MEDICARE AND MEDICAID TECHNICAL CORRECTIONS RELATING TO NURSING HOME REFORM.

SEC. 6901. MEDICARE AND MEDICAID TECHNICAL CORRECTIONS RELATING TO NURSING HOME REFORM. (a) Moratorium on Implementation or February 2, 1989 Regulation.—The regulations promulgated by the Secretary of Health and Human Services on February 2, 1989 (54 Federal Register 5315 et seq., relating to requirements for long-term care facilities) shall not be effective before October 1, 1990, insofar as such regulations apply to skilled nursing facilities and intermediate care facilities under title XVIII or XIX of the Social Security Act. (b) Nurse Aide Training.— (1) Delay in requirement.—Sections 1819(b)(5) and 1919(b)(5) of the Social Security Act (42 U.S.C. 1395i–3(b)(5), 1396r(b)(5)) are each amended— (A) in subparagraph (A), by striking “January 1, 1990” and inserting “October 1, 1990”, and (B) in subparagraph (B), by striking “July 1, 1989” and “January 1, 1990” and inserting “January 1, 1990” and “October 1, 1990”, respectively. (2) Publication of proposed regulations.—The Secretary of Health and Human Services shall issue proposed regulations to establish the requirements described in sections 1819(0(2) and 1919(0(2) of the Social Security Act by not later than 90 days after the date of the enactment of this Act. (3) Requirements for training and evaluation programs.—Sections 1819(f)(2)(A) and 1919(f)(2)(A) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A), 1396r(f)(2)(A)) are each amended— (A) in clause (i)(I), by inserting “care of cognitively impaired residents,” after “social service needs,”; (B) in clause (ii), by striking “cognitive, behavioral and social care” and inserting “recognition of mental health and social service needs, care of cognitively impaired residents”; (C) by striking the period at the end of clause (iii) and inserting “; and”; and (D) by adding at the end the following new clause: “(iv) requirements, under both such programs, that— “(I) provide procedures for determining competency that permit a nurse aide, at the nurse aide’s option, to establish competency through procedures or methods other than the passing of a written examination and to have the competency evaluation conducted at the nursing facility at which the aide is (or will be) employed (unless the facility is described in subparagraph (B)(iii)(I)), and 103 STAT. 2299 “(II) prohibit the imposition on a nurse aide of any charges (including any charges for textbooks and other required course materials and any charges for the competency evaluation) for either such program.”. (4) Delay and transition in 75-hour training program requirement.— (A) Section 1919(i)(2)(B)(ii) of such Act (42 U.S.C. 1396r(f)(2)(B)(ii)) is amended by striking “January 1, 1989” and inserting “July 1, 1989”. (B) A nurse aide shall be considered to satisfy the requirement of sections 1819(b)(5)(A) and 1919(b)(5)(A) of the Social Security Act (of having completed a training and competency evaluation program approved by a State under section 18I9(e)(1)(A) or 1919(e)(1)(A) of such Act), if such aide would have satisfied such requirement as of July 1, 1989, if a number of hours (not less than 60 hours) were substituted for “75 hours” in sections 1819(f)(2) and 1919(l)(2) of such Act, respectively, and if such aide had received, before July 1, 1989, at least the difference in the number of such hours in supervised practical nurse aide training or in regular in-service nurse aide education. (C) A nurse aide shall be considered to satisfy the requirement of sections 1819(b)(5)(A) and 1919(b)(5)(A) of the Social Security Act (of having completed a training and competency evaluation program approved by a State under section 1819(e)(1)(A) or 1919(e)(1)(A) of such Act), if such aide was found competent (whether or not by the State), before July 1, 1989, after the completion of a course of nurse aide training of at least 100 hours duration. (D) With respect to the nurse aide competency evaluation requirements described in sections 1819(b)(5)(A) and 1919(b)(5)(A) of the Social Security Act, a State may waive such requirements with respect to an individual who can demonstrate to the satisfaction of the State that such individual has served as a nurse aide at one or more facilities of the same employer in the State for at least 24 consecutive months before the date of the enactment of this Act. (5) Clarification of temporary enhanced federal financial participation for nurse aide training by nursing facilities.— (A) In general.—Section 1903(a)(2)(B) of such Act (42 U.S.C. 1396b(a)(2)(B)) is amended— (i) by inserting “(including the costs for nurse aides to complete such competency evaluation programs)” after “1919(e)(1)”, and (ii) by inserting “(or, for calendar quarters beginning on or after July 1, 1988, and before July 1, 1990, the lesser of 90 percent or the Federal medical assistance percentage plus 25 percentage points)” after “50 percent”. (B) No allocation of costs before october 1, 1990.—In making payments under section 1903(a)(2)(B) of the Social Security Act for amounts expended for nurse aide training and competency evaluation programs, and competency 103 STAT. 2300evaluation programs, described in section 1919(e)(1) of such Act, in the case of activities conducted before October 1, 1990, the Secretary of Health and Human Services shall not take into account, or allocate amounts on the basis of, the proportion of residents of nursing facilities that is entitled to benefits under title XVIII or XIX of such Act. (6) Effective dates.— (A) In general.—Except as provided in subparagraph (B), the amendments made by this subsection shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987. (B) Exception.—The amendments made by paragraph (3) shall apply to nurse aide training and competency evaluation programs, and nurse aide competency evaluation programs, offered on or after the end of the 90-day period beginning on the date of the enactment of this Act, but shall not affect competency evaluations conducted under programs offered before the end of such period. (c) Publication of Proposed Regulations Respecting Preadmission Screening and Annual Resident Review.—The Secretary of Health and Human Services shall issue proposed regulations to establish the criteria described in section 1919(f)(8)(A) of the Social Security Act by not later than 90 days after the date of the enactment of this Act (d) Other Amendments.— (1) Clarification of applicability of enforcement rules to dually-certified facilities.—Section 1919(h)(8) of the Social Security Act (42 U.S.C. 1396r(h)(8)) is amended by adding at the end the following: “The provisions of this subsection shall apply to a nursing facility (or portion thereof) notwithstanding that the facility (or portion thereof) also is a skilled nursing facility for purposes of title XVIII”. (2) Clarification of federal matching rate for survey and certification activities.—During the period before October 1, 1990, the Federal percentage matching payment rate under section 1903(a) of the Social Security Act for so much of the sums expended under a State plan under title XIX of such Act as are attributable to compensation or training of personnel responsible for inspecting public or private skilled nursing or intermediate care facilities to individuals receiving medical assistance to determine compliance with health or safety standards shall be 75 percent. (3) Medicare waiver authority for certain demonstration projects.—(A) The Secretary of Health and Human Services may waive the survey and certification requirements of sections 1819(g) and 1864(a) of the Social Security Act to the extent the Secretary determines is required to carry out a demonstration project in New York (relating to testing an approved alternative survey and certification process), which has been approved as of the date of the enactment of this Act. Such waiver shall apply only during the period beginning on November 1, 1988, and ending on October 31, 1991. (B) The Secretary also may waive the survey and certification requirements described in subparagraph (A) to the extent the Secretary determines is required to carry out a pilot demonstration project in Wisconsin (relating to testing an approved alternative survey and certification process). Such waiver shall apply 103 STAT. 2301only during the one-year period beginning on the date of implementation of the project. (4) Miscellaneous technical corrections.—Sections 1819 and 1919 of the Social Security Act are each further amended— (A) in subsection (c)(I)(A)(ii)(II), by striking the closing parenthesis after “Secretary” and inserting a closing parenthesis after “obtained”, (B) in subsection (c)(I)(A)(v)(I), by striking “accommodations” and inserting “accommodation”, (C) in subsection (f)(2)(A)(i), by striking “, content of the curriculum” and inserting “and content of the curriculum”, and (D) in subsection (h)(2)(C) (of section 1819) and in subsection (h)(3)(D) (of section 1919), by inserting “after the effective date of the findings” after “6 months”. (5) Additional miscellaneous technical corrections.—Section 1910 of such Act (42 U.S.C. 13961) is amended— (A) by inserting “and intermediate care facilities for the mentally retarded” after “rural health clinics”, (B) in subsection (b)(1), by striking “skilled nursing or intermediate care facility” and inserting “intermediate care facility for the mentally retarded”, (C) in subsection (b)(1), as amended by section 411(l)(6)(F) of the Medicare Catastrophic Coverage Act of 1988, by striking “1902(a)(28) or section 1919 or section 1905(c)” and inserting “1902(a)(31) or section 1905(d)”, and (D) in subsections (b)(1) and (b)(2), by striking “skilled nursing facility or intermediate care facility” each place it appears and inserting “intermediate care facility for the mentally retarded”. (6) Effective date.— (A) In general.—Except as provided in subparagraph (B), the amendments made by this subsection shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987. (B) Exception.—The amendment made by paragraph (1) shall take effect on the date of the enactment of this Act.