These provisions, which are titled the “Nursing Home Transparency and Improvement Act” and the “Patient Safety and Abuse Prevention Act,” include:

Owners and employees of a long term care facility that receives at least $10,000 annually in federal funding are required to report to the Department of Health and Human Services (DHHS) and local law enforcement any reasonable suspicion of a crime committed against a resident within designated times. Failure to make the report may result in fines and exclusion from federal health care programs.

Effective March 10, 2013, all nursing and skilled nursing facilities must have an operating compliance and ethics program effective in preventing and detecting criminal civil and administrative violations and in promoting quality of care.  The PPACA requires that such program include:

• Standards and procedures to be followed by employees which are reasonably capable of reducing the prospect of criminal, civil, and administrative violations.
• Specified officers assigned responsibility to oversee compliance with such standards and procedures.
• Steps to communicate effectively such standards and procedures to all employees, such as training programs or by disseminating publications that explain in a practical manner what is required.
• Monitoring and auditing systems reasonably designed to detect violations and having in place and publicizing a reporting system whereby individuals could report violations without fear of retribution.
• Enforcement through disciplinary mechanisms, including, discipline for failure to detect an offense.
• Periodically reassessment and amendment of the compliance program to reflect changes within the organization and its facilities.

Under the PPACA, skilled nursing facilities are required to have detailed ownership and other information available upon request including the identity of members of the governing body as well as owners, officers, and those individuals which exercise operational, financial, or managerial control over the facility.

The PPACA requires nursing facilities to include dementia and abuse prevention training as part of the pre-employment initial training and, if HHS determines appropriate, as part of ongoing training.

New regulations will establish procedures for long term care providers to conduct nationwide background checks on prospective “direct patient access” employees.  “Direct patient access” employees are those who have access to and duties that involve one-on-one contact with a patient or resident.  The background check must include state and national criminal history checks and utilize abuse and neglect registries, licensing boards, and State Medicaid Fraud Control Units as well as a fingerprint check using the FBI’s Integrated Automated Fingerprint Identification System.  States will be required to develop “rap back” capability, meaning that if any employee is subsequently convicted of a crime, the state will notify the long term care provider employer.

For more information, contact Steven Boell or John Rice at 610-797-9000.