Chairman Bilirakis, Congressman Brown, distinguished Committee members, thank you for
inviting us here today to discuss our efforts to improve protections for nursing home residents.
The Health Care Financing Administration (HCFA) is aggressively working to improve the
oversight and quality of nursing home care. Preventing inappropriate eviction of Medicaid
residents is an essential part of this effort.
There have been intolerable situations in which facilities transferred or discharged Medicaid
residents on false grounds and without appropriate notice. This creates serious disruptions in
care and untold emotional toll on frail beneficiaries we are sworn to protect.
We have taken swift and strong action in these situations, including the imposition of $10,000
per day of civil money penalties. States have also taken swift and strong action. States and
HCFA together have made clear that we are very serious about protecting Medicaid residents
from inappropriate transfers and discharges. But we need to do more, and we need legislation to
do it.
Chairman Bilirakis, America's nursing home residents need the bill you and Congressman Davis
are introducing to be enacted into law. I am proud to say that the Clinton Administration and my
agency strongly support your legislation. America's nursing home residents must not live in fear
that they will be evicted solely because they rely on Medicaid to pay for their care. We must
enact this bill to prohibit transfers or discharges of Medicaid residents when a nursing home
chooses to leave the Medicaid program. I know my staff has provided technical assistance to
your staff in drafting the legislation. We look forward to working with you further to ensure
passage and to ensure that the goals of this legislation are met. We also may need to address
further protection of Medicaid residents when nursing homes decrease the number of beds
available to Medicaid residents, and we look forward to working with you on that issue as well.
BACKGROUND
About 1.6 million elderly and disabled Americans receive care in approximately 16,800 nursing
homes across the United States
. Through the Medicare and Medicaid programs, the federal
government provides funding to the States to conduct on-site inspections of nursing homes
participating in Medicare and Medicaid and to recommend sanctions against those homes that
violate health and safety rules.
Medicaid nursing home participation is voluntary, and current law allows nursing homes to
determine and change the extent of their participation. They can designate that only part of their
facilities, for example a certain number of beds or certain wings, are available to Medicaid
beneficiaries. If a nursing home wants to reduce the portion of its facilities that are available to
Medicaid patients, it must give 30 days notice of its intentions to both the State and the affected
residents. It also must ensure that any displaced residents continuously receive all necessary care
as they are moved to other appropriate facilities.
USING REGULATORY AUTHORITY
We are taking steps to address problems created when facilities curtail service to Medicaid
residents with the authority we have now. We recently issued new policy stating that a nursing
home may decrease the portion of its facilities that are available to Medicaid or Medicare
residents only once per year. We also are considering whether further regulatory changes would
help protect Medicare and Medicaid residents. However, without the legislation Chairman
Bilirakis and Rep. Davis are proposing, we do not have authority to prevent evictions of
Medicaid patients if nursing homes leave the Medicaid program.
NURSING HOME INITIATIVE PROGRESS
As I said, preventing inappropriate evictions is an essential component of our broad initiative for
improving the quality of nursing home care and oversight. These reforms build on progress made
since 1995, when we began enforcing the toughest nursing home regulations ever. We have
made solid progress since we announced our new initiative last July. We have taken several
steps to improve inspections by States, who have the primary responsibility for conducting these
on-site inspections and recommending sanctions for care and safety violations. We have:
-
issued new guidance to States to strengthen their nursing home inspection systems;
- made clear that States will lose federal funding if they fail to adequately perform surveys
and protect residents because we can and will contract with other entities, if necessary, to
make sure those functions are performed properly;
- established a new monitoring system to ensure that States identify problems and impose
appropriate sanctions;
- formally reminded States that they must enforce sanctions for serious violations and may
not lift them until an on-site visit verifies that problems are fixed;
- required States to sanction facilities found guilty more than once for violations that harm
residents, with no option to avoid penalties by correcting problems during a grace period;
- required States to conduct more frequent inspections for nursing homes with repeated
serious violations while not decreasing their inspections for other facilities;
- required States to stagger surveys and conduct a set amount on weekends, early mornings
and evenings, when quality and safety and staffing problems often occur;
- instructed States to look at an entire chain's performance when serious problems are
identified in any facility that is part of a chain, and begun developing further guidelines
for sanctioning facilities within problem chains;
- begun developing new regulations to let States impose civil money penalties for each
serious incident and repeal current rules that link penalties only to the number of days
that a facility was out of compliance with regulations;
begun developing new survey protocols to detect quality problems in nursing homes
- using a systematic, data-driven process, with initial changes to be implemented this year;
and
- secured, with strong support from Congress, a fiscal year 1999 budget with $171 million
for survey and certification activities, including $4 million earmarked for the new
initiative, and requested $60.1 million for fiscal year 2000 to enable us and other HHS
components to fully implement all provisions of the Nursing Home Initiative. This
includes $35 million for HCFA to strengthen State inspection and enforcement efforts,
$15.6 million in mandatory Medicaid money to supplement State inspection and
enforcement efforts, and $9.5 million to ensure adequate resources for timely judicial
hearings and court litigation.
We have taken additional steps to help consumers choose facilities, help facilities improve care,
and help our law enforcement partners prosecute the most egregious cases. We have:
- created and begun testing a new Internet site, Nursing Home Compare, at
www.medicare.gov, which will allow consumers to compare survey results and safety
records when choosing a nursing home;
- posted best practice guidelines at cms.hhs.gov/medicaid/siq/siqhmpg.htm on how to
care for residents at risk of weight loss and dehydration;
- begun planning national campaigns to educate residents, families, nursing homes and the
public at large about the risks of malnutrition and dehydration, nursing home residents'
rights to quality care, and the prevention of resident abuse and neglect;
- begun a study on nursing home staffing that will consider the potential costs and benefits
of establishing minimum staffing levels; and
- worked with the Department of Justice to prosecute egregious cases where residents have
been harmed, and to improve referral of egregious cases for potential prosecution.
Legislative Proposals
The Clinton Administration's fiscal year 2000 budget includes proposals for:
- requiring nursing homes to conduct criminal background checks of prospective
employees;
- establishing a national registry of nursing-home workers who have abused or neglected
residents or misappropriated residents' property; and
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- allowing more types of nursing-home workers with proper training to help residents eat
and drink during busy mealtimes.
The cost of conducting background checks and querying the national registry will be financed
through user fees. The Administration will put forward additional proposals as needed for
additional legislative authority to further improve nursing home quality and safety.
CONCLUSION
We are making solid progress in our efforts to improve the oversight and quality of nursing home
care, but there is more that we must do. We are doing what we can with the regulatory authority
we now have. We are working to secure passage of the President's legislative initiatives to
further protect nursing home residents.
The legislation that Chairman Bilirakis and Congressman Davis are introducing today to prevent
inappropriate Medicaid evictions is another crucial piece that we need to protect nursing home
residents. We thank you for your hard work on this matter. We look forward to working with
you to secure passage of your bill and the President's proposals. And I am happy to answer your
questions.