GPO-CRECB-1988-Pt17-5-3.Pdf

25026 EXTENSIONS OF REMARKS September 22, 1988 EXTENSIONS OF REMARKS H.R. 5233, THE MEDICAID QUAL ing payments for services provided in ICF's/ Revising Current Waiver Authority (Sec ITY SERVICES TO THE MEN MR with more than 15 beds. It does not re tion 102). Under the current "section 2176 TALLY RETARDED AMEND quire States to draw up and implement a 5- home and community-based services" waiver, Stat~s may, on a budget-neutral MENTS OF 1988 year plan for transferring individuals out of basis, provide habilitation services to the · large ICF's/MR into smaller residential set mentally retarded in designated areas tings. And it does not prohibit the Secretary within the State, if those individuals have HON. HENRY A. WAXMAN from setting minimum standards for the quality been discharged from a nursing facility or OF CALIFORNIA of community-based services paid for with ICF /MR. This section would delete the re Federal Medicaid funds. quirement that waiver beneficiaries must IN THE HOUSE OF REPRESENTATIVES In response to the great Member and public have been discharged from an institution. Thursday, September 22, 1988 interest in this issue, the Subcommittee on Quality Assurance for Community Habili Mr. WAXMAN. Mr. Speaker, on August 11, I Health and the Environment will hold a hear tation Services (Section 103J. Directs the Secretary of HHS to develop, by January 1, introduced H.R. 5233, the Medicaid Quality ing on September 30, 1988, on this bill and on 1991, outcome-oriented instruments and Services to the Mentally Retarded Amend the Medicaid Home and Community Quality methods for evaluating and assuring the ments of 1988. This bill has two basis pur Services Act of 1987, H.R. 3454, introduced quality of community habilitation services. poses: First, to increase the availability of by Representative FLORIO. The subcommittee Effective July 1, 1991, payment for commu quality community-based services to the men will take testimony from Members, clients, par nity habilitation services may not be made tally retarded under Medicaid; second, to im ents, CBO, and representatives of workers, if such instruments and methods indicate prove the quality of Medicaid-financed institu providers, and the States. I am hopeful that they are substandard. tional services for the mentally retarded. this hearing will give us the information we QUALITY ASSURANCE FOR HABILITATION Medicaid, the Federal-State entitlement for need to develop and enact reform legislation FACILITY SERVICES (TITLE II) the poor, is the major source of Federal fi in the next Congress. Under current law, States have the option nancing for health care services for persons SUMMARY OF MEDICAID QUALITY SERVICES TO of providing services to the mentally retard with mental retardation or related conditions. THE MENTALLY RETARDED AMENDMENTS OF ed and persons with related conditions in in Of the $30.5 billion that the Federal Govern 1988, H.R. 5233 termediate care facilities for the mentally ment is projected to spend on Medicaid the retarded <ICFs/MR>. Under the bill, ICF/ fiscal year ending this month, just under 12 OPTIONAL EXPANSION OF COMMUNITY-BASED MR services would remain an optional serv SERVICES (TITLE U percent, or roughly $3.6 billion will pay for ice, but would be retitled "habilitation facil services to this population. The overwhelming Community habilitation services (Section ity services." 1 OV. Allows States, at their option, to cover In the Omnibus Budget Reconciliation majority of these dollars pay for services in in on a statewide basis under their Medicaid Act of 1987, P.L. 100-203, the Congress en termediate care facilities for the mentally re programs a new benefit, "community habili acted a series of reforms in Medicaid policy tarded [ICF's/MR] on behalf of roughly tation services." These are services designed to improve the quality of life and the qual 154,000 individuals, many of whom are pro to assist individuals <1) in acquiring, retain ity of care in general nursing homes serving foundly or severely retarded. These facilities, ing, and improving self-help, socialization, primarily the elderly. These reforms, involv which number over 3,600, provide services on and adaptive skills necessary to function ing requirements for participation, survey a 24-hour basis and range in size from 4 to succes8fully in a home or community-based and certification procedures, and enforce 1,500 beds. An increasing, but still relatively setting, and (2) in participating in communi ment remedies, did not affect ICFs/MR. ty or other activities. Federal Medicaid This bill would address the quality of life small amount of Medicaid funds-under $300 matching funds would be available for these and quality of care issues in ICFs/MR, million-is used to purchase home and com services at each State's regular matching which would be retitled "habilitation facili munity-based services for this population rate. In order to offer this benefit, States ties." under the "2176" waiver program, under would have to assure the Secretary of Requirements for Habilitation Facilities which participating States must operate under Health and Human Services <HHS> that (Section 201J. In order to qualify for Medic tight budget-neutrality rules. they comply with the employee protection aid reimbursements, habilitation facilities The "2176" waiver program, first enacted in requirements in section 501 of the bill. Any would have to meet requirements relating to 1981, has been a useful beginning, but it does supervised residential settings in which such the provision of services, clients' rights, and not go far enough in making Federal funds services are provided must meet standards administration. promulgated by the Secretary. The requirements relating to provision of available for community-based services for In connection with this new optional ben services address quality of life, individual this population. I believe that the Medicaid efit, States would be allowed to extend, on a program plans, comprehensive functional Program must give the low-income mentally statewide basis, services to a new optional assessments, specific services and activities retarded, and their families, a choice between eligibility group composed of persons who, to be provided, and physician supervision of payment for quality institutional services and although they are living in the community, clinical records. payment for quality community services. H.R. would be eligible for Medicaid if they were The clients' right requirements include 5233 would allow, but not require, States to in an institution because more liberal insti general rights <such as freedom from abuse offer that choice for those at risk of institution tutional income and resource standards ap and from restraints, privacy, and free choice al placement. It would also establish Federal plied. In addition, there must be a determi of medical care and treatment), transfer and nation that, but for the provision of commu discharge rights, access and visitation standards and procedures to assure that the nity habilitation services, these individuals rights, and protections for client funds. quality of both community and institutional would require the level of care provided in a The requirements relating to administra services paid for by Medicaid is maintained. habilitation facility (now known as an inter tion and other matters concern licensing This bill would increase Federal Medicaid mediate care facility for the mentally re and life safety code, sanitary and infection outlays. While I do not yet have final cost esti tarded, or ICF/MR>. control, and compliance with professional mates from the Congressional Budget Office, I Nothing in this section is to be construed standards. believe on the basis of preliminary discussions as abrogating the right of Medicaid clients Survey and Certification Process (Section with CBO staff that the costs will be realistic to freedom of choice with respect to the 202). Each habilitation facility would be providers from whom they can receive serv subject, once a year, to an unannounced in the context of congressional deficit reduc ices. survey which reviews (1) the quality, appro tion efforts. Both the new optional service and the new priateness, and effectiveness of active treat I want to emphasize what this bill does not optional eligibility category would be effec ment provided to a representative sample of do. It does not cap Federal Medicaid match- tive October 1, 1989. clients and <2> the facility's compliance with e This "bullet" symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. September 22, 1988 EXTENSIONS OF REMARKS 25027 the requirements of participation set forth mitted to habilitation facilities on or after resentatives once again passed further eco in section 201. Surveys of State-operated fa October l, 1989. In determining whether ad nomic sanctions against the Government and cilities would be conducted by the Secre mission was appropriate, States would use people of South Africa. This legislation is now tary; surveys of all other facilities would be criteria developed by the Secretary of HHS before the other body for consideration and conducted by State survey agencies. The as of July 1, 1989. Secretary would be required to conduct States would also be required, effective our colleagues must ask themselves what I "look behind" surveys of a representative October 1, 1989, to review each client in a believe to be the pivotal question in this sample of facilities in each State. habilitation facility to determine whether debate: "Will further economic sanctions help States would be required, through their or not the client <1 > requires the level of facilitate the end of apartheid?" To find an survey agencies, to investigate allegations of services provided by the facility and <2> answer we need only look to the results of the client neglect and abuse by facility staff.

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