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1 MEDICAID CERTIFICATION AND APPROVAL OF SKILLED

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NURSING AND INTERMEDIATE CARE FACILITIES

SEC. 22. (a) Section 1910 of the Social Security Act is

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5 "CERTIFICATION AND APPROVAL OF SKILLED NURSING AND

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INTERMEDIATE CARE FACILITIES

"SEC. 1910. (a) The Secretary shall make an agree8 ment with any State which is willing and able to do so 9 whereby the State health agency or other appropriate State 10 or local agencies (whichever are utilized by the Secretary 11 pursuant to section 1864 (a)) will be utilized to recommend 12 to him whether an institution in the State qualifies as a 13 skilled nursing facility (for purposes of section 1902 (a) (28)) or an intermediate care facility (for purposes of section 1905 (c)).

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"(b) The Secretary shall advise the State agency administering the medical assistance plan of his approval or disapproval of any institution certified to him as a qualified

skilled nursing or intermediate care facility for purposes of section 1902 (a) (28) and specify for each institution the period (not to exceed twelve months) for which approval is granted, except that the Secretary may extend that term

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up to two months, where the health and safety of patients will not be jeopardized, if he finds that an extension is

necessary to prevent irreparable harm to the facility or

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1 hardship to the facility's patients or if he finds it impracti2 cable within the twelve-month period to determine whether 3 the facility is complying with the provisions of this title and 4 applicable regulations. The State agency may upon approval 5 of the Secretary enter into an agreement with any skilled 6 nursing or intermediate care facility for the specified approval 7 period.

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"(c) The Secretary may cancel approval of any skilled 9 nursing or intermediate care facility at any time if he finds 10 that a facility fails to meet the requirements contained in 11 section 1902 (a) (28) or section 1905 (c), or if he finds 12 grounds for termination of his agreement with the facility 13 pursuant to section 1866 (b). In that event the Secretary 14 shall notify the State agency and the skilled nursing or inter15 mediate care facility that approval of eligibility of the facility 16 to participate in the programs established by this title and 17 title XVIII shall be terminated at a time specified by the 18 Secretary. The approval of eligibility of any such facility to 19 participate in the programs may not be reinstated unless the Secretary finds that the reason for termination has been removed and there is reasonable assurance that it will not

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"(d) Effective July 1, 1978, no payment may be made

any State under this title for skilled nursing or intermedi

25 ate care facility services furnished by any facility—

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"(1) which does not have in effect an agreement with the State agency pursuant to subsection (b), or "(2) whose approval of eligibility to participate in the programs established by this title or title XVIII has been terminated by the Secretary and has not been reinstated, except that payment may be made for up to thirty days for skilled nursing or intermediate care facility services furnished to any eligible individual who was admitted to the facility prior to the effective date of the termination.".

"(e) Any skilled nursing facility or intermediate care 12 facility which is dissatisfied with any determination by the 13 Secretary that it no longer qualifies as a skilled nursing 14 facility or intermediate care facility for purposes of this 15 title shall be entitled to a hearing by the Secretary to the 16 same extent as is provided in section 205 (b) and to judicial 17 review of the Secretary's final decision after such hearing as 18 is provided in section 205 (g). Any agreement between such 19 facility and the State agency shall remain in effect until the 20 period for filing a request for a hearing has expired or, if a 21 request has been filed, until a decision has been made by the 22 Secretary: Provided, however, That the agreement shall 23 not be extended if the Secretary makes a written determina24 tion, specifying the reasons therefor, that the continuation 25 of provider status constitutes an immediate and serious

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1 threat to the health and safety of patients, and if the Secre

2 tary certifies that the facility has been notified of its defi

3 ciencies and has failed to correct them.".

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(b) Section 1869 (c) of the Social Security Act is 5 amended by adding at the end the following sentence: "If 6 the Secretary's determination terminates a provider with an 7 existing agreement pursuant to section 1866 (b) (2), or if 8 that determination consists of a refusal to renew an existing 9 provider agreement, the provider's agreement shall remain in 10 effect until the period for filing a request for a hearing has 11 expired or, if a request has been filed, until a final decision 12 has been made by the Secretary: Provided, however, That 13 the agreement shall not be extended if the Secretary makes a 14 written determination, specifying the reasons therefor, that 15 the continuation of provider status constitutes an immediate 16 and serious threat to the health and safety of patients and if 17 the Secretary certifies that the provider has been notified 18 of such deficiencies and has failed to correct them.".

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(c) The amendments made by this section shall become effective on the date on which final regulations, promul21 gated by the Secretary to implement the amendments, are

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22 issued; and those regulations shall be issued not later than

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1 the first day of the sixth calendar month following the month

2 in which this Act is enacted.

3 VISITS AWAY FROM INSTITUTION BY PATIENTS OF SKILLED

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NURSING OR INTERMEDIATE CARE FACILITIES

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SEC. 23. Section 1903 of the Social Security Act is

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"(1) In the administration of this title, the fact that an 8 individual who is an inpatient of a skilled nursing or inter9 mediate care facility leaves to make visits outside the facility 10 shall not conclusively indicate that he does not need services 11 which the facility is designed to provide; however, the fre12 quency and length of visits away shall be considered, to13 gether with other evidence, in determining whether the in14 dividual is in need of the facility's services.".

ESTABLISHMENT OF HEALTH CARE FINANCING

ADMINISTRATION

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SEC. 30. (a) Section 702 of the Social Security Act is

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(1) by inserting "(a)" immediately after "SEC. 702.", and

(2) by adding at the end the following subsection: 22 "(b) The Secretary shall establish, within the De23 partment of Health, Education, and Welfare, a separate 24 organization to be known as the Health Care Financing 25 Administration (which shall include the functions and per

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