[Congressional Record Volume 143, Number 40 (Tuesday, April 8, 1997)]
[House]
[Pages H1297-H1299]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CORRECTION TO NURSE AIDE TRAINING
The Clerk called the bill (H.R. 968) to amend title XVIII and XIX of
the Social Security Act to permit a waiver of the prohibition of
offering nurse aide training and competency evaluation programs in
certain nursing facilities.
The Clerk read the bill, as follows:
H.R. 968
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. PERMITTING WAIVER OF PROHIBITION OF OFFERING NURSE
AIDE TRAINING AND COMPETENCY EVALUATION
PROGRAMS IN CERTAIN FACILITIES
Section 1819(f)(2) of the Social Security Act (42 U.S.C.
1395i-3(f)(2)) and section 1919(f)(2) of such Act (42 U.S.C.
1396r(f)(2)) are each amended--
(1) in subparagraph (B)(iii), by inserting ``subject to
subparagraph (C),'' after ``(iii)''; and
(2) by adding at the end the following new subparagraph:
``(C) Waiver autohrized.--Clause (iii) of subparagraph (B)
shall not apply to a program offered in (but not by) a
nursing facility in a State if the State--
``(i) determines that there is no other such program
offered within a reasonable distance of the facility,
``(ii) assures, through an oversight effort, that an
adequate environment exists for operating the program in the
facility, and
``(iii) provides notice of such determination and
assurances to the State long-term care ombudsman.''.
The SPEAKER pro tempore. Pursuant to the rule, the bill is considered
read for amendment.
Committee Amendments
The SPEAKER pro tempore. The Clerk will report the amendments
recommended by the Committee on Ways and Means.
The Clerk read as follows:
Committee amendments, page 2, line 12, strike ``(iii)'' and
insert ``(iii)(I).''
Page 2, line 14, insert ``(or skilled nursing facility for purposes
of title XVIII)'' after ``nursing facility.''
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Michigan [Mr. Camp] and the gentleman from Wisconsin [Mr. Kleczka] will
each control 30 minutes.
The Chair recognizes the gentleman from Michigan [Mr. Camp].
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 968, a bill introduced
by the gentleman from Maryland [Mr. Ehrlich]. The gentleman's
legislation would amend the Social Security Act to permit a waiver of
the prohibition of offering nurse aide training and competency
evaluation programs in certain facilities.
As chairman of the Speaker's Advisory Group, it was my pleasure to
work with Congressman Ehrlich and the minority ranking member, the
gentleman from California, Mr. Waxman, and the rest of the minority
members and majority members of the committee to expedite consideration
of this Corrections Day legislation.
This bill was favorably reviewed by the Speaker's Advisory Group and
is fully supported by my colleagues on the other side of the aisle. The
advisory group was able to work with the Speaker and the committees of
jurisdiction to bring this bill to the floor today.
Mr. Speaker, this bill is particularly well suited to be considered
here under the Corrections Day procedure as we are doing today. Despite
the good intentions of the nurse aide training legislation of the
1980's, certain aspects have created significant problems with its
implementation.
The 1987 reconciliation bill instituted training standards for nurse
aids working in long-term care facilities. Under existing law, nursing
facilities which are subject to an extended survey are prohibited from
offering facility-based nurse aide training and competency evaluation
for a period of up to 2 years.
As an unintended consequence, a nursing home that is subject to a
review is not allowed to have a nurse aide training program at their
facility, even if the care provided by the nurse aide is unrelated to
the review itself.
This bill would waive the prohibition on nurse aide training programs
if the State determines there is no other training program within a
reasonable distance of the facility. The State must also assure that an
adequate environment exists for operating a program.
Nurse aide training programs are vital to health care delivery. Our
current law, however, is particularly burdensome in rural areas which
face difficulties recruiting nurse aids. It does not make sense that
these very nurse aide training programs are improving patient care as
rural providers find it increasingly difficult to recruit nurse aids.
[[Page H1298]]
This legislation is technical in nature, has strong bipartisan
support, and was scored by the Congressional Budget Office as having no
budgetary impact.
Mr. Speaker, this is a straightforward, bipartisan bill that corrects
an inefficient and burdensome law. This targeted bill will lead to
improved health care in rural areas like the Fourth District of
Michigan which I represent. I urge my colleagues to support H.R. 968.
Mr. Speaker, I reserve the balance of my time.
Mr. KLECZKA. Mr. Speaker, first, let me say that the gentleman from
Michigan [Mr. Camp] has adequately explained the bill. This is a
correction bill.
Back in 1987, we passed the legislation on nurse aide training. I
think in this one area we went too far. This bill provides States with
the flexibility to continue needed nursing aide training, even though
the home itself might be under some type of a review. I would ask all
of my colleagues to join the gentleman from Michigan [Mr. Camp] and
myself in supporting this needed legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. CAMP. Mr. Speaker, I yield such time as he may consume to the
gentleman from North Carolina [Mr. Burr].
Mr. BURR. Mr. Speaker, as a member of the Committee on Commerce which
also has jurisdiction on this bill and as a cosponsor of the bill, I am
pleased to speak in support of this very important legislation.
H.R. 968 would permit the continuation of nurse aide training and the
competency evaluation programs in certain nursing facilities. Under
existing Federal law, a nursing facility may lose its ability to offer
facility-based nurse aide training and competency evaluations for
reasons that are unrelated to the quality of the program itself.
This unintended consequence of the current law arises when a facility
has unrelated operational deficiencies which are being corrected by the
facility. As a result, nursing facilities, particularly those in rural
communities, are prevented from conducting the training and evaluation
that is an integral part in providing quality nursing care and
preventing staff shortages.
{time} 1430
This legislation would revise the current law. The bill would permit
the continuation of nurse aide training and competency evaluation
programs in affected facilities under certain circumstances. In order
for a facility to continue its training and evaluation programs, the
State would have to, one, make a determination that no similar program
is in existence within a reasonable distance of the facility; two,
conduct oversight activities to ensure that an adequate environment
exists for operating the program in the facility; and three, provide
notice of such determination to the State long-term-care ombudsman.
This noncontroversial measure was recently reported by the Committee
on Commerce on March 12 by voice vote. In addition, the Committee on
Ways and Means reported the legislation by voice vote on March 13. I am
pleased to say that the bill also has the support of the administration
and will have no budgetary impact on the Federal Government.
Mr. Speaker, the legislation sends an important message to the
American people that Congress is listening, listening to their concerns
about burdensome Federal regulations and taking action to address their
concerns. H.R. 968 achieves this objective by eliminating unnecessary
and burdensome regulations, a goal that Members on both sides of the
aisle have endorsed.
Again, I appreciate the opportunity to speak on this important piece
of legislation. I urge my colleagues to support H.R. 968.
Mr. KLECZKA. Mr. Speaker, I yield such time as he may consume to the
gentleman from Ohio [Mr. Brown].
Mr. BROWN of Ohio. Mr. Speaker, I rise in support of H.R. 968. The
Committee on Commerce has acted on this bill twice, first in September
1996, and then in March 1997. This legislation is also supported by the
administration and was proposed by the President and Vice President
through the reinventing government initiative in 1995.
Nurse aide training programs play an important role, not only by
preparing students to care for patients, but also by helping to meet
the patient's needs in staffing health care facilities. The failure to
make these changes for training programs could have dire consequences
in terms of a nursing facility's ability to provide quality care for
its patients. This bill will allow certain facilities to continue nurse
aide training programs, particularly in rural and other areas which
lack training alternatives.
Mr. Speaker, I recommend we pass this bill today.
Mr. CAMP. Mr. Speaker, I yield such time as he may consume to the
gentleman from Maryland [Mr. Ehrlich].
Mr. EHRLICH. Mr. Speaker, I rise as chief sponsor of the bill. I want
to thank a number of people for their support and cooperation; the
gentleman from California [Mr. Waxman] has been wonderful to work with
in respect to this piece of legislation. I also congratulate the
gentleman from Michigan [Mr. Camp], the chairman of the corrections day
committee, a very important committee. I am sure we will be bringing a
lot of pieces of legislation to the floor in the 105th Congress, and I
thank my friend and colleague, the gentleman from North Carolina [Mr.
Burr] from the Committee on Commerce.
Mr. Speaker, I will be brief. H.R. 968 prevents the termination of
certain training programs where the reason for the termination is an
operational deficiency unrelated to the quality of the program, and
where no alternative training program exists within a reasonable
distance.
In this regard it is vitally important for rural America that the
nursing home provisions of the Reconciliation Act of 1987 instituted
training standards for long-term facility nurse aides, requiring a
minimum of 75 hours of training for these aides. These requirements,
among others, must be met in order for nursing facilities to be
eligible for payment by Medicare and Medicaid.
However, these current Federal nursing facility laws often deprive
nursing facilities of the ability to provide in-house training. The law
allows approval of these training programs to be denied due to problems
in the facility unrelated to the training program, and in this regard
makes no sense.
Once a program is terminated, the facility becomes ineligible as a
training site for 2 years, even after the facility has corrected its
alleged deficiencies. The current restriction makes it difficult to
recruit nurse aides, especially in rural and other areas which lack
training alternatives.
Mr. Speaker, many nursing homes rely on their own nurse aide training
programs to certify nurse aides with basic nursing skills and personal
care skills. Because long-term care providers are funded primarily by
Medicare and Medicaid, they are at an economic disadvantage in
competing for labor. On-site training programs serve as an excellent
recruitment tool by providing nursing career opportunities for entry
level personnel.
Finally, the presence of these nurse aides to a nursing home staff
ensures that the residents receive high-quality personal care and also
allows the nursing staff to focus more on the delivery of quality
medical care. To compromise this ability to provide the highest level
of care possible brings about the very result Congress intended to
avoid: a threat to the quality of long-term care provided to our
Nation's senior citizens.
Mr. Speaker, I thank everyone associated with this bill.
Mr. KLECZKA. Mr. Speaker, I have no further requests for time, and I
yield back the balance of my time.
Mr. CAMP. Mr. Speaker, I have no further requests for time, and I
yield back the balance of my time.
The SPEAKER pro tempore (Mr. Goodlatte). Pursuant to the rule, the
previous question is ordered on the amendments recommended by the
Committee on Ways and Means and on the bill.
The question is on the committee amendments.
The committee amendments were agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
[[Page H1299]]
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and (three-fifths having voted in favor
thereof) the bill was passed.
A motion to reconsider was laid on the table.
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