[Congressional Record Volume 141, Number 188 (Tuesday, November 28, 1995)]
[Senate]
[Pages S17673-S17674]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              NURSING HOME QUALITY AND THE BOREN AMENDMENT

 Mr. DORGAN. Mr. President, there has been considerable 
discussion on the Senate floor about the proposed changes to Federal 
nursing home quality standards.
  In addition to making major cuts in projected Medicaid spending, 
early versions of the 7-year budget plan would have repealed entirely 
the nursing home standards adopted in 1987 as part of the Medicaid law. 
The final House-Senate compromise bill recently adopted by the Congress 
did not go that far, but it would weaken or eliminate several of these 
standards and would allow States to get waivers from the remaining 
Federal requirements.
  Several of my colleagues have come to the floor to remind the Senate 
of the conditions in some nursing homes which led to the adoption of 
these standards in the first place.
  Now I do not believe that all or even most nursing homes drugged or 
restrained their residents unnecessarily before the quality standards 
were put in place. Nursing homes in my State have a strong record of 
providing quality care.
  But it is undeniable that some nursing homes did engage in these 
practices. And it is also undeniable that some states were too slow in 
putting an end to this kind of abuse. Therefore, I continue to believe 
that there should be minimum Federal quality standards, especially 
since the majority of Medicaid funding for nursing homes comes from the 
Federal Government.
  However, one critical point which has not received as much attention 
in this debate is the ability of nursing homes to maintain the quality 
of their care--Federal standards or not--in the face of significant 
reductions in Medicaid reimbursement. As we all know, the budget plan 
would reduce by $163 billion future Federal funding for Medicaid. But 
that is not all.
  A little noticed provision of this plan to turn the Medicaid Program 
into a block grant to the States is the repeal of the Boren amendment. 
The Boren amendment currently requires States to provide reimbursement 
to hospitals and nursing homes which is reasonable and adequate to 
cover their costs. This has provided critical protection from state 
attempts to cut Medicaid reimbursement below levels necessary to 
deliver quality care.
  My fear is that repealing this protection is part of a deal with the 
States so that they will accept significantly reduced Federal funding 
for Medicaid. The budget proposal tells States to make due with less 
funding, but it allows them to, in effect, shift that funding shortfall 
onto nursing homes and hospitals. Well it may make the numbers add up, 
but what will it do to the care these institutions are able to provide 
to their patients?
  So as we continue to debate the various changes which have been 
proposed to the Medicaid Program, let us not forget that Federal 
quality standards are not the only part of the Medicaid Program that 
impact quality of care. The $163 billion in cuts, combined with the 
repeal of the Boren amendment are also a great threat to the quality of 


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care received by Medicaid beneficiaries. I believe the Boren amendment 
must be preserved in any final compromise on the budget, and I intend 
to fight to see that it is. 

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