President Obama Signs Elder Justice Act and Nursing Home Transparency and Improvement Act Into Law
The historic health care reform bill that President Obama signed
into law this week includes the Elder Justice Act, the Nursing Home
Transparency and Improvement Act, the Patient Safety and Abuse
Prevention Act, the CLASS Act and provisions designed to improve the
ability of people to get needed long-term care services at home.
CANHR will provide updated reports as details of the new laws and
implementation timelines emerge.
The following bulletin was issued by NCCNHR, the National
Consumer Voice for Quality Long-Term Care (www.nccnhr.org);
Nursing Home Transparency, Elder Justice Act Swept into Law
with Health Care Reform Bill
It took almost 100 years to reform the nation's health care
system. But although the campaign for long-term care reforms also
seemed endless at times, it took a relatively short three years to
enact Nursing Home Transparency and Improvement, seven to pass
the Elder Justice Act, and a dozen to create a national program
of criminal background checks on long-term care
workers. Tuesday they all became law when President
Obama signed the Patient Protection and Affordable Care Act.
Thank you to everyone who contacted your Representative last week
before the House's historic Sunday vote. To see how your
Representative voted, click on http://clerk.house.gov/evs/2010/roll165.xml. Please
take time to thank your member who voted for the bill. You can call
the Capitol switchboard at 202/224-3121 or go to https://writerep.house.gov/writerep/welcome.shtml to send him
or her an e-mail.
We know you are eager for detailed information about the
legislation, and NCCNHR is preparing a summary and timeline showing
when key provisions will be implemented. (Most provisions of the
law will be effective only after one or two years of regulations
development--a critical part of the implementation process because
regulations will spell out the details of how the law will be
enforced.) We will post the summary on the NCCNHR website and
alert you when it is available. We will also solicit your input
and advice in the coming months about the provisions needed in the
regulations to ensure effective compliance.
Following are some important long-term care highlights of the new
Nursing Home Transparency and Improvement
The nursing home transparency provisions are the first
comprehensive improvements in nursing home quality since OBRA '87.
When fully implemented, the law will provide consumers a substantial
amount of new information about individual facilities, most of it from
resolutions passed by NCCNHR members. The legislation was sponsored by
Senator Herb Kohl (D-WI), Senator Chuck Grassley (R-IA), Rep. Henry
Waxman (D-CA), Rep. Pete Stark (D-CA), and Rep. Jan Schakowsky
- Public disclosure of nursing home owners, operators, and other
entities and individuals that provide management, financing, and
services to nursing homes.
- Establishment of internal procedures by nursing homes
("compliance and ethics programs") to reduce civil and
criminal violations and improve quality assurance.
- Collection of staffing data electronically from payroll
records and other verifiable sources and public reporting
of hours per resident day of care and turnover and retention
- Improved public information on Nursing Home Compare, including
staffing data for each facility that includes hours of care
per resident day, turnover, and retention rates; links to
facilities' survey reports (Form 2567) and plans of
correction on state websites; summaries of complaints against
facilities, including number, type, severity and outcome; a
standardized complaint form; and adjudicated criminal violations by
facilities and their employees inside the facility, including civil
monetary penalties levied against the facility, its employees,
contractors, and other agents.
- Establishment of a consumer rights information page on Nursing
Home Compare, including services available from the long-term care
- A review of Nursing Home Compare's accuracy, clarity, timeliness,
and comprehensiveness and modifications of the site based on the
- A Government Accountability Office study of the Five Star Quality
- Improved timeliness of survey information made available to the
- A requirement for nursing homes to make surveys and complaint
investigations for three years available on request and to post a
notice that they are available.
- A requirement that states maintain a website with information on
all nursing homes in the state, including survey reports (Form 2567),
complaint investigation reports, plans of correction, and other
information that the state or CMS considers useful.
- A statutory requirement for a special focus
- Establishment of a methodology for categorization and public
reporting of facilities' expenditures, regardless of source of
payment, for direct care (including nursing, therapy, and medical
services); indirect care (including housekeeping and dietary
services); capital assets; and administrative services.
- Improved complaint handling, including a voluntary standardized
form for filing complaints with the survey agency and ombudsman; and
protection of residents' legal representatives and other
responsible parties from retaliation when they complain
about quality of care.
- Escrowing of civil monetary penalties after an independent
informal dispute resolution process and pending resolution
of further appeals. (Allows for reduction of CMP amounts for
- Sixty-day advance notification of facility closure and
authorization to continue Medicaid payments pending relocation of all
- Dementia care and abuse prevention in nurse aide training
- Demonstration projects to identify best
practices in culture change and information technology.
- Demonstration program to develop, test, and implement federal
oversight of interstate and large intrastate chains. (Chains apply to
participate in the demonstrations.)
Elder Justice Act
The Elder Justice Act was sponsored in the Senate by Senator Blanche
Lincoln (D-AR) and Senator Orrin Hatch (R-UT) and in the House by Rep.
Peter King (R-NY) and Rep. Jan Schakowsky (D-IL) and Rep. Tammy
Baldwin (D-WI). See the NCCNHR website for a summary of the
Patient Safety and Abuse Prevention Act
Sponsored by Senator Herb Kohl (D-WI), the legislation creates a
national program of criminal background checks on employees of
long-term care providers who have access to residents of facilities or
people receiving care in their own homes. The legislation was added to
the health care reform bill by Senator Debbie Stabenow (D-MI).
Creates a voluntary payroll deduction plan for long-term
care. Employees who pay into the program for at least five years will
be entitled to a daily cash benefit of at least
$50 that they can use for long-term care at home or in a
community-based setting. Medicaid beneficiaries in nursing homes would
retain 5 percent of their cash benefit; and Medicaid beneficiaries
receiving home and community-based services would keep 50 percent. The
legislation was sponsored and championed by the late Senator Ted
Kennedy (D-MA) during the last several years of his life.
Home and Community-Based Services
- Creates a state Medicaid option to provide community-based
attendant services and supports for people who meet their state's
nursing home eligibility standards.
- Gives states the option to provide home and community-based
services through a state plan amendment, rather than a waiver.
Requires the plan to be statewide; prohibits caps on the number
served; and enables targeting of individuals with specific conditions.
- Creates incentives for states to move Medicaid beneficiaries out
of nursing homes into home and community-based services. Extends the
Money Follows the Person program for six years.
- Extends spousal impoverishment protections to spouses of Medicaid
beneficiaries receiving home and community-based services.
- Eliminates Medicare Part D cost-sharing requirements for people
who are receiving long-term care under a home and community-based
- Provides for grants and demonstration programs to train workers in
geriatrics and long-term care.
NCCNHR will provide detailed summaries of the legislation
and implementation dates in the coming days. Watch our website
(www.nccnhr.org) for updates and details on the legislation.