[Congressional Record Volume 142, Number 94 (Monday, June 24, 1996)]
[Senate]
[Pages S6725-S6726]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself and Mr. Grassley):
  S. 1901. A bill to amend title XIX of the Social Security Act to 
repeal the requirement for annual resident review for nursing 
facilities under the Medicaid program and to require resident reviews 
for mentally ill or mentally retarded residents when there is a 
significant change in physical or mental condition; to the Committee on 
Finance.


                       long-term-care legislation

  Mr. DORGAN. Mr. President, today I am introducing legislation that 
will relieve nursing homes of unnecessary regulation without 
jeopardizing the high quality of care nursing home residents receive. 
These two bills, which enjoy bipartisan support, will improve long-term 
care in this country by giving nursing homes the flexibility they need 
to focus scarce resources on providing quality care.
  I have long believed that the Federal Government has an important 
role to play in ensuring against the kinds of abuses that occurred in 
some areas of the country prior to enactment of Federal nursing home 
standards. I do not believe that those abuses were the norm in nursing 
homes. In fact, nursing homes in my State of North Dakota have a strong 
record of providing quality care, and I believe that this was the case 
in most nursing homes.
  But it is clear that some nursing homes did not meet that high 
standard, and many States were far too slow to respond. To address that 
critical problem, I supported and continue to support minimum Federal 
quality standards. Our first priority in nursing home legislation must 
be the quality of care provided to residents, and we should not pass 
any laws that would compromise that goal.
  However, I believe that some of our efforts to regulate nursing homes 
have not resulted in greater quality of care for residents. In some 
cases, by imposing unnecessary burdens and diverting scarce resources 
in nursing facilities, these laws and regulations can hinder the 
delivery of quality care. The legislation I am offering today will 
address two such instances.


                      nurse-aide training program

  The first bill I am introducing has enjoyed broad bipartisan support 
during the 104th Congress. I am joined in offering this bill by Senator 
Grassley and Senator Harkin. This bill would exempt rural nursing 
facilities from the possibility of termination of their nurse-aide 
training programs for reasons unrelated to the quality of the training 
program
  Simply put, this is a commonsense amendment. In rural areas all over 
the country, nursing facilities offer people an opportunity to learn 
the basic nursing and personal care skills needed to become a certified 
nurse aide. In return, those who participate in a nurse-aide training 
program help nursing facilities meet their staffing needs and allow the 
nursing staff to focus more on administering quality nursing care.
  Nurse-aide training programs are especially important in rural areas 
like my State of North Dakota, where potential nurse aides might have 
to travel hundreds of miles for training if it is not available at the 
nursing facility in their community. These nurse-aide training programs 
comply with strict guidelines related to the amount of training 
necessary and determination of competency for certification.
  Despite these safeguards, current law allows programs to be 
terminated for up to 2 years if a facility has been cited for a 
deficiency or assessed a civil money penalty for reasons completely 
unrelated to the quality of the nurse-aide training program. In North 
Dakota, this could result in real hardship not just for the nursing 
facility and potential nurse aides, but for the nursing home residents 
who rely on nurse aides for their day-to-day care.
  Under my bill, rural areas would be exempt from termination of nurse-
aide training programs in these specific instances only if: first, no 
other program is offered within a reasonable distance of the facility; 
second, the State assures that an adequate environment exists for 
operating the program; and third, the State provides notice of the 
determination and assurances to the State long-term care ombudsman.
  Congress included this exception for rural nurse-aide training 
programs in the Balanced Budget Act passed last December, and the 
President included it in his 1997 budget proposal.


                        annual resident reviews

  The second bill I am introducing today relates to the pre-admission 
screening and annual resident review [PASARR] requirements enacted as 
part of OBRA '87. Senator Grassley joins me in introducing this bill, 
which also has bipartisan support and was included in the President's 
balanced budget proposal.
  PASARR was enacted to prevent inappropriate placements of residents 
with mental health or developmental disabilities. The need for 
assessments to determine whether a mental health

[[Page S6726]]

or developmental disability exists is critical, and we still have some 
way to go in ensuring that residents with these problems receive 
appropriate placement and treatment in all cases.
  However, the annual resident review process duplicates other 
mandatory assessments and has not resulted in identifying inappropriate 
placements or improving the quality of care for nursing home residents. 
The current law adds an average of $700,000 to State costs for long-
term care and diverts valuable nursing facility resources. We must 
continue to work to ensure that nursing home residents receive the 
quality care they need, but we should not do so by placing unnecessary 
or ineffective burdens on nursing facilities and their staffs.
  My bill would retain the pre-admission screening for each resident, 
but would repeal the annual resident review requirement for each 
patient. This would go a long way toward streamlining the regulatory 
process and allowing nursing homes to focus more time on providing 
quality care.
  I hope my colleagues will join me in supporting these sound policy 
proposals.

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