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Transparency in health reform or a ball-and-chain?

July 1, 2009
by Bob Gatty
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As lawmakers work to meet an October deadline imposed by President Obama for passing national healthcare reform legislation, options under consideration could have a direct impact on skilled nursing facilities (SNFs), beyond questions of funding under Medicare and Medicaid.

A healthcare reform option paper published by the Senate Finance Committee proposes several changes intended to improve transparency of information about SNFs and nursing homes, enforcement of standards and rules, and training of staff.

Whether those specific provisions will be included in the final healthcare reform legislation is uncertain, but if they are, long-term care facilities will have additional issues with which to deal. The panel, chaired by Sen. Max Baucus (D-Mont.), must contend with the broad issues of how to finance healthcare reform and how to provide coverage for more Americans. But it is also focusing on the details of how to make improvements in the existing system itself.

Here is a summary of the options advanced for consideration by the Senate panel:

  • Required disclosure of ownership. SNFs and nursing facilities would be required to make available information on ownership (including direct and indirect ownership) and additional disclosable parties, as well as information describing the governing body and organizational structure of the facility. Information would be made available to the Department of Health and Human Services (HHS), the HHS Office of Inspector General, the states, and the state long-term care ombudsman programs upon request.

  • Accountability requirements. SNFs and nursing homes would be required to develop and implement compliance and ethics programs to be followed by their employees and agents. HHS would be required to develop regulations for an ethics and compliance program within two years of enactment. The program would be required to have standards and procedures designed to detect criminal, civil, and administrative violations under the Social Security Act. HHS would create regulations on quality assurance and performance improvement (QAPI) plans, which facilities would be required to implement. HHS would provide technical assistance to help facilities meet QAPI standards.

  • Nursing Home Compare Web site. HHS would be required to include additional information in the Medicare Nursing Home Compare Web site, including: standardized data on nursing staff and other staff providing medical and therapy services available; links to state Web sites regarding state survey and certification programs, as well as to inspection reports, facility plans of correction, and information to guide consumers in how to interpret and understand the reports; a standardized complaint form including explanatory material on how to use the form, how to file a complaint with the state survey and certification program and long-term care ombudsman program; a summary of information on enforcement action against the facility including substantiated complaints and remedies proposed and imposed during the preceding three years; and a summary of facility expenditures for direct care staffing based on data submitted. HHS would set up a system to review the accuracy, clarity, timeliness, and comprehensiveness of the information provided. There are also requirements relating to the availability of reports, complaint investigation documents, and correction plans.

  • Reporting of expenditures. SNFs and nursing homes would be required to report expenditures for wages and benefits for direct care staff on facility cost reports, broken into categories including registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff.

  • Standardized complaint form. HHS would develop a standardized form for SNF and nursing facility residents and their representatives to use in submitting quality of care complaints. States would be required to develop a process for resolving complaints.

  • Ensuring staffing accountability. HHS would establish a process to require facilities to regularly report staffing data, including agency and contract staff, by staff position categories, based on verifiable and auditable data. The requirements would include the category of work performed, resident census data, information on turnover and tenure, and hours of care provided per resident per day. HHS would consult with stakeholders to develop the requirements, and the process would be electronic and data reported in a uniform format.

  • Civil monetary penalties. HHS would develop regulations providing facilities with an opportunity to participate in an independent informal dispute resolution process that would produce a written record and occur within 30 days of imposition of a penalty. In instances where deficiencies are cited at the level of actual harm and immediate jeopardy, HHS would have the authority to place civil monetary penalties in an interest-bearing escrow account following completion of the informal dispute resolution process, pending resolution of any appeal. A portion of the money collected could be used to fund activities that benefit residents, such as resident and family support councils, resident relocation, and protection in situations where a facility closes or is decertified. Funds could also be used for approved facility improvements.