H.R.2270 - Medicaid Nursing Home Quality Care Amendments of 1987100th Congress (1987-1988)
|Sponsor:||Rep. Dingell, John D. [D-MI-16] (Introduced 05/05/1987)|
|Committees:||House - Energy and Commerce|
|Latest Action:||House - 12/22/1987 See H.R.3545. (All Actions)|
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Summary: H.R.2270 — 100th Congress (1987-1988)All Information (Except Text)
Introduced in House (05/05/1987)
Medicaid Nursing Home Quality Care Amendments of 1987 - Amends title XIX (Medicaid) of the Social Security Act to establish a single set of requirements for skilled nursing and intermediate care facilities (other than facilities for the mentally retarded), and to refer to such facilities as "nursing facilities." Sets forth requirements for nursing facilities, including requirements that such facilities: (1) primarily engage in providing residents with nursing care or rehabilitative services directed toward residents' mental, psychosocial, and physical well-being; (2) provide such care in accordance with a written plan of care initially prepared and periodically reviewed and revised by a licensed health care professional on the basis of assessments of a resident's functional capacity conducted upon the resident's admission and after a significant change in the resident's physical or mental condition, but in no case less often than annually; (3) provide, in addition to nursing and rehabilitative services, such physicians' services, medically-related social services, pharmaceutical services, dietician services, and dental services as are required to fulfill each resident's plan of care; (4) not use any individual who is not a licensed health care professional or licensed social worker to provide nursing or nursing-related services after 1989 to facility residents unless the individual has completed a State-approved training program or is enrolled in such a program, and is competent to provide such services; (5) require a physician's supervision of each patient's care, the maintenance of clinical records on all patients, and 24-hour nursing services; (6) protect specified patient rights, including the right to appeal an involuntary transfer or discharge from the facility; (7) safeguard a patient's funds upon the patient's authorization; (8) not admit any new resident, after 1988, who is mentally ill or retarded unless the State mental health authority deems such individual to require nursing facility services and decides whether the individual requires active treatment for mental illness or retardation; (9) notify the State agency responsible for licensing the facility of changes in the ownership, control, or administration of the facility; (10) adopt certain measures to preserve facility safety and sanitation; and (11) meet such other conditions which the Secretary of Health and Human Services deems necessary for patient health and safety.
Requires States to specify, by January 1, 1989, those nursing facility personnel training programs which meet the minimum standards to be established by the Secretary by July 1, 1988, and have the State's approval. Prohibits State approval of a training program offered by a facility that has been out of compliance with this Act's requirements within the previous two years. Requires States to: (1) establish a fair mechanism which meets Federal guidelines to be established by October 1, 1988, for hearing appeals on involuntary transfers of residents from nursing facilities; and (2) implement and enforce standards which are to be developed by the Secretary by January 1, 1989, regarding the qualifications of nursing facility administrators.
Requires that, in addition to the preadmission review of mentally ill or retarded individuals, State mental health authorities conduct an annual review of mentally ill or retarded residents to determine whether such residents require nursing facility services and whether they require active treatment for mental illness or retardation. Directs that such preadmission and annual reviews be conducted in accordance with criteria to be developed by the Secretary by October 1, 1988. Sets forth required nursing facility responses to determinations as to whether such residents need nursing facility services and need, or do not need, active treatment for mental illness or retardation. Gives long-term residents who do not require nursing facility services, but who require active treatment, the choice of remaining in the facility or receiving covered services in an alternative setting. Requires nursing facilities to provide for the active treatment of residents in need of treatment for mental illness or retardation regardless of their continued need for nursing facility services or their discharge from such facility.
Sets the Federal matching percentage for nursing facility personnel training programs at 50 percent and for preadmission and annual screening of mentally ill or retarded residents at 75 percent.
Directs the Secretary to designate an instrument(s) by April 1, 1990, and States to specify the instrument by July 1, 1990, for use by States in assessing a resident's functional capacity. Requires the Secretary to report to the Congress by January 1, 1992, on the implementation of the resident assessment process. Imposes civil monetary penalties on individuals who falsify resident assessments.
Makes the Secretary responsible for certifying that State nursing facilities comply, and States responsible for certifying that other nursing facilities comply, with Medicaid nursing facility requirements. Bases such certification on standard surveys to be conducted within two months of any change in the ownership or administration of such a facility and, on an unannounced basis, at nine- to 15-month intervals. Subjects facilities with poor compliance records to extended surveys. Directs the Secretary to: (1) develop and test a protocol for conducting surveys; (2) establish minimum qualifications for surveyors and train them in the use of resident assessment instruments; and (3) conduct sample surveys of nursing facilities, within two months of State surveys, to test the adequacy of State surveys and reduce Federal payments for State Medicaid administrative costs if such State surveys prove inadequate. Authorizes the Secretary to conduct a special survey of a facility when there is reason to question its compliance with this Act.
Requires States to investigate complaints against, and monitor the compliance of, a facility with this Act's requirements if the facility was previously found out of compliance with such requirements or the State has reason to question its compliance.
Requires that certain information regarding nursing facilities and their compliance with this Act's requirements be made available to the public. Provides long-term care ombudsmen, resident's physicians, and the State board which licenses facility administrators with notice of a facility's poor quality of care. Gives State Medicaid fraud and abuse control units access to facility survey and certification information.
Sets the Federal matching percentage for nursing facility certification activities at 90 percent in FY 1990, 85 percent in FY 1991, 80 percent in FY 1992, and 75 percent thereafter.
Eliminates current penalties applied to a State when its control over the utilization of skilled nursing or intermediate care facility services is deemed inadequate. Requires that when the Secretary or a State determines that a nursing facility's deficiencies immediately jeopardize residents' health and safety, such facility's participation in Medicaid be terminated. Directs the Secretary and States to apply certain other remedies where the health and safety of facility residents is not immediately jeopardized. Provides that if a facility is out of compliance with any of this Act's requirements six months after having been found out of compliance with such requirements, Medicaid payments for newly admitted or eligible residents shall be denied. Sets forth special rules which are to be applied where a State and the Secretary do not agree on a finding of noncompliance or the remedies which should be prescribed.