[Congressional Record Volume 148, Number 97 (Wednesday, July 17, 2002)]
[Senate]
[Pages S6949-S6950]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JOHNSON (for himself and Mr. Daschle):
  S. 2738. A bill to provide for the reimbursement under the Medicaid 
program under title XIX of the Social Security Act of nursing 
facilities that are located on an Indian reservation in the State of 
South Dakota and owned or operated by an Indian tribe or tribal 
organization, and for other purposes; to the Committee on Finance.
  Mr. JOHNSON. Mr. President, South Dakota tribes are prevented from 
developing elder care on their reservations due to a State imposed 
moratorium on the construction or acquisition of additional nursing 
home beds. This impasse has gone on for nearly a decade, much too long.
  Today I am introducing legislation along with my good friend and 
colleague Senator Daschle, that will facilitate the development and 
operation of nursing facilities that are owned or operated by an Indian 
tribe or tribal organization on Indian reservations that are located in 
the State of South Dakota. Additionally, the legislation will protect 
the right of members of Indian tribes and tribal organizations to

[[Page S6950]]

access health care provided by nursing facilities in the exercise of 
those members' entitlement to medical assistance under the Medicaid 
program.
  The facts and information discussed during the Senate Indian Affairs 
July 10, 2002, Hearing on Elder Health Issues, confirms the need for 
this legislation. The National Resource Center on Native American Aging 
at the University of North Dakota, NRCNAA, reports that there is a 
``greater level of need for personal assistance among the Native 
American elders than in the general population''. Only 6.5 percent of 
the Native American elders over 55 receive such services. This fact is 
especially alarming in light of the fact that Indian elders are 
affected disproportionately by disability and poor health. For example, 
the prevalence of diagnosed diabetes among American Indians and Alaska 
Natives age 65 and over, is 21.5 percent. This is nearly double the 
rate of 11 percent for the non-Hispanic white population, age 65 and 
over. Additionally, because of their rural isolation, poverty, and 
other barriers, reservation elders have little access to existing long 
term care delivery mechanisms that may serve mainstream or urban 
elderly populations.
  This legislation will reduce existing barriers and give South Dakota 
tribes, their tribal elders, and their families long-term care 
alternatives. This legislation will assist tribes in their goal of 
providing their elders with care that preserves the individuals' 
dignity and health. I will continue to work closely with tribal leaders 
in South Dakota and Senator Daschle to address this critical problem 
facing the Native American community. I urge my colleagues to support 
passage of the South Dakota Tribal Nursing Facilities Act of 2002.
  Mr. DASCHLE. Mr. President, today I join the Senator from South 
Dakota, Mr. Johnson, in introducing the South Dakota Tribal Nursing 
Facilities Act of 2002. I am proud to be an original cosponsor of this 
legislation, which will address the growing need for tribally-operated 
nursing homes on South Dakota's Indian reservations.
  The Committee on Indian Affairs recently held a hearing on the 
growing health concerns facing Native American elders throughout Indian 
Country. Elderly Native Americans suffer from diabetes and other 
debilitating illnesses at rates hundreds of times higher than the 
general population. As more and more people live longer, it is 
necessary to find new ways to provide them with the health care, 
support, and services they need to lead productive, dignified lives.
  American Indian elders are well respected and play a strong, central 
role in their communities. They are the storytellers, the historians, 
the teachers, and the link between the younger generation and the past. 
Unfortunately, Native American elderly in need of nursing home or other 
long-term care are forced to enter off-reservation facilities, or pay 
for private care, which many cannot afford. In rural States like South 
Dakota, many off-reservation facilities are hundreds of miles from the 
reservation, which places an increased burden on family members and 
ioslated the elders who are housed there. Many families cannot afford 
to visit their parents or grandparents in these distant nursing homes, 
and the elders often die forgotten and alone. While these nursing homes 
provide for the physical well-being, their spiritual health suffers.
  There are only eleven tribally operated nursing home nationwide, and 
only one in South Dakota, operated by the Rosebud Sioux Tribe. The 
National Indian Council on Aging estimates that there are approximately 
165,000 American Indians elderly nationwide, with less than 700 tribal 
nursing home beds available. Tribal nursing homes will allow tribal 
elders to remain in their communities, surrounded by friends and loved 
ones in their later years. In recent years, several South Dakota tribes 
have expressed an interest in establishing nursing homes on their 
reservations to provide for their tribal elderly. However, the South 
Dakota Legislature, in response to a surplus of nursing home beds and 
dwindling Medicaid funding, enacted a moratorium prohibiting the 
construction and licensing of new nursing homes.
  While the moratorium does not apply to construction on Indian 
reservations in the State, the prohibition on licensing has the 
unfortunate effect of blocking access to a key and critical source of 
funding for any tribally-operated nursing home, Medicaid. Federal law 
requires that nursing homes be licensed by the State in which they are 
located to be eligible for reimbursement under Medicaid. The South 
Dakota Tribal Nursing Facilities Act of 2002 will overcome this 
obstacle by authorizing Indian tribes to construct, operate and license 
their own nursing homes. This will level the playing field to afford an 
opportunity to tribal governments that is afforded already to States. 
It is my hope this proposal will serve as a starting point so we can 
begin to address the long-term health care needs of American Indians 
across the country. I hope you will support our joint efforts
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