1 Because of these reasons, public institutions are a necessity. And, when nursing care is a part of that needed service, it should be provided. And the mentally retarded person ought to have a right to be considered eligible for the benefits of the Social Security Laws just as much as the patient with severe diabetes, a stroke, or congenital heart disease. What precise steps did Oregon take? 1. The plan was initiated. The State Mental Health and Public Welfare Divisions began plans for implementation in the fall of 1968. Inability to obtain confirming information from Federal agencies delayed the effort for many months. Queries of other states revealed similar frustrations. A determination was made of feasibility. The Oregon Legislative Assembly passed enabling legislation late in its 1969 session-chapter 507, Oregon Laws 1969 (Enrolled House Bill 1220). 2. A decision was made as to Skilled Nursing Home and Intermediate Care Facility. A review was made of Public Law 89-97 and Public Law 90-248, as well as relevant regulations as published on June 24, 1969, in the Federal Register, Volume 34, Number 120, Part II. Confirmation of the appropriateness of providing care in an Intermediate Care Facility as part of a medical facility was obtained from the U.S. Department of Health, Education, and Welfare Regional Office in San Francisco. Exhibit J is a copy of the letter confirming Oregon's plan. Note that specific reference is made to the mentally retarded. 3. Nursing Home Rules and Regulations were established. Exhibit K is a copy of the Oregon State Board of Health Rules, Regulations, and Standards for Nursing Homes for the Mentally Retarded in Oregon, as adopted on October 7, 1969. These rules allow licensing of Nursing Homes which can be certified as Skilled Nursing Homes and Intermediate Care Facilities. 4. Definitions of Nursing Care were established. Exhibit I clearly defines Nursing Care versus Personal Care as applicable to the mentally retarded. This is an extrapolation from a previously established, but not as inclusive, defintion of Nursing Care.. 5. All patients were individually reviewed and certified. The Mental Health Division supplied the Public Welfare Division with a statistically screened list of patients. Beginning with this list, all eligible patients were individually screened on the basis of legal eligibilty, fiscal eligibility, and need for nursing care. Recertification has continued. As of January 30, 1970, 1,567 patients out of a population of 2,960 have been determined eligible. All patients have had initial review. Only new patients or recertifications are now being processed. 6. Special appropriations were obtained to implement Nursing Home standards, certification requirements, etc. Exhibit L indicates State (Legislative) Emergency Board allocations through March 1970 to the Mental Health Division to implement the program. In addition, on August 22, 1969, an Emergency Fund allocation of $118,483 was made to the Public Welfare Division for additional personnel for this program. Allocations totaling $792,287 represent out-of-pocket expenses. Exhibit M summarizes the status of licensing of facilities. This summary includes the reduction in total capacity to date of 123 beds with a total licensed capacity of 2,207 beds to meet the needs of 1,567 eligible patients. It should be noted that the Mental Health Division sought additional funds to improve staffing ratios above those required by the State Board of Health, but action by the Emergency Board was deferred until mid-biennium pending submission of the report of the Oregon Commission on Staffing Standards relative to the SCOPE staffing methodology. 7. Reimbursement was commenced for certified patients in licensed and certified facilities effective December 1, 1969. 8. Expanded community programs for the mentally retarded were proposed. Exhibit N indicates the direction of expanded services for the mentally retarded. On page 2 of the memorandum, reference is made to the importance of reduced bed capacity resulting from conversion to licensed nursing homes. This plan proposes greatly enhanced alternate care possibilities, as well as programs which will prevent the need of future institutional care. In Oregon's program, the following elements pertain: 1. Patient care facilities are improved. 2. Patient medical and nursing care is improved. 3. Placement in alternate care programs is enhanced. 4. Patients have improved access to medical services under the Social Security Act when out of the institution. 5. Patient personal spending allowances are provided--often for the first time in the patient's lifetime. 6. Family financial liability is reduced or obviated. 7. Program expansion is facilitated. In June 1970, there were 2,835 persons resident in Oregon's hospitals for the mentally retarded. 1,431 of these patients were receiving Social Security benefits-86 were receiving care in Skilled Nursing Homes and 1,345 in Intermediate Care Facilities. The remaining patients do not need such services or are not eligible. Oregon has developed its plan in the conviction that it was within legal boundaries and was not inconsistent with Congressional intent. The participant agencies have expended enormous effort. Legislative concurrence has been obtained, including the funding of program improvements. This program addresses itself to improving the lot of some of Oregon's most destitute, most handicapped, and most deserving citizens. RECOMMENDATIONS 1. The operation of an Intermediate Care Facility as a part of public institution for the mentally retarded should be considered an appropriate use of the facility, within the law, and consistent with administrative interpretation. 2. States which meet the Federal requirements for providing the necessary elements of care within an Intermediate Care Facility should not be penalized because of the disputation that other states have not met the requirements. 3. Adequate certification and utilization controls should be established and enforced. The Federal agency should adopt a definition of Nursing Care. 4. States should not be left to develop definitions, interpret the laws and regulations, and implement programs in the absence or unavailability of Federal agency assistance. The lack of clarity of the law and the haziness of Federal agency interpretation should not result in disparagement of the states for attempting to put Federal programs to good use. 5. The proposed amendments to Section 1121(e) of the Social Security Act as cited on page 107, lines 7 through 11, should be deleted from H.R. 17550. |