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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 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 . 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 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 . 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. needs community habilitation services. first sanctions imposed by Congress 2 years States would also be required to maintain These reviews would have to be conducted adequate staff to investigate complaints of at least once each year. In the case of cli­ ago. Let's look at the results. violations of requirements of participation ents found no longer to require habilitation The evidence available confirms what many by habilitation facilities. facility services, the State would have to of my colleagues on this side of the aisle Enforcement Process (Section 203). Re­ prepare and orient them for discharge, ar­ feared would ultimately happen as a result of quires that, when a habilitation facility's de­ range for their safe and orderly discharge, using economic sanctions as a way to dis­ ficiencies immediately jeopardize the health and, when necessary, continue to provide mantle the racist apartheid system. Quite or safety of its clients, the State must either active treatment services outside of the fa. terminate the facility from Medicaid or ap­ simply put, it doesn't work. Sanctions imposed cility. in 1986 have lessened further reform of the point temporary management to oversee the Revision of Utilization Review Provisions operation of the facility. In a case where a (Section 302). Repeals existing requirements apartheid system, created economic hardship facility is not in compliance with one or relating to utilization review, including phy­ for black South Africans, and further en­ more of the requirements of participation, sician certification and recertification, and trenched the hardline conservatives in the but the deficiencies do not immediately inspection of care. Government. jeopardize client health or safety, States Sanctions have not only retarded the pace could, in lieu of terminating all Medicaid PAYMENT FOR COMMUNITY HABILITATION SERV· payments to the facility, impose one or ICES AND HABILITATION FACILITY SERVICES of reform by the Botha government, but have more of the following intermediate sanc­ (TITLE IV) polarized the various factions in the country. tions: denial of payment for new admissions; Payment Rules (Section 401J. Requires The rightwing faction has grown in size and civil money penalties for each day of non­ States to assure that rates for community power in Parliament, and since the last elec­ compliance; or appointment of temporary habilitation services (section 101) or habili­ tion have displaced the Progressive Party as management. The Secretary is given the au­ tation facility services

preservation of rights tion plan under which <1 > the number of United States companies who have operations certified beds in the facility is permanently and benefits under existing collective bar­ gaining agreements, (2) assurance of em­ in South Africa and have actively worked to reduced and (2) home and community-based ployment of affected employees with at dismantle apartheid from within. services are provided to the clients displaced least the same pay and the same level of re­ THE TIMKEN Co., by the reduction in beds. Federal Medicaid sponsibilities, (3) establishment of paid Canton, OH, August 5, 1988. matching payments would continue to be training and retraining programs for em­ Hon. BOB McEWEN, available during the period, not to exceed 3 ployment in the delivery of community ha­ House of Representatives, Cannon Office years, of implementation of an approved re­ bilitation services, and <4> establishment of Building, Washington, DC. duction plan. Reduction plans would be sub­ a grievance procedure to enable affected DEAR MR. McEWEN: It is my understand­ ject to the employee protection require­ employees to enforce these arrangements. ing that there will be a floor vote in the U.S. ments under section 501. Federal matching funds would be available House of Representatives on H.R. 1580, Effective Dates (Section 204). The new re­ for the costs of training and retraining. during the week of August 8, 1988, which quirements of participation and survey and Use of State Developmental Disabilities calls for a comprehensive ban on all U.S. certification procedures would be effective Agency (Section 502J. Allows a State to trade with and investment in South Africa. October 1, 1989. The enforcement provisions assign to the State developmental disabil­ Before you vote on this bill, I would like to would be effective on enactment, and would ities agency specific Medicaid program man­ express to you the opinion of The Timken apply to existing ICFs/MR until the new agement functions relating to the provision Company on the issues of this very impor­ habilitation facility requirements take of services to mentally retarded individuals. tant legislation. effect on October 1, 1989. The Timken Company operates a small Annual Report (Section 205). Requires the manufacturing subsidiary in South Africa. Secretary of HHS to report annually to THE QUESTION OF SANCTIONS Over 60% of our employees in this facility Congress on the extent of compliance by ha­ are black South Africans. Some of these bilitation facilities and the number of en­ people have been employed by us in excess forcement actions taken. HON. BOB McEWEN of 20 or 30 years. Working for us, many of APPROPRIATE PLACEMENT FOR MENTALLY OF these people have achieved Job levels, earn­ RETARDED INDIVIDUALS (TITLE III) IN THE HOUSE OF REPR::!SENTATIVES ings and a standard of living which would State Preadmission Screening and Annual Thursday, September 22, 1988 have been quite improbable, if not impossi­ Client Review (Section 301J. Requires States ble, otherwise. In addition, we have provided to implement a preadmission screening pro­ Mr. McEWEN. Mr. Speaker, before the a non-discriminatory atmosphere in which gram for mentally retarded individuals ad- August/Labor Day recess the House of Rep- to work and have contributed generously to 25028 EXTENSIONS OF REMARKS September 22, 1988 educational, social and recreational pro­ indicates that the use of sanctions and disin­ 30%. We know that other American compa­ grams in the communities in which our em­ vestment does not contribute to ending nies have similar achievements and that ployees live. As a. result, we believe the pres­ apartheid, but may in fact have uninten­ American companies have led the change ence of The Timken Company and other tional but very real effects which work to toward equal economic opportunities American companies in South Africa. has led the detriment of nonwhite South Africans. throughout South African industry. To re­ to the empowerment of blacks economically. The policy of the American government quire disinvestment by Tupperware and The ultimate elimination of apartheid re­ must be one which goes beyond symbolic other American companies is to neutralize quires the empowerment of blacks economi­ gestures and in fact actually contributes to valued allies in the struggle against apart­ cally rather than further impoverishment the goal of ending the apartheid system. heid and to withdraw some of the most ef­ through disinvestment and other economic The most direct and concrete path to that fective builders of a post-apartheid society. sanctions. end is by the empowerment of the nonwhite It is most ironic that sanctions and disin­ There is growing evidence that the sanc­ majority in South Africa. To the extent vestment are being considered by the Con­ tions approach toward ending apartheid is that United States government policies gress as a means of helping black South Af­ largely counterproductive and that black assist in that effort they should be vigorous­ ricans. The results of the 1986 sanctions­ empowerment is the most potent weapon ly pursued; to the extent that those policies higher black unemployment, withdrawal of against the apartheid system. Unlike sanc­ hinder that process they should be aban­ American companies and their social com­ tions, black empowerment is a strategy doned. mitments, and a dangerous swing to the which embodies clear and achievable goals I hope this information will convince you right by the government-have all been neg­ which work to the direct advantage of black to vote against H.R. 1580. ative for blacks. Most black South Africans South Africans and to the ultimate erosion Very truly yours, realize that further sanctions will only of apartheid. Apartheid simply cannot coex­ NANCY S. KOLIC, make the situation worse. Unfortunately, ist with black empowerment. Director-Shareholder their voices are not being heard in Washing­ The record of The Timken Company and Relations & Assistant Secretary. ton because a few prominent South Africans other American companies in South Africa. are erroneously assumed to speak for the is one which clearly demonstrates that PREMARK INTERNATIONAL, millions who will be hurt by United States these companies are a force for change. Deerfield, IL, June 9, 1988. policy. Within the workplace and in the society Hon. BoB McEWEN, Congress should not pursue this course of as a whole, American business is in the fore­ House of Representatives, Cannon House action without a responsible understanding front of bringing economic and political Office Building, Washington, DC. of the effects it will have on many innocent pressures to bear in efforts to end apartheid Re H.R. 1580-Anti-Apartheid Amendments people. I ask that you personally satisfy and bring empowerment to nonwhite South Act of 1988 yourself as to the true consequences of sanc­ Africans. To legislate their withdrawal from DEAR CONGRESSMAN McEWEN: Premark tions and disinvestment and cast your vote South Africa is totally counterproductive. International is a diversified company with against them. In October 1986, Congress passed the $2 billion in sales which maintains its corpo­ Sincerely yours, Comprehensive Anti-Apartheid Act. The rate headquarters in Deerfield, . Our WARREN L, BATTS, intent of Congress was to apply pressure on Food Equipment Group, which makes Chairman and the South African Government to end Hobart, Vulcan, Wolf, and Stero products, Chief Executive Officer. apartheid. To date, for several reasons, the has a manufacturing facility at Hillsboro, Act has been unsuccessful and has had a Ohio. CRISP AUTOMATION, INC., number of unintended and undesirable re­ One of our operating units-Tupperware­ Dublin, OH, June 27, 1988. sults. First, the sanctions have had little ad­ has a small operation in South Africa. It Hon. BoB McEWEN, verse effect on the overall economy of represents only 1% of our sales and profits, House of Representatives, Cannon Building, South Africa. Second, the sanctions have and its loss through mandatory disinvest­ 1st and Independence Avenue, Washing­ caused the South African Government to ment would not be a major financial burden ton, DC. become more firmly entrenched in resisting to Premark. However, because of its involve­ DEAR CONGRESSMAN McEWEN: The Senate needed change. Third, and most unfortu­ ment in the fight against apartheid through may be called upon to consider the Dellums nately, the sanctions have adversely affect­ education, community development, and Bill or similar legislation which would place ed black South Africans, the very people the social justice projects, its disinvestment further sanctions on South Africa. As Presi­ Act was intended to assist. Fourth, the sanc­ would be a serious loss to the many non­ dent of Crisp Automation, Inc., a unit of Joy tions have limited United States access to whites affected by its presence. Technologies Inc., a Fortune 500 Company South African minerals strategic to the U.S. Three members of our Board of Directors which has operated in South Africa for economy and national defense, while in­ recently visited Tupperware South Africa to many years, I have grave concern about this creasing U.S. dependence on the only other reassess our presence there. The group proposed legislation. I believe that addition­ supplier of these minerals, the Soviet spoke with dozens of black and white South al sanctions against South Africa at this Union. Lastly, the U.S. uranium conversion Africans of all points of view, including time would hinder rather than hasten the and coal industries have been hurt by the many in leadership positions in the black end of the apartheid system. sanctions. This short letter does not permit communities. We are more convinced than Joy has actively worked for the elimina­ the development in detail of the above rea­ ever that the economic slowdown caused by tion of apartheid within South Africa and sons. I will be happy to do that in a separate sanctions and disinvestment will fall dispro­ has taken a leadership position along with letter if you wish. portionately hard on blacks, will not con­ many other American companies, most of The Timken Company and other Ameri­ tribute to the dismantling of apartheid, and whom are signatories to the Statement of can businesses in South Africa have played is opposed by the great majority of black Principles, by supporting the development an important role in efforts to eliminate South Africans. of the trade union movement and devoting apartheid and empower nonwhite South Af­ Disinvestment by American companies corporate resources to the development of ricans economically and politically. They will remove from South Africa one of the black businesses. have carried on these efforts both in the most positive forces for change, both in Apartheid will not end because American workplace and in society as a whole. Ameri­ business and in the society at large. For ex­ companies are required to leave South can business is a positive force for change ample, our Tupperware subsidiary, although Africa. I feel that American companies must within South Africa. small, has helped fund a medical clinic, a maintain a presence in South Africa in There can be no doubt that there is a legal clinic, an old age center, a primary order to promote and influence events that broad consensus within the United States school, and preschool child care, as well as will bring about an end to apartheid and for vigorous efforts by both our public and housing loans and scholarships for black achieve a democratic, nonracial society in private sectors to work toward the complete employees. In total, Tupperware South Afri­ that country. elimination of apartheid within South ca's contributions to community projects The record of American companies clearly Africa. The Timken Company and other total more than 12% of its payroll. Beyond demonstrates that we are a force for American companies have long supported its financial commitments, Tupperware change. Our company alone has constructed this view and intend to continue maximum people of all colors work closely with non­ and equipped health clinics, founded legal efforts to accomplish this goal. While there white South Africans to design and imple­ clinics, provided scholarships, improved may be differences of opinion on the best ment these programs. As importantly, schools by upgrading educational aids and methods of reaching this end, there is no through its normal business, Tupperware setting up computer centers, provided Joy disagreement as to the goal itself. . trains literally thousands of non-white employees to train both students and teach­ The Timken Company and other Ameri­ South Africans to be independent sales deal­ ers alike, and sponsored workshops to assist can companies contend that the experience ers, a significant contribution in a country black and white community leaders in devel­ with the Comprehensive Anti-Apartheid Act where the black unemployment rate is over oping effective interdependent working rela- September 22, 1988 EXTENSIONS OF REMARKS 25029 tionships among communities. If you multi­ WHAT THE U.S. MUST Do IN SOUTH AFRICA vide jobs for South Africa's exploding popu­ ply this effort by 100, which is the approxi­