[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4804 Introduced in House (IH)]

  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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Long-Term Care Patient Protection 
Act of 1998''.

SEC. 2. SPECIAL REQUIREMENTS FOR INDIVIDUALS PROVIDING FEEDING AND 
              HYDRATION ASSISTANCE 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 following 
                        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 assistant in the facility unless 
                the individual--
                            ``(i) has completed a feeding and hydration 
                        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 assistant defined.--In 
                this paragraph, the term `feeding and hydration 
                assistant' means any individual who assists residents 
                in a nursing facility to eat or drink but does not 
                otherwise provide any nursing or nursing-related 
                services to such residents, but does not include an 
                individual who--
                            ``(i) is a licensed health professional (as 
                        defined in paragraph (5)(G)) or a registered 
                        dietitian,
                            ``(ii) volunteers to provide such services 
                        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 competency 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 
                        malnutrition 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 requirements 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 hydration assistance 
        training and evaluation programs.--For purposes of subsections 
        (b)(8) and (e)(8), the Secretary shall establish--
                    ``(A) requirements for the approval of feeding and 
                hydration assistance training and competency 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
                            (iii) by adding at the end the following 
                        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 skilled nursing facility must 
                not use on a full-time or other paid basis any 
                individual as a feeding and hydration assistant in the 
                facility unless the individual--
                            ``(i) has completed a feeding and hydration 
                        assistance training and competency evaluation 
                        program approved by the State under subsection 
                        (e)(6), and
                            ``(ii) is competent to provide feeding and 
                        hydration services.
                    ``(B) Feeding and hydration assistant defined.--In 
                this paragraph, the term `feeding and hydration 
                assistant' means any individual that assists residents 
                in a skilled nursing facility to eat or drink but does 
                not otherwise provide any nursing or nursing-related 
                services to such residents, but does not include an 
                individual--
                            ``(i) is a licensed health professional (as 
                        defined in paragraph (5)(G)) or a registered 
                        dietitian,
                            ``(ii) volunteers to provide such services 
                        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:
            ``(6) Specification and review of feeding and hydration 
        assistance training and competency 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)(8), 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 
                        malnutrition 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)(8)(B).
        The failure of the Secretary to establish requirements under 
        subsection (f)(8) 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:
            ``(8) Requirements for feeding and hydration assistance 
        training and evaluation programs.--For purposes of subsections 
        (b)(8) and (e)(6), the Secretary shall establish--
                    ``(A) requirements for the approval of feeding and 
                hydration assistance training and competency 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.''.
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