[Congressional Record Volume 144, Number 94 (Wednesday, July 15, 1998)]
[Senate]
[Pages S8241-S8242]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM (for himself, Mr. Chafee, Mr. Johnson, Mr. 
        Grassley, Mr. Harkin, Mr. Hollings, and Mr. Inouye):
  S. 2308. A bill to amend title XIX of the Social Security Act to 
prohibit transfers or discharges of residents of nursing facilities as 
a result of a voluntary withdrawal from participation in the Medicaid 
Program; to the Committee on Finance.


                  NURSING HOME PATIENT PROTECTION ACT

  Mr. GRAHAM. Mr. President, I rise today, along with Senators Chafee, 
Johnson, Grassley, Harkin, Hollings, and Inouye to introduce the 
Nursing Home Patient Protection Act--legislation to protect our 
nation's seniors from indiscriminate patient dumping. This bill 
modifies the original legislation to include several simple changes to 
alleviate the concerns of the nursing home industry and senior citizen 
advocates. It is with their support that we encourage the Senate to 
take action on this important piece of legislation. I have also 
included the following letters of support from the American Home Care 
Association and the National Seniors Law Center.
  A few months ago, it looked like 93-year old Adela Mongiovi might 
have to spend her 61st Mother's Day away from the assisted living 
facility that she has called home for the last four years.
  At least that's what son Nelson and daughter-in-law Gina feared when 
officials at the Rehabilitation and Healthcare Center of Tampa told 
them that their Alzheimer's Disease-afflicted mother would have to be 
relocated so that the nursing home could complete ``renovations.''
  As the Mongiovis told me when I met with them and visited their 
mother in Tampa last March, the real story far exceeded their worst 
fears. The supposedly temporary relocation was actually a permanent 
eviction of all 52 residents whose housing and care were paid for by 
the Medicaid program.
  The nursing home chain which owns the Tampa facility and several 
others across the United States wanted to purge its nursing homes of 
Medicaid residents, ostensibly to take more private insurance payers 
and Medicare beneficiaries which pay more per resident.
  This may have been a good financial decision in the short run, 
however, its effects on our nation's senior citizens, if practiced on a 
widespread basis, would be even more disastrous.
  In an April 7, 1998 Wall Street Journal article, several nursing home 
executives argued that state governments and Congress are to blame for 
these evictions because they have set Medicaid reimbursement rates too 
low.
  While Medicaid payments to nursing homes may need to be revised, 
playing Russian roulette with elderly patients' lives is hardly the way 
to send that message to Congress. And while I am willing to engage in a 
discussion as to the equity of nursing home reimbursement rates, I and 
my colleagues are not willing to allow nursing facilities to dump 
patients indiscriminately.
  The fact that some nursing home companies are willing to sacrifice 
elderly Americans for the sake of their bottom-line is bad enough. 
What's even worse is their attempt to evade blame for Medicaid 
evictions.
  The starkest evidence of this shirking of responsibility is found in 
the shell game many companies play to justify evictions. Current law 
allows nursing homes to discharge patients for inability to pay.
  If a facility decreases its number of Medicaid beds, the state and 
federal governments are no longer allowed to pay the affected 
residents' bills. They can then be conveniently and unceremoniously 
dumped for--you guessed it--their inability to pay.
  Evictions of nursing home residents have a devastating effect on the 
health and well-being of some of society's most vulnerable members.
  A recent University of Southern California study indicated that those 
who are uprooted from their homes undergo a phenomenon known as 
``transfer trauma.'' For these seniors, the consequences are stark. The 
death rate among these seniors is two to three times higher than that 
for individuals who receive continuous care.
  Those of us who believe that our mothers, fathers, and grandparents 
are safe because Medicaid affects only low-income Americans, we need to 
think again.
  A three-year stay in a nursing home can cost upwards of $125,000. As 
a result, nearly half of all nursing home residents who enter as 
privately-paying patients exhaust their personal savings and lose 
health insurance coverage during their stay. Medicaid becomes many 
retirees' last refuge of financial support.
  On April 10, the Florida Medicaid Bureau responded to evidence of 
Medicaid dumping in Tampa by levying a steep, $260,000 fine against the 
Tampa nursing home. That was a strong and appropriate action, but it 
was only a partial solution. Medicaid funding is a shared 
responsibility of states and the federal government.
  And while the most egregious incident occurred in Florida, Medicaid 
dumping is not just a Florida problem. While nursing homes were once 
locally-run and family-owned, they are increasingly administered by 
multi-state, multi-facility corporations that have the power to affect 
seniors across the United States.
  Mr. President, let me also point out that the large majority of 
nursing homes in America treat their residents well and are responsible 
community citizens. Our bill is designed solely to prevent potential 
future abuses by bad actors.
  And this new bill is better, simple and fair. It would prohibit 
current Medicaid beneficiaries or those who ``spend down'' to Medicaid 
from being evicted from their homes. And that is a crucial point, Mr. 
President.
  Adela Mongiovi is not just a ``beneficiary.'' She is also a mother 
and grandmother. And to Adela Mongiovi, the Rehabilitation and Health 
Care Center of Tampa is not an ``assisted living facility.'' To Adela 
Mongiovi--this is home.
  This is the place where she wants--and deserves--like all seniors--to 
live the rest of her life with the security of knowing that she will 
not be evicted. And through passage of this bill, Mr. President, we can 
provide that security to Adela Mongiovi and all of our nation's 
seniors.
  Mr. President, I ask unanimous consent that letters in support of the 
legislation be printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                             American Health Care Association,

                                    Washington, DC, June 11, 1998.
     Hon. Bob Graham,
     Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: I am writing to lend the support of 
     the American Health Care Association to your legislation 
     which helps to ensure a secure environment for residents of 
     nursing facilities which withdraw from the Medicaid program. 
     Understand you will be filing this legislation in the next 
     few days.
       We know firsthand that a nursing facility is one's home, 
     and we strive to make sure residents are healthy and secure 
     in their home. We strongly support the clarifications your 
     bill will provide to both current and future nursing facility 
     residents, and do not

[[Page S8242]]

     believe residents should be discharged because of 
     inadequacies in the Medicaid program.
       This bill addresses a troubling symptom of what could be a 
     much larger problem. The desire to end participation in the 
     Medicaid program is a result of the unwillingness of some 
     states to adequately fund the quality of care that residents 
     expect and deserve. Thus, some providers may opt out of the 
     program to maintain a higher level of quality than is 
     possible when relying on inadequate Medicaid rates. Nursing 
     home residents should not be the victims of the inadequacies 
     of their state's Medicaid program.
       In 1996, the Congress voted to retain all standards for 
     nursing facilities. We support those standards. In 1997, 
     Congress voted separately to eliminate requirements that 
     states pay for those standards. These two issues are 
     inextricably linked, and must be considered together. 
     Importantly, your legislation mandates the Department of 
     Health and Human Services study the link between payment and 
     the ability to provide quality care. We welcome the 
     opportunity to have this debate as Congress moves forward on 
     this issue.
       Again, we appreciate the chance to work with you to provide 
     our residents with quality care in a home-like setting that 
     is safe and secure. We also feel that it would be most 
     effective when considered in the context of the relationship 
     between payment and quality and access to care.
       Finally, we greatly appreciate the inclusive manner in 
     which this legislation was crafted, and strengthened. When 
     the views of consumers, providers, and regulators are 
     considered together, the result, as with your bill, is 
     intelligent public policy.
           Sincerely yours,
                                             Dr. Paul R. Willging,
     Executive Vice President.
                                  ____

                                         National Senior Citizens,


                                                   Law Center,

                                    Washington, DC, June 26, 1998.
     Senator Bob Graham,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Graham: Earlier this year, the Vencor 
     Corporation began to implement a policy of withdrawing its 
     nursing facilities from participation in the Medicaid 
     program. The abrupt, involuntary transfer of large numbers of 
     Medicaid residents followed. Although Vencor reversed its 
     policy, in light of Congressional concern, state agency 
     action, and adverse publicity, the situation highlighted an 
     issue in need of a federal legislative solution--what happens 
     to Medicaid residents when a nursing facility voluntarily 
     ceases to participate in the federal payment program.
       I have read the draft bill that your staff has written to 
     address this issue. The bill protects residents who were 
     admitted at a time when their facility participated in 
     Medicaid by prohibiting the facility from involuntarily 
     transferring them later when it decides to discontinue its 
     participation. As you know, many people in nursing facilities 
     begin their residency paying privately for their care and 
     choose the facility because of promises that they can stay 
     when they exhaust their private funds and become eligible for 
     Medicaid. In essence, the bill requires the facility to honor 
     the promises it made to these residents at admission. It 
     continues to allow facilities to withdraw from the Medicaid 
     program, but any withdrawal is prospective only.
       This bill gives peace of mind to older people and their 
     families by affirming that their Medicaid-participating 
     facility cannot abandon them if it later chooses to end its 
     participation in Medicaid.
       The National Senior Citizens Law Center supports this 
     legislation. We look forward to working with your staff on 
     this legislation and on other bills to protect the rights and 
     interests of nursing facility residents and other older 
     people.
           Sincerely,
                                                  Toby S. Edelman.
                                 ______