
withdrawal, the facility shall provide
notice orally and in a prominent man-
ner in writing on a separate page at
the time the individual begins resi-
dence of the information described in
clause (ii) and shall obtain from each
such individual at such time an ac-
knowledgment of receipt of such infor-
mation that is in writing, signed by
the individual, and separate from
other documents signed by such indi-
vidual.
Nothing in this subparagraph shall be con-
strued as affecting any requirement of a
participation agreement that a nursing fa-
cility provide advance notice to the State
or the Secretary, or both, of its intention
to terminate the agreement.
‘‘(ii) INFORMATION
FOR
NEW
RESI-
DENTS.—The information described in this
clause for a resident is the following:
‘‘(I) The facility is not participat-
ing in the program under this title
with respect to that resident.
‘‘(II) The facility may transfer or
discharge the resident from the facil-
ity at such time as the resident is un-
able to pay the charges of the facility,
even though the resident may have be-
come eligible for medical assistance
for nursing facility services under this
title.
‘‘(iii) CONTINUATION
OF
PAYMENTS
AND
OVERSIGHT
AUTHORITY.—Notwith-
standing any other provision of this title,
with respect to the residents described in
clause (i)(I), a participation agreement of
a facility described in clause (i) is deemed
to continue in effect under such plan after
the effective date of the facility’s voluntary
withdrawal from participation under the
State plan for purposes of—
‘‘(I) receiving payments under
the State plan for nursing facility
services provided to such residents;
‘‘(II) 
maintaining 
compliance
with all applicable requirements of
this title; and
‘‘(III) continuing to apply the
survey, certification, and enforcement
authority provided under subsections
(g) and (h) (including involuntary ter-
mination of a participation agreement
deemed continued under this clause).
‘‘(iv) APPLICATION
TO
SIGNIFICANT
REDUCTIONS
OF
EXTENT
OF
PARTICIPA-
TION.—The provisions of this subpara-
graph shall apply to a significant voluntary
reduction in the extent of participation
under a State plan in the case of a resi-
dent who, on (or within 90 days after) the
effective date of the reduction, is entitled
to medical assistance under this title with
respect to nursing facility services in a
manner similar to the manner in which
this subparagraph applies to a voluntary
withdrawal of participation.
‘‘(v) NO APPLICATION TO NEW RESI-
DENTS.—This paragraph (other than sub-
clause (III) of clause (i) and so much of
clause (iv) as the Secretary determines re-
lates to such subclause) shall not apply to
an individual who begins residence in a fa-
cility on or after the effective date of the
withdrawal from participation under this
subparagraph.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to voluntary withdrawals from
participation (and significant reductions of extent of par-
ticipation) occurring on or after the date of the enactment
of this Act.
(c) REPORT ON IMPLEMENTATION.—Not later than
5 years after the date of the enactment of this Act, the
Secretary of Health and Human Services shall submit to
Congress a report on the impact of the implementation
of the amendment made by subsection (a) on nursing fa-
cilities, their residents, and medicaid beneficiaries. The re-
port shall include—
(1) an analysis of the impact of changes in
medicaid reimbursement rates for nursing facility
services on the extent to which nursing facilities vol-
untarily withdraw from (or significantly reduce the
extent of participation in) the medicaid program and
on access to and quality of such services; and
(2) 
recommendations 
for 
such 
legislative
changes as the Secretary deems appropriate.
Æ