Header, the Administration of the Honorable Lincoln C. Almond
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August 7, 1996


In accordance with the provisions of Section 43-1-4 of the General Laws, I am transmitting herewith, with my disapproval, 96-S-2937, Substitute A, "An Act Relating to Health and Safety Licensing of Health Care Facilities."

This Act contains a comprehensive set of standards and requirements for licensed nursing facilities, and provides for rights of residents of nursing facilities. The provisions are based largely on provisions of current federal law. However, the Act provides that it would take effect only upon "(I) Congressional repeal of 42 U.S.C. section 1395i-3 and 42 U.S.C. section 1396r-3 and (2) failure to enact equivalent federal standards." The Act quite obviously was passed in response to the potential repeal of current federal standards so as to maintain certain federal requirements under Rhode Island law.

While many of the provisions of the Act are meritorious and in fact essential to ensuring high quality nursing care with proper regard for the rights of nursing home residents, I must disagree with the wholesale adoption of comprehensive federal standards and the conditional nature of the enactment.

With the anticipated reduction in the rate of increase in Medicaid funds to Rhode Island, we should be pursuing greater flexibility in our delivery of long term care services in order to more efficiently use scarce federal and state resources. The Act seeks to do just the opposite to lock Rhode Island into the current "one-size-fits-all" federal regulatory scheme with rigid staffing and procedural requirements. Rhode Island should be free to establish both more accommodating and more rigorous standards and requirements depending upon the needs presented by the particular nursing facility. This flexibility could prove critical in developing greater home and alternative nursing care for our elderly. In this regard, the Department of Human Services presently is embarking upon a comprehensive process to reform the health care system in Rhode Island which will include examination of these long-term care issues.

Aside from the merits, the conditional nature of the Act is troubling. The Act, by its terms, is not effective until two conditions are met: Congress must repeal two federal statutes and, presumably, the General Assembly must fail to enact equivalent federal standards. This provision, however, leaves the effective date unclear. Is the Act effective if only one of the statutes are repealed, or if one or both statutes are repealed-only in part? At what point in time will there be deemed to be a failure by the General Assembly to enact equivalent federal standards? Moreover, what would be considered "equivalent federal standards," given that the Act in fact is not identical to the federal statutes cited.

Finally, since it is highly unlikely that Congress will act on Medicaid reform during its current session, the Act is premature.

For the foregoing reasons, I disapprove of this legislation and respectfully urge your support of this veto.


Lincoln Almond