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Home > Practices > Health Law Practice Group > Healthcare Reform Center
Healthcare Reform Center
Healthcare Reform Compliance - Provisions Impacting Nursing Homes, Home Care Services and New Alternatives to Nursing Homes
Nursing Home Ownership Disclosure
The Act requires that skilled nursing facilities under Medicare and nursing facilities under Medicaid make available information on ownership, including organizational structures; information on officers, directors, trustees, or managing employees; owners of whole or part interest in any mortgage, deed, or other obligation exceeding 5% of a facility's total property/assets; entities that provide policies or procedures for any operation of the facility; and entities that provide financial or cash management services, management or administrative services, or accounting and financial services to the facility.
The Act also includes a requirement that referring physicians for imaging services must inform patients in writing that the individual patient may obtain such service from a person other than the referring physician, a physician who is a member of the same group practice, or an individual who is supervised by the physician, or by another physician in the group.
Nursing Home Compliance Planning
The Act requires that, within three years every nursing home have in operation a compliance and ethics program and applicable regulations will be promulgated by March 23, 2012, The Act also provides for more stringent reporting of data on the Nursing Home Compare Medicare website by March 23, 2011. In addition, effective March 23, 2011, the Secretary shall develop a standardized complaint form for use by a resident or person acting on the resident's behalf in filing a complaint with the state survey agency with respect to a facility. States will also be required to establish a complaint resolution process.
New Community-Based Care Transitions Program
A Community-Based Care Transitions Program will be established to provide funding to hospitals with high readmission rates, and certain other entities, to furnish improved care transition services to high-risk Medicare beneficiaries. Such hospitals must enter into a partnership with a community-based organization in order to participate in the program. In approving entities to participate in the program, priority will be given to those that serve medically underserved populations, small communities and rural areas.
Independence at Home Demonstration Program
The Independence at Home Demonstration Program is built on a model where physicians and nurse practitioners direct home-based primary care teams comprised of professionals including physicians, nurses, physician assistants, pharmacists and other health and social services staff. The program is designed to develop and carry out plans of care tailored to a Medicare beneficiary's chronic conditions in an effort to reduce hospital stays and readmissions and improve health outcomes. The payment methodology includes establishment of a target spending level and incentive payments if actual expenditures are less than the spending target.
New Models for Long-Term Care Alternatives to Nursing Homes
The Act provides that a state will be designated a "balancing incentive payment state" if less than 50% of the state's total annual Medicaid expenditures are for non-institutional long-term services. Federal funds provided to the state may be used only to provide new or expanded offerings of non-institutional long-term care services. In order to access the funds, the state must agree to certain conditions, including development of a statewide system that enables consumers to access all long-term care services through a single point of entry.
Expanded Coverage for In-Home Services (Community First Choice Option)
Beginning October 1, 2010, a state may provide, through a state plan amendment, personal care and other services to individuals who meet the income test, choose to receive home and community-based services, and who would otherwise require the level of care provided in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases. Services must be made available through a person-centered plan based on an assessment of functional need, in a home or community setting, under an agency-provider or other model (such as consumer controlled). Services such as room and board costs, special education services, assistive technology devices, medical supplies and equipment, and home modifications are excluded. Expenditures for transition from an institution are permissible, however, including first month's rent, utility deposits, bedding, basic kitchen supplies and other necessities. States that choose the Community First Choice Option would be eligible for an increased federal financial participation of 6%.
Medicare Bundled Payments for In-Patient, Post-Acute and Physician Services
The Act authorizes HHS to establish a demonstration project in up to 8 states beginning January 1, 2012 to evaluate the use of bundled payments, adjusted for severity, for an episode of care that includes a hospitalization, post-acute care services and physicians services during a hospitalization. The conditions to be included in the bundled payments are: (1) acute-care inpatient hospital services; (2) physician services delivered inside and outside of the acute-care hospital setting; (3) outpatient hospital services, including emergency department visits; (4) services associated with acute-care hospital readmissions; (5) post acute-care services including home health; (6) skilled nursing, inpatient rehabilitation; (7) long-term care hospital; and (8) other services that the Secretary determines appropriate.
For additional information on any of the issues referenced on this page, please contact Nicholas J. Lynn, Susan V. Kayser or the Duane Morris attorney with whom you are regularly in contact.
