For Internal Use Only
January 13, 2000

Vice President Al Gore Announces Administration To Seek Multi-Million Dollar Investment To Assure Quality Care In Nursing Homes

Vice President Al Gore announced today that the Administration's FY 2001 budget will include a major new increase to strengthen nursing home quality nationwide and outlined how recently enacted investments in nursing home reimbursement and consumer protections would be allocated. The Administration's budget will invest $70.1 million, a 29 percent increase over last year's funding level to increase the Administration's continuing oversight of nursing homes.

The Vice President also announced that the implementation of provisions in the Balanced Budget Refinement Act, beginning this month, would invest over $2.7 billion over 5 years, a $500 million increase in reimbursement in 2000 alone. Finally, Gore announced that this year, the Department of Health and Human Services (HHS) will dedicate $10 million to provide older Americans and their caregivers with critical information necessary to make important choices they face on long term care services.

"When the time comes when a family makes the choice to move a loved one into a nursing home, all of us need to know that all our parents will be well cared for," said Vice President Al Gore. "These new steps will give families a greater sense of security in knowing we are working to assure our nursing homes safe and secure."

PROTECTING NURSING HOME RESIDENTS FROM ABUSE AND NEGLECT. About 1.6 million older Americans and people with disabilities receive care in approximately 16,700 nursing homes. The Clinton-Gore Administration -- along with the help of consumer advocates and responsible leaders in the nursing home industry -- has made the health and safety of nursing home residents a top priority. However, there have been reports that have concluded that oversight of "bad apple" nursing homes have been inadequate, leaving too many residents at risk. To address this issue, the Administration is continuing and enhancing its commitment to adequate funding of those who oversee nursing homes as well as those who provide services to patients. Today, the Clinton-Gore Administration announced:

A 29 PERCENT INCREASE IN FUNDING TO ENSURE THE DELIVERY OF HIGH QUALITY CARE IN NURSING HOMES. The Administration's FY 2001 budget will include an additional $15.9 million, a 29 percent increase over continuing quality monitoring activities in last year's budget to improve Federal and state oversight of nursing homes. With these new funds, HHS will be able to expand current activities, including:

• Training surveyors in the effective inspection of nursing homes. Additional funds will be invested to train state inspectors to use new tools that make it easier to identify quality problems in nursing homes. This system integrates quality of care data statewide and automatically identifies areas of concern, such as bedsores, malnutrition, and abuse affecting nursing-home residents, for surveyors to focus on when they visit facilities. This data is continually integrated into the Health Care Financing Association's Nursing Home Compare website, which provides prospective consumers effective information about choosing a nursing home, including facility specific information to evaluate the quality of care and educate individuals about residents' rights, abuse, and issues related to proper nutrition and hydration.
  
  
• Surveying nursing homes during evenings and weekends. Because of limited resources, nursing homes are often surveyed at predictable intervals, making it easy for substandard homes to ensure they are in compliance at the time of the surveyor's visit. These new funds will be used to ensure that at least 10 percent of all survey visits will be conducted after traditional business hours or on weekends, makes it more difficult for low-quality nursing homes to pass inspections.
  
  
• Surveying substandard facilities more frequently than other facilities. Additional funds will be used to target at least 100 facilities with the worst records of compliance with quality standards, to ensure these nursing homes are inspected more often.
  
  
• Ensure swift and effective enforcement of nursing home quality standards. The FY 2001 budget provides a 42 percent increase in funding to ensure that almost 1000 additional cases on the will be heard by the Department's Appeals Board, over twice the amount projected to be resolved in 2000, will be closed in FY 2001. In addition, new funds will be used to ensure that resident complaints of abuse or neglect placing a loved one in danger are swiftly investigated.

ANNOUNCING A NEW $2.7 BILLION INVESTMENT OVER FIVE YEARS IN SKILLED NURSING FACILITIES BEGINNING THIS MONTH. The passage of the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 enhances Medicare beneficiaries' access to high-quality health care by addressing many of the problems with the BBA raised by the Administration and Congress. This landmark legislation, which will invest a total of $500 million in nursing homes in 2000 alone, will:

• Increase payment rates. Beginning this month, nursing homes have the option to be paid at the full Federal rate for the skilled nursing facility prospective payment system rather than their current payment rate, providing an additional $700 million over five years for these facilities and an investment of $100 million this year.
  
  
• Provide immediate increases in payment for high-cost cases and raises reimbursement rates across the board beginning in 2001. Beginning on April 1, 2000 and ending on September 30, 2000, nursing homes treating certain clinically complex cases, such as patients with multiple sclerosis, cerebral palsy, or AIDS, will receive a 20 percent increase in payment. In addition, beginning in 2001, payments for nursing homes will increase across-the-board by 4 percent for 2001 and 2002. Together, these two policies will invest $1.4 billion over 5 years and $200 million this year in nursing homes nationwide.
  
  
• Impose two-year moratorium on payment caps. Beginning in January 1, 2000, this bill puts a two-year moratorium on harmful limits on payments for occupational, physical, and speech therapy, steps up medical review to prevent fraud, and revises a BBA-mandated study to develop an alternative, more rational system for therapy services payment for a total investment of $600 million over 5 years and a total investment of $200 million this year.

In addition, this month, HCFA will send a letter to all the nursing homes trade associations informing them of this impact of the new choice to be paid at the full Federal rate and outlining the effective dates and implementation schedule of other components of the BBRA that affect nursing homes.

EDUCATING OLDER AMERICANS ABOUT LONG-TERM CARE OPTIONS. Last year, the President successfully worked with Congress to get $10 million for a campaign to provide all 39 million Medicare beneficiaries with critical information about long-term care options, including: what long-term care Medicare covers; how to find out about Medicaid long-term care coverage; what to look for in a quality private long-term care policy; and how to access information about home-and community-based care services that best fit beneficiaries' needs. This year, information will be presented in an easy-to-understand format specifically targeted to caregivers and older Americans and will be distributed nationwide through venues such as the Medicare and You handbook, the Guide to Heath Insurance, and state organizations devoted to health insurance as well as public service announcements for television and radio.

BUILDING ON THE CLINTON GORE ADMINISTRATION'S COMMITMENT TO ENSURING HIGH QUALITY OF CARE IN NURSING HOMES NATIONWIDE. Protecting patients in nursing homes has been and will continue to be a priority of the Clinton-Gore Administration.

• In 1995, the President threatened to veto legislation pending before the Congress that would eliminate Federal enforcement of nursing home quality standards, and issued the toughest nursing home regulations in the history of the Medicare and Medicaid programs, leading to measurable improvements in quality of care for nursing home residents.
  
  
• In July of 1998, the Clinton-Gore Administration initiated a new nursing home quality initiative that ensures swift and strong penalties for nursing homes failing to comply with standards, strengthened oversight of state enforcement mechanisms, and implemented unprecedented efforts to improve nutrition and prevent bed sores.
  
  
• The Administration also established the Nursing Home Compare website, which provides prospective consumers effective information about choosing a nursing home, including facility specific information to evaluate the quality of care and educate individuals about residents' rights, abuse, and issues related to proper nutrition and hydration.

Finally, the Administration recently instructed states to impose immediate sanctions, such as fines, against nursing homes any time that a nursing home is found to have caused harm to a resident on consecutive surveys, in order to put additional pressure on nursing homes to meet all health and safety standards.