[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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