[Congressional Record Volume 145, Number 37 (Tuesday, March 9, 1999)]
[House]
[Pages H1029-H1033]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          NURSING HOME RESIDENT PROTECTION AMENDMENTS OF 1999

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 540) 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.
  The Clerk read as follows:

                                H.R. 540

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Nursing Home Resident 
     Protection Amendments of 1999''.

     SEC. 2. RESTRICTIONS ON TRANSFERS OR DISCHARGES OF NURSING 
                   FACILITY RESIDENTS IN THE CASE OF VOLUNTARY 
                   WITHDRAWAL FROM PARTICIPATION UNDER THE 
                   MEDICAID PROGRAM.

       (a) In General.--Section 1919(c)(2) of the Social Security 
     Act (42 U.S.C. 1396r(c)(2)) is amended by adding at the end 
     the following new subparagraph:
       ``(F) Continuing rights in case of voluntary withdrawal 
     from participation.--
       ``(i) In general.--In the case of a nursing facility that 
     voluntarily withdraws from participation in a State plan 
     under this title but continues to provide services of the 
     type provided by nursing facilities--

       ``(I) the facility's voluntary withdrawal from 
     participation is not an acceptable basis for the transfer or 
     discharge of residents of the facility who were residing in 
     the facility on the day before the effective date of the 
     withdrawal (including those residents who were not entitled 
     to medical assistance as of such day);
       ``(II) the provisions of this section continue to apply to 
     such residents until the date of their discharge from the 
     facility; and
       ``(III) in the case of each individual who begins residence 
     in the facility after the effective date of such withdrawal, 
     the facility shall provide notice orally and in a prominent 
     manner in writing on a separate page at the time the 
     individual begins residence of the information described in 
     clause (ii) and shall obtain from each such individual at 
     such time an acknowledgment of receipt of such information 
     that is in writing, signed by the individual, and separate 
     from other documents signed by such individual.

     Nothing in this subparagraph shall be construed as affecting 
     any requirement of a participation agreement that a nursing 
     facility provide advance notice to the State or the 
     Secretary, or both, of its intention to terminate the 
     agreement.
       ``(ii) Information for new residents.--The information 
     described in this clause for a resident is the following:

       ``(I) The facility is not participating in the program 
     under this title with respect to that resident.
       ``(II) The facility may transfer or discharge the resident 
     from the facility at such time as the resident is unable to 
     pay the charges of the facility, even though the resident may 
     have become eligible for medical assistance for nursing 
     facility services under this title.

       ``(iii) Continuation of payments and oversight authority.--
     Notwithstanding any other provision of this title, with 
     respect to the residents described in clause (i)(I), a 
     participation agreement of a facility described in clause (i) 
     is deemed to continue in effect under such plan after the 
     effective date of the facility's voluntary withdrawal from 
     participation under the State plan for purposes of--

       ``(I) receiving payments under the State plan for nursing 
     facility services provided to such residents;
       ``(II) maintaining compliance with all applicable 
     requirements of this title; and
       ``(III) continuing to apply the survey, certification, and 
     enforcement authority provided under subsections (g) and (h) 
     (including involuntary termination of a participation 
     agreement deemed continued under this clause).

       ``(iv) No application to new residents.--This paragraph 
     (other than subclause (III) of clause (i)) shall not apply to 
     an individual who begins residence in a facility on or after 
     the effective date of the withdrawal from participation under 
     this subparagraph.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to voluntary withdrawals from participation occurring 
     on or after the date of the enactment of this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 540.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 540, the Nursing Home Resident 
Protection Amendments of 1999. This measure will protect the health and 
dignity of nursing home residents who rely on Medicaid.
  In a hearing of my Subcommittee on Health and Environment on February 
11, Mr. Nelson Mongiovi described the trauma that his mother suffered 
when she was targeted for eviction by her nursing home in Tampa, 
Florida. That facility attempted to evict over 50 Medicaid residents 
last year under the guise of remodeling their wing.

[[Page H1030]]

  In fact, those residents were targeted for eviction solely, solely 
because they relied on Medicaid. Although a court halted the evictions 
in Tampa, this was not an isolated incident. Discrimination against 
Medicaid residents has also been reported in other States.
  HCFA estimates that an average of 58 nursing homes voluntarily 
withdraw from the Medicaid program each year. In an informal survey of 
47 States' ombudsmen, 15 cited transfer and discharge violations as 
highly problematic.
  To stop this outrageous practice, the gentleman from Florida (Mr. Jim 
Davis) and I worked on a bipartisan basis to draft H.R. 540. Our bill 
adopts a simple and fair approach. It protects current nursing home 
residents from eviction when their facility withdraws from Medicaid. It 
does not, and I repeat, it does not force nursing homes to remain in 
the Medicaid program, and facilities may continue to decide which 
residents to admit in the future.
  If a facility, however, withdraws from the program, H.R. 540 requires 
the home to provide clear notice to future residents that it does not 
accept Medicaid payments. This safeguard will prevent new residents 
from assuming that they can remain in a facility once they exhaust 
their assets and become Medicaid-eligible.
  This legislation, Mr. Speaker, is necessary to close a loophole that 
exists under current law. In testimony before my subcommittee, Mike 
Hash, Deputy Administrator of HCFA, stated clearly, and I quote him, 
``We do not have the authority to prevent evictions of Medicaid 
patients if nursing homes leave the Medicaid program.''
  I represent a district, Mr. Speaker, with one of the highest 
concentrations of senior citizens in the country. I am committed to 
reforming our Nation's long-term care system.

                              {time}  1230

  The bill before us is part of a larger effort to remedy these 
problems. It addresses one serious concern by guaranteeing that nursing 
home residents and their families will not have to live with a fear of 
eviction.
  H.R. 540 is a responsible measure supported by a broad range of 
seniors' advocates, including AARP, the Seniors Coalition, and the 60 
Plus Association. In addition, the nursing home industry and the 
administration have endorsed the bill. It is the product of our 
bipartisan effort to improve safeguards for vulnerable residents of 
nursing homes.
  I am proud to bring H.R. 540 to the floor as the first measure 
approved by my subcommittee in this Congress. Passage of this bill 
sends a clear message that we put patients ahead of profits. I urge all 
Members to vote in favor of H.R. 540.
  Before I sign off, Mr. Speaker, I would like to express my gratitude 
to the gentleman from Virginia (Chairman Bliley), to the gentleman from 
Michigan (Mr. Dingell) and the gentleman from Ohio (Mr. Brown), and of 
course to the staffs, Todd Tuten of my personal staff, and Mr. Mark 
Wheat and Mr. Tom Giles of the committee staff, and of course, Mr. John 
Ford, the head of the minority staff.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself as much time as I may 
consume.
  Mr. Speaker, I commend the gentleman from Florida (Mr. Davis) for his 
hard work and obvious commitment to preempting further mistreatment of 
low-income nursing home residents.
  I would also like to recognize the outstanding efforts of the 
gentleman from Florida (Mr. Bilirakis). Under his thoughtful 
leadership, this subcommittee worked on a fully informed bipartisan 
basis to move this important piece of legislation.
  H.R. 540 has symbolic as well as practical importance. In practical 
terms, it tells nursing facilities they cannot provide a home to some 
patients and a boarding house to others.
  There are more than 90,000 licensed nursing home beds in my home 
State of Ohio. They are licensed for the purpose of providing long-term 
care. That purpose should not vary with the income status of the 
patient.
  It is abusive to evict a Medicaid or pre-Medicaid patient without 
notice or without cause. But nursing homes in Florida and Indiana did 
just that, abandoning their residents along with the premise that long-
term care signified anything more than short-term profit making.
  The practical purpose of this bill is to prevent that kind of 
mistreatment from recurring. Its symbolic purpose is to assert that 
nursing home residents are not to be mistreated, period.
  When Congress repealed the Boren Amendment, it in effect silenced 
nursing homes, removing their right to appeal inadequate reimbursement. 
If nursing homes are truly being underpaid, then they are not the only 
ones to blame for the mistreatment of nursing home residents. We should 
rethink the 1997 Congressional appeal of the Boren Amendment.
  H.R. 540 is a bold effort because it says Congress can, in fact, 
prevent mistreatment of Medicaid beneficiaries. Congress should pass 
H.R. 540 for the sake of low-income seniors and their families and 
because it is the right thing to do.
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 7 minutes to the gentleman 
from Florida (Mr. Davis) who worked so hard on this bill.
  Mr. DAVIS of Florida. Mr. Speaker, more so than ever before in the 
history of our country Americans are outliving their savings and good 
health. Many of these men and women defended our country in times of 
war and built our country through their hard work and sacrifice. These 
men and women are our parents and grandparents. Thanks to them, we 
enjoy a lot of the success and opportunity we have today. Many of these 
seniors are now in nursing homes across the country, and now it is our 
turn to care for them.
  The issue before us today is protecting Medicaid residents from being 
evicted from nursing homes. The issue is preventing nursing homes from 
draining a patient's savings dry and then kicking them out because 
Medicaid is needed to pay the nursing home bill.
  I believe that nursing home residents and their families should not 
have to live with fear of eviction based on how they pay their bills. 
It is unfair and flat out wrong that our most vulnerable and frail 
citizens, and their families, must worry about being evicted in nursing 
homes in favor of people who can pay higher rates.
  The bill before us today provides security for these patients and 
their families by ensuring that they cannot be evicted from a nursing 
home in favor of higher paying patients if the nursing home chooses to 
voluntarily withdraw from the entire Medicaid program. Very simply, Mr. 
Speaker, our bill will ensure that our nursing homes do not put profits 
ahead of patients.
  In April of 1998, a nursing home in my hometown of Tampa, Florida, in 
Hillsborough County, tried to evict 54 Medicaid residents, including 
Adelaida Mongiovi, under the guise of emptying their facility for 
remodeling. A judge halted the evictions, and the nursing home then 
told residents they could stay. If it had not been for the commitment 
and determination of the Mongiovis, we would not be here today.
  Mr. Speaker, I would like to thank Nelson and Geri Mongiovi, 
Adelaida's son and daughter-in-law, for their commitment for their 
loved-one and for bringing this issue to the forefront. Although 
Adelaida Mongiovi passed away late last year, I know that she is proud 
of her son and daughter-in-law for continuing to volunteer at that 
nursing home every day and for fighting for the rights of those nursing 
home residents. I am proud to represent them. The Mongiovis are a clear 
example of how citizens throughout this country can identify problems 
that need to be addressed by Congress and persuade Congress to do the 
right thing.
  After the judge halted the evictions in Tampa, an investigation by 
the Florida Agency for Health Care Administration found the evictions 
were based solely on the fact that these residents relied on Medicaid 
to pay their bills. The nursing home was subsequently fined by both the 
State and Federal Government.
  Opponents of this legislation will argue that what the nursing home 
in Tampa did was illegal and that current law prevents them from 
evicting Medicaid residents. Mr. Speaker, that is simply not true. Yes, 
the nursing home in Tampa was fined because they did

[[Page H1031]]

not follow legal procedures for transferring and discharging patients. 
However, if they had followed those procedures, it would have been 
perfectly legal for them to remove these most frail and vulnerable 
citizens.
  Under the current law, one of the criteria for transferring or 
discharging a nursing home resident is failure to pay. If the national 
chain that operated the nursing home in Tampa had been honest about 
what they were attempting to do, withdrawing from the Medicaid program, 
and had notified the residents and families of their intention to 
withdraw, they could have legally evicted these Medicaid residents for 
failure to pay their bills. If a nursing home no longer accepts 
Medicaid payment and the resident has no other means to pay their bill, 
they have failed to pay their bills.

  According to the Health Care Financing Administration, about 58 
nursing homes a year over the last 3 years have voluntarily withdrawn 
from Medicaid. It has been reported that in one nursing home chain 
alone, Medicaid residents were evicted in 13 homes in 9 separate States 
as part of a corporate plan to withdraw an additional 25 homes from the 
Medicaid program.
  This is not just a Florida problem. It is a national problem which 
must be addressed by Congress. There are incidents of evictions and 
improper transfers of Medicaid residents in nursing homes in Indiana, 
California, Tennessee and other States. As a result of this problem, 
California passed legislation prohibiting these mass evictions by 
requiring the nursing homes that withdraw from Medicaid to wait until 
the patients die or choose to leave the facility.
  While the Omnibus Budget Reconciliation Act of 1987 established 
standards to guard against resident abuse, nothing in current law 
protects Medicaid nursing home residents who rely solely on Medicaid to 
pay their bills. Residents who spend their life savings on a lengthy 
nursing home stay are at the mercy of a facility which could later 
decide to dump them based solely on the fact that they are using 
Medicaid to pay their bills.
  H.R. 540 is simple and fair. This bill prohibits nursing homes who 
have already accepted a Medicaid patient or private pay patient from 
evicting or transferring that resident based on his or her payment 
status. Nursing homes may continue to decide which residents are 
admitted to their facility and could withdraw entirely from the 
Medicaid program. However, they will not be permitted to dump these 
residents once they are admitted.
  Under this bill, nursing homes can still voluntarily leave the 
Medicaid system, and they should be free to do so. However, residents 
need minimum protection once they enter these facilities which have 
left Medicaid.
  Many residents enter a facility as private paying clients with the 
expectation that they will become eligible for Medicaid when they have 
depleted their personal assets by paying for their care. Sixty-three 
percent of nursing home residents who enter a nursing home do so as a 
private pay patient and exhaust their personal savings in just 13 
weeks, and 87 percent of them exhaust their savings in just 36 weeks.
  H.R. 540 addresses this problem. If a patient enters a nursing home 
with the expectation that they will be eligible for Medicaid coverage 
in the future, they will, in fact, be protected should the nursing home 
withdraw from the Medicaid program in the midst of their spend down of 
personal assets.
  Another protection included in the bill is advance notification when 
the nursing home decides not to participate in the Medicaid program. 
Under this provision, if a nursing home no longer participates, it must 
provide clear and conspicuous notice to future residents that the 
nursing home does not participate in the Medicaid program and it does 
not accept Medicaid patients.
  Mr. Speaker, fortunately, I have not yet and hopefully will not have 
to experience having a loved one in a nursing home. I can only imagine 
what a trying and stressful time that must be. This provision of the 
bill is intended to relieve some of the stress of that situation. Under 
our bill, family members will know in advance whether the nursing home 
they are choosing to enter their loved one in is the appropriate 
nursing home for them.
  I am pleased this bill has received bipartisan support in the House 
with 62 cosponsors. I want to thank the gentleman from Florida 
(Chairman Bilirakis) for his support of the legislation and for moving 
it so swiftly through the House of Representatives. I want to also 
thank the gentleman from Michigan (Mr. Dingell), the ranking Democrat 
on the Committee on Commerce, and the gentleman from Ohio (Mr. Brown), 
the ranking Democrat on the Subcommittee on Health and Environment, for 
their support.
  In addition to their support of this bill, the bill is supported by 
many senior citizen advocacy groups, including the National Senior 
Citizens Law Center, the AARP, the National Citizens' Coalition for 
Nursing Home Reform, the Seniors Coalition and the 60 Plus Association.
  Mr. Speaker, in closing, 1.6 million nursing home residents are at 
risk of eviction if this legislation is not approved. To these most 
vulnerable citizens, their nursing facility is, in fact, their home. 
Everyone should feel safe and secure in their home, including residents 
in nursing homes.
  I urge my colleagues to join me in passing this bill to prevent our 
most frail and vulnerable citizens from being evicted from their homes.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Smith).
  Mr. SMITH of Michigan. Mr. Speaker, I thank the gentleman from 
Florida (Chairman Bilirakis) for yielding me this time.
  Mr. Speaker, let me just say that it would appear that the challenge 
of future nursing home care is as much a challenge as Social Security 
or Medicare or Medicaid. As we look at the dramatic demographics in the 
changes of an increased senior population, the challenge in the future 
is even going to be more overwhelming.
  My neighbor, Eddie Michel, of Addison, Michigan, came to me a couple 
of years ago concerned about the care that her mother was getting in a 
nursing home. That was a factor in my request from GAO along with the 
gentleman from Michigan (Mr. Dingell) and others that GAO investigate 
the Federal compliance with our rules in terms of the care in nursing 
homes. That report, at a press conference, will be released officially 
on March 18 of this month.
  In conclusion, let me say that I compliment the gentleman from 
Florida (Chairman Bilirakis) for bringing this bill forward and for all 
of the people that have supported this kind of legislation. I hope that 
we can work together in a bipartisan effort in the future to face the 
challenge of the tremendous cost of nursing home care in the future. A 
logical alternative, of course, is expanding the kind of legislation 
that is going to make it easier for seniors to live in their own homes. 
It is going to be a significant challenge. I look forward to working 
with Republicans and Democrats.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I rise in strong support of H.R. 540, the 
Nursing Home Residents Protection Amendments of 1999. This legislation 
provides new and strengthened authority to protect frail elderly and 
disabled nursing home residents who rely on the Medicaid program for 
their support.
  This legislation was developed in response to an action by the Vencor 
nursing home chain to withdraw from the Medicaid program and evict 
residents in the facility whose care was paid for by Medicaid. The bill 
was developed by our colleague, the gentleman from Florida (Mr. Davis), 
with strong bipartisan support, including that of the gentleman from 
Florida (Mr. Bilirakis), the chairman of the Subcommittee on Health and 
Environment of the Committee on Commerce. Further, it has the strong 
support of the administration, consumer groups, and others.
  Yet, during the consideration of this bill, the gentleman from 
Oklahoma (Mr. Coburn) raised concerns about the unintended consequences 
that he thought might be possible. He feared States will take advantage 
of the requirement that nursing homes must continue to care for 
Medicaid patients once they are a resident in the facility and would 
reduce their Medicaid payments to those facilities.

[[Page H1032]]

  I think it is important to separate the issues here. First, there is 
no question that the residents in the facilities deserve protection, as 
the bill would give them. What a State may do with its reimbursement 
rates should not be used as an excuse to put the resident patients at 
risk.

                              {time}  1245

  But the issue of adequate payment to Medicaid nursing homes so that 
they can provide quality care to their residents is an important issue. 
And let me remind my colleagues we used to have a provision in the 
Medicaid law, the so-called Boren Amendment, that required States to 
pay nursing homes reasonable and adequate rates, rates that would allow 
an efficiently run facility to provide the required care. That 
provision was repealed in the Balanced Budget Act.
  I believe that was a mistake. I think the concerns some of my 
colleagues have raised, that State payments might be inadequate to 
support what we are requiring in this bill, is a strong argument to 
return to consideration of the Boren Amendment. It should be part of 
the Medicaid law.
  So I urge my colleagues to support this bill that is before us. I 
urge that we also return to a reconsideration of the Boren Amendment at 
some time in the future, and the assurance that Medicaid payments are 
reasonable and adequate to provide the quality care we all support for 
the frail elderly and disabled people who are in nursing homes.
  I urge support for the bill and appreciate this opportunity to make 
these comments for the Record.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank my colleague very much 
for his kindness and thank the chairman and all of the cosponsors for a 
very needed and instructive piece of legislation.
  Mr. Speaker, H.R. 540 is long overdue. This bill prohibits nursing 
homes from evicting patients who receive Medicaid after the facility 
has voluntarily withdrawn from the Medicaid program.
  Let me say that I have experienced this in recently walking through a 
nursing home facility in my district, receiving many, many calls from 
constituents who have loved ones in nursing homes near their community. 
This was a different set of facts, because this happened to be a 
nursing home that was being sold, and the word went out that these 
individuals, these family members, would be dispersed throughout the 
State, moved away from their particular loved ones. What an enormous 
burden. What a responsibility. What a feeling of helplessness.
  This bill helps in another area, where a particular nursing home no 
longer uses Medicaid and they seek to replace the Medicaid-based 
patients with those who can privately pay.
  Nursing homes provide long-term medical and residential care to 
patients with complex medical needs, and these services should not be 
based on the patient's receipt of Medicaid.
  Traditionally, nursing facilities provided long-term custodial 
services for the elderly. However, age is no longer the predominant 
factor in determining a patient's need for long-term care. Nursing 
facilities also care for children and other adults with mental and 
physical disabilities and other chronic illnesses.
  Despite this trend, the elderly continue to need the long-term care 
services provided by nursing facilities due to chronic illnesses, such 
as Alzheimer's and Parkinson's disease. So many Americans do not plan 
for their long-term care and later become impoverished when their 
private insurance runs out.
  Medicaid is the major funding source for long-term care at most 
nursing facilities. I realized that many of those who I saw were 
individuals who no longer had any family members.
  It covers almost 52 percent of the cost which includes room, board 
and nursing care. Although Medicaid will only pay for nursing care for 
patients who meet a state-determined poverty level, half of the nursing 
home residents eventually rely on Medicaid because they have depleted 
their financial resources.
  This bill is important to protect the rights of patients who receive 
Medicaid. Nursing facilities cannot evict patients because it 
voluntarily chooses to withdraw from the Medicaid program.
  This bill is an important bill, Mr. Speaker, to protect the rights of 
patients who receive Medicaid. I ask my colleagues to join us in 
supporting H.R. 540.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  In closing, I would just merely communicate that we have checked with 
HCFA. We are trying to address a concern raised by a member of the 
subcommittee. There is no record of Medicaid reimbursement reductions. 
Further, in CBO's opinion, and I quote them, ``Nursing facilities are 
highly dependent on Medicaid revenue. Therefore, it is unlikely that 
there would be a large-scale withdrawal from Medicaid program 
participation under current law.''
  And, additionally, something maybe we are overlooking or forgetting, 
the 1997 Balanced Budget Act, which did repeal the Boren Amendment, 
directed the Secretary of Health and Human Services to study these 
concerns. HHS must report to Congress by August 2001 on the effect of 
States' reimbursement rates on nursing home patient care.
  I also would like to read from three comments that we have received 
in writing from Florida Secretary of Elder Affairs, Secretary 
Hernandez.

       I applaud and strongly support your efforts to provide 
     additional protection to elders. The evidence is overwhelming 
     that, without extraordinary preparatory efforts that are 
     hardly ever made, any move is harmful for the preponderance 
     of the frail elderly; the technical term is ``transfer 
     trauma''.

  And from AARP, Mr. Horace Deets, the Executive Director,

       H.R. 540 establishes clear legal authority to prevent 
     inappropriate discharges, even when a nursing home withdraws 
     from the Medicaid program. AARP believes this is an important 
     and necessary step in protecting access to nursing homes for 
     our Nation's most vulnerable citizens.

  And from Mr. James L. Martin, President of the 60 Plus Association, 
in testifying before our committee, when he said,

       Nursing homes become just that. They are not a hospital 
     room, nor a hotel room, they are a ``home'' to these 
     patients. Attrition, not eviction, should be the rule, so 
     indigent patients do not suffer relocation trauma.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume to simply ask for a ``yes'' vote on H.R. 540 and again thank 
the gentleman from Florida (Mr. Davis) for his exceptional work.
  Mr. STARK. Mr. Speaker, nursing home residents and their advocates 
welcomes speedy passage of this bill, which is designed to prevent 
facilities that prospectively withdraw from Mediciaid from kicking out 
frail elderly people whose care is paid for through that program.
  Last April, the Wall Street Journal brought national attention to 
evictions of Medicaid residents from a nursing home in Indiana run by 
the chain Vencor, Inc. Subsequently, Florida fined a Vencor facility in 
Tampa $270,000 for doing the same thing.
  The legislation before us today is only a first step. Congress can 
and should enact additional legislation to confirm the Health Care 
Financing Administration's authority to prevent nursing homes that are 
reimbursed by Medicaid from arbitrarily changing the number of beds 
allocated for residents who are enrolled in this program. If we fail to 
do this, facilities will continue dumping elderly people who are 
admitted as private-pay residents, and later told that they must leave 
once they have ``spent down'' because `` no Medicaid beds are 
available.''
  Similarly, we should ensure that seniors are protected who are 
Medicaid-eligible at the time they seek admission to nursing homes. Too 
often, facilities tell these folks that their Medicaid beds are full, 
in hopes that a patient who can afford to pay a higher private rate 
will soon apply.
  Such discriminatory practices, which are unfortunately all too common 
today, deny needed care and services to vulnerable elderly individuals 
who deserve our help. Yet under current law, seniors and their families 
have very limited ability to seek redress. The legislation we are 
considering today will protect some residents now living in facilities 
that choose to withdraw from Medicaid. However, few nursing homes 
voluntarily withdraw from Medicaid. And for those who are denied 
admission in the first instance as Medicaid enrollees, or who are asked 
to leave after they have exhausted their resources, this proposal is 
not an answer.

[[Page H1033]]

  In the coming weeks, I will introduce legislation designed to add 
protections to Medicare and Medicaid to bolster enforcement efforts and 
improve residents' rights. I hope my colleagues will join me in 
supporting additional efforts to improve the quality of care in our 
nation's nursing facilities.
  Mrs. CAPPS. Mr. Speaker, I rise today in strong support of this 
important legislation to protect some of the most vulnerable in our 
society--residents of nursing homes.
  This bill would prohibit a nursing home from discharging or 
transferring a resident if the nursing home voluntarily withdraws from 
Medicaid. It would also require nursing homes that do not participate 
in Medicaid to inform individuals who would become residents that it 
does not participate in Medicaid and that it may transfer or discharge 
such a resident if he or she no longer is able to pay on their own, 
even if they become Medicaid-eligible.
  The series of events that brought us this legislation are the worst 
nightmare for nursing home residents and their families. In April, 
1998, a Tampa, FL, nursing home attempted to evict 52 Medicaid 
residents under the guise of remodeling the facility. Eventually, after 
the courts and the state intervened, the nursing home relented and 
invited back all the discharged patients.
  But the point is not that the residents are back in their nursing 
home. The point is that they shouldn't have had to put up with this 
callous and potentially fatal disruption in their lives. The 
culmination of a year of confusion came last April. As Nelson Mongiovi 
of Tampa testified before the Health Subcommittee last month, when he 
went to the facility where his mother was living after newspaper 
stories began to appear about Medicaid dumping:

       (I) saw many residents being moved out so rapidly that no 
     one knew what was going on. The residents were crying 
     hysterically, not knowing what was happening or where they 
     were going. Within two days, ten residents had been evicted 
     from this facility . . . There was utter chaos at the 
     facility at this time with everyone, residents and family 
     members, trying to determine what, if anything, would we be 
     able to do.

  Mr. Speaker, this legislation will hopefully put an end to scenes 
like that.
  Protection for Medicaid-eligible nursing home residents is critical 
because of the large proportion of residents, often over 60% of a 
facility, who eventually end up on Medicaid. Typically, nursing home 
residents rely on Medicare to finance the first 100 days of nursing 
home, and then the resident relies on his or her own resources until 
they become eligible for Medicaid. According to some estimates, 63% of 
the elderly exhaust their own resources within 13 weeks and 87% within 
52 weeks. These residents, who have spent all their own resources, 
should not be treated as second class citizens in nursing home 
facilities just because they now fall under Medicaid. This bill offers 
that protection, for residents now in homes and for future residents.
  I am pleased that the Commerce Committee acted swiftly on this 
legislation and that the House has seen fit to act quickly as well. We 
must protect our vulnerable seniors in nursing homes, and their 
families, from the type of callous disruptions that the Mongiovi family 
faced.
  Mr. PACKARD. Mr. Speaker, I rise today in support of H.R. 540, the 
Nursing Home Resident Protection Amendment. This legislation will 
prevent nursing homes from discriminating against residents who rely on 
Medicaid to cover their nursing home costs.
  We have all heard the horror stories of seniors who have been evicted 
because their nursing home decided to withdraw from the Medicaid 
program. H.R. 540 will protect our seniors from being unfairly removed 
from their homes. This legislation will also serve to protect the 
nursing homes ability to withdraw from the Medicaid program, or 
determine which residents are admitted in the future. Under H.R. 540, 
nursing homes which choose to leave Medicaid are required to provide a 
``clear and conspicuous'' notice to incoming residents that Medicaid 
payments are no longer accepted. Facilities will also be allowed to 
transfer residents who pay with private funds, but later become 
Medicaid-eligible.
  Mr. Speaker, the choice to enter a nursing home is often one of the 
most difficult decisions to make for individuals and families. Let's 
not increase the stress associated with this decision by leading our 
seniors to believe that they could be evicted simply for the method of 
payment they choose.
  I urge my colleagues to support H.R. 540 and protect our Nation's 
seniors.
  Mr. BROWN of Ohio. Mr. Speaker, I have no further requests for time, 
and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. LaTourette). The question is on the 
motion offered by the gentleman from Florida (Mr. Bilirakis) that the 
House suspend the rules and pass the bill, H.R. 540.
  The question was taken.
  Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed until tomorrow.

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