H.R. 1649 — To amend title XIX of the Social Security Act to require nursing facilities participating in the medicaid program to pay, on a phased-in basis, nursing personnel at a rate at least equal to the mean rate paid nursing personnel employed outside nursing facilities.

 
HR 1649 IH
101st CONGRESS
1st Session
 H. R. 1649
To amend title XIX of the Social Security Act to require nursing facilities
participating in the medicaid program to pay, on a phased-in basis, nursing
personnel at a rate at least equal to the mean rate paid nursing personnel
employed outside nursing facilities.
IN THE HOUSE OF REPRESENTATIVES
March 23, 1989
Mr. WALGREN introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to require nursing facilities
participating in the medicaid program to pay, on a phased-in basis, nursing
personnel at a rate at least equal to the mean rate paid nursing personnel
employed outside nursing facilities.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. MINIMUM WAGE RATE FOR NURSING PERSONNEL IN NURSING FACILITIES.
  (a) MINIMUM WAGE RATE REQUIREMENTS- Section 1902(a)(13) of the Social
  Security Act (42 U.S.C. 1396a(a)(13)) is amended--
  (1) by striking `and' at the end of subparagraph (D);
  (2) by inserting `and' at the end of subparagraph (E); and
  (3) by adding at the end the following new subparagraph:
  `(F)(i) in making payment for nursing facility services under the plan,
  for payment of the costs (attributable to individuals receiving medical
  assistance under the State plan) of wages and benefits of the facility's
  nursing personnel (including nurses' aides) who provide or supervise
  direct care of residents at a rate that is at least equal to the minimum
  rate of wages and benefits established under subsection (s)(1) for nursing
  personnel in a locality in the State;
  `(ii) for recovery by the State (through offset or otherwise) from a nursing
  facility of such amounts as are paid to the facility pursuant to clause
  (i) but are not expended by the facility for wages and benefits of nursing
  personnel described in such clause; and
  `(iii) that the State shall--
  `(I) for the period consisting of the 4 calendar quarters that ends at
  least 180 days before this subparagraph is effective in the State, conduct a
  survey to determine, through a statistically representative sample, the mean
  rate of wages and benefits paid in each locality in the State to nursing
  personnel (including nurses' aides) who provide, in nursing facilities,
  nursing services described in clause (i) to individuals receiving medical
  assistance under the State plan,
  `(II) for periods consisting of the 4 calendar quarters that end at least 180
  days before each period described in subsection (s)(1), conduct a survey to
  determine, through a statistically representative sample, the mean rate of
  wages and benefits paid in each locality in the State to nursing personnel
  (including nurses' aides) who provide, outside nursing facilities, nursing
  services comparable to those described in clause (i),
  `(III) report to each nursing facility in a locality in the State on the
  mean rates of wages and benefits determined under subclauses (I) and (II)
  for that locality, and
  `(IV) report to the Secretary on the mean rates of wages and benefits
  determined under subclauses (I) and (II) for each locality in the State;'.
  (b) COMPUTATION OF MINIMUM WAGE RATE- Section 1902 of such Act is further
  amended by inserting after subsection (r) the following new subsection:
  `(s)(1) Except as provided in paragraph (2), for the purposes of subparagraph
  (F) of subsection (a)(13), the minimum rate of wages and benefits for
  nursing personnel in a locality in the State--
  `(A) for the first 4 calendar quarters in which such subparagraph is
  effective in the State, is 66.5 percent of the base rate plus 33.5 percent
  of the adjusted rate,
  `(B) for the next 4 calendar quarters in which such subparagraph is effective
  in the State, is 66.5 percent of the base rate plus 33.5 percent of the
  adjusted rate,
  `(C) for the next 4 calendar quarters in which such subparagraph is effective
  in the State, is 33.5 percent of the base rate plus 66.5 percent of the
  adjusted rate,
  `(D) for the next 4 calendar quarters in which such subparagraph is effective
  in the State, is 33.5 percent of the base rate plus 66.5 percent of the
  adjusted rate, and
  `(E) for each succeeding period of 4 calendar quarters in which such
  subparagraph is effective in the State, is 100 percent of the adjusted rate.
  `(2) If during any period described in paragraph (1), the base rate is
  greater than the adjusted rate, for the purposes of subparagraph (F)
  of subsection (a)(13), the minimum rate is the base rate.
  `(3) As used in this subsection--
  `(A) the term `base rate' means the rate determined for the locality under
  subsection (a)(13)(F)(iii)(I), and
  `(B) the term `adjusted rate' means the rate determined for the locality
  for the appropriate period under subsection (a)(13)(F)(iii)(II).'.
  (c) TRANSITION- For the purposes of the amendment made by section 1(3), for
  periods ending before October 1, 1990, any reference to `nursing facility
  services' shall be deemed a reference to `skilled nursing facility services'
  and `intermediate care facility services'.
SEC. 2. INCORPORATING REQUIREMENTS INTO STATE PLAN.
  (a) EFFECTIVE DATE- The amendment made by section 1(3) applies to payments
  under title XIX of the Social Security Act for calendar quarters beginning
  with the first calendar quarter that begins more than 180 days after the
  date of the enactment of this Act, without regard to whether regulations
  to implement such amendment are promulgated by such date.
  (b) STATE PLAN AMENDMENTS- If an amendment to a State plan for medical
  assistance under title XIX of the Social Security Act is necessary for
  compliance with the requirements of section 1902(a)(13)(F) of such Act
  (as added by section 1(3) of this Act), then the State shall submit such
  amendment to the Secretary of Health and Human Services not later than 90
  days after the date of the enactment of this Act. The Secretary shall,
  not later than 180 days after the date of the enactment of this Act,
  review each such plan amendment for compliance with such requirements
  and by such date shall approve or disapprove each such amendment. If the
  Secretary disapproves such amendment, the State shall immediately submit
  a revised amendment which meets such requirements. The absence of approval
  of such a plan amendment does not relieve the State or any nursing facility
  of any obligation or requirement under title XIX of the Social Security Act.
To amend title XIX of the Social Security Act to require nursing facilities participating in the medicaid program to pay, on a phased-in basis, nursing personnel at a rate at least equal to the mean rate paid nursing personnel employed outside nursing facilities.

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