[Congressional Record (Bound Edition), Volume 148 (2002), Part 3]
[Extensions of Remarks]
[Page 3911]
[From the U.S. Government Publishing Office, www.gpo.gov]




  INTRODUCTION OF THE MEDICARE AND MEDICAID NURSING FACILITY QUALITY 
                        IMPROVEMENT ACT OF 2002

                                 ______
                                 

                             HON. DAVE CAMP

                              of michigan

                    in the house of representatives

                       Wednesday, March 20, 2002

  Mr. CAMP. Mr. Speaker, today I introduce the Medicare and Medicaid 
Nursing Facility Quality Improvement Act of 2002.
  This session, legislation has been introduced on numerous important 
long term care issues ranging from criminal background checks for 
nursing home staff to additional funding for the Medicaid program that 
provides the lion's share of financing for long term care. A variety of 
other financing and regulatory proposals have been introduced or are 
being discussed. This gives us an important opportunity to discuss a 
broad range of options intended to improve the quality of care provided 
to residents in long term care facilities. Today, I am introducing 
legislation that would improve the quality of care in our nation's 
nursing homes where thousands of our most frail and elderly seniors 
live. It is my hope that these provisions perhaps combined with other 
valuable proposals can be enacted into law.
  My legislation will provide incentives for the best facilities to 
improve and give facilities experiencing quality of care issues 
additional opportunities to provide better care for residents. I 
believe the changes will also focus regulatory efforts on improving 
outcomes, fostering innovation and ensuring that the federal and state 
oversight system is more fair and accurate, to the benefit of residents 
and providers alike. This legislation would:
  Alleviate the shortage of well-trained staff. The legislation would 
restore the ability of more facilities to train nurses aides in order 
to help hundreds of facilities in Michigan as well as many others 
across the nation respond more effectively to the shortage of long term 
care workers and to the needs of their residents. Unfortunately, 
current law prevents nursing facilities from training nurses aides on 
site for a full two years after the original problem that led to the 
prohibition on training is remedied. This penalty is highly 
counterproductive. It does not serve the interests of residents and 
hinders rather than enhances the provision of quality care.
  Flexibility and Innovation. The legislation would allow for an eight 
state survey and certification waiver demonstration program so states 
can adopt innovative regulatory process for nursing homes that focus on 
improving resident outcomes. Sates should work together with consumers, 
providers, labor representatives and other involved parties to craft 
innovative systems that can improve the quality of care. For example in 
the state of Washington there is broad support among all key 
stakeholders for such a waiver, and I believe other states would come 
forward with valuable waiver applications if such a process were 
available. In addition, states would be given some narrow additional 
discretion to work within the current enforcement process to avoid any 
unintended consequences of current law which could harm resident 
quality of life.
  Establish incentives and additional opportunities for technical 
assistance to help all facilities improve the quality of care. The 
legislation would establish a range of incentives to encourage nursing 
homes that are providing the best possible care to exceed their already 
high standards, while facilitating the provision of technical 
assistance and advice on best practices to facilities that need to 
improve care for residents. Such measures will help both good 
facilities to implement even more effective care practices and assist 
those that face challenges in their efforts to provide excellent 
services. Current law provides many penalties to deter and punish those 
who provide low quality care but strangely absent are incentives for 
the overwhelming majority of responsible nursing facilities to improve 
the quality of care.
  Insure fair and accurate survey results. Residents, families and 
health care providers are best served if all disputes concerning 
surveys of long term care facilities can be resolved quickly and cost-
effectively through an independent review process. In fact, in my home 
state of Michigan providers and regulators are able to resolve many 
disputes through an independent dispute resolution process. 
Unfortunately, in many states the process is not independent enough of 
the state regulatory agency to provide for fair and impartial review. 
Our independent process in Michigan, as well as the independent systems 
in several other states can offer many lessons for the nation. Michigan 
also believes additional steps are needed to insure that all citations, 
even those that do not result in the immediate imposition of a penalty, 
can be subject to an appeal. Basic fairness and the principles of due 
process require us to allow nursing facilities to appeal all publicly 
reported deficiencies.
  Ensure proper medical care. The legislation would prevent government 
inspectors from overturning the orders of patient's own physicians. 
Inspectors are charged with evaluating the medical condition of nursing 
home patients and for making sure nursing facilities provide the best 
possible care. However some inspectors, even though they are not 
physicians, overturn doctor's orders. The changes could endanger a 
resident's health. Patients do not lose the right to the care 
prescribed by a personal physician simply because they have entered a 
nursing facility. When government inspectors substitute their judgment 
for that of a physician, nursing home providers must choose between the 
doctor's orders and government sanctions. An efficient and fair system 
requires that without fear of punishment, nursing home providers be 
allowed to follow a doctor's orders in keeping with the best interest 
of their residents. Optimal quality care means that patients should 
enter nursing homes with the assurance that the care prescribed by 
their physician is the care they will receive.
  I hope this legislation fosters a constructive debate over the best 
ways to improve care for residents and that involved stakeholders can 
come together to reach consensus on the need for changes in the current 
system. I am pleased that already the Michigan Association of Homes and 
Services for the Aging, the American Association of Homes and Services 
for the Aging, Lutheran Services in America, the Council for Health and 
Human Service Ministries of the United Church of Christ and the 
Catholic Health Association support this legislation. I appreciate the 
input I have received from others as well and look forward to working 
with other key stakeholders in long term care and interested Members of 
Congress. As Congress considers further improvements to the Medicare 
program, I urge my colleagues to support this important effort.

                          ____________________