The Affordable Care Act And Its Impact On Nursing Facilities

For nursing homes operating anywhere in the US, March 23, 2013 isn't just another date on the calendar. It’s the deadline for compliance with some important requirements imposed by The Affordable Care Act (the ACA, also known as “Obama Care”). By that date, nursing care facilities accepting Medicare or Medicaid must adopt written programs and procedures designed to accomplish two broad goals:

•   Make the facilities safer for patients and residents
•  Improve fiscal integrity (cut down on Medicare and Medicaid fraud).

The new written programs and procedures can help you evaluate or choose a nursing facility for yourself or a loved one. As discussed in my blog post on selecting the right care facility, it’s good to have a plan of action, especially if you have a deadline for choosing a nursing home.

At your first meeting with a facility’s administrator, ask for a copy of their new Compliance and Ethics Program. The document you receive will tell you a great deal about that particular care center. The law requires that any adopted program meet certain criteria, and you’ll want to know whether the home you’re considering measures up to the legal requirements.

Here’s what to look for:

Physical and Emotional Safety – The physical safety and mental well being of residents should top the list of concerns for any responsible nursing facility, and the Compliance and Ethics Program required by the ACA should reflect that fact. The program should:

Provide for regular contact with residents by personnel trained to recognize the signs of physical injury and emotional abuse;

• Identify clear procedures for reporting incidents up the administrative chain of command without fear of retribution, and for investigating the facts surrounding any instance of injury or abuse;
• Charge a specific high-level administrator with direct responsibility to oversee compliance with safety standards and assign that person the necessary power and authority to enforce those standards; 
• Set forth the procedures to be followed within the facility to prevent the hiring or continued employment of persons who are likely to harm or abuse residents 
• Set up training programs and provide for the distribution of written materials so that everyone within the organization knows what the safety standards require
• Spell out reasonable enforcement procedures and disciplinary measures to be taken when residents are physically or emotionally harmed through the conduct of facility personnel. Fraud Prevention – A primary objective of the ACA is to lower health care costs through the prevention of Medicare and Medicaid fraud. Read the Compliance and Ethics Program to be sure that: 
• The facility takes care to prevent persons with a history of financial mismanagement or fraud from exercising discretion or control over the flow of money; 
• Audits are regularly conducted to detect financial irregularities
• Procedures are in place to prevent repetition of any financial offense that might occur, and to repay any funds lost or diverted through financial mismanagement or fraud.

Of course, it’s the implementation (not the adoption) of the Compliance and Ethics Program that really counts; and that can only happen over time. What are the chances that the facility you’re evaluating will actually carry out the program in the months and years to come? Here are some tips to help you predict the future:

1. Talk with more than one administrator and ask them how they feel about the ACA requirements. Look for a positive attitude. They should not see the law as just another government-imposed administrative burden. Even if they have a strong track record in both care quality and patient safety, they should view the new requirements as an opportunity to improve both. They should welcome the chance to demonstrate to residents and their families that the home fully intends to implement the law.
2. Ask to meet the senior administrator who will have direct responsibility for enforcing safety practices and procedures. This person is vital. Make your own judgment whether you’re dealing with a strong, positive personality. Is this person a leader? Ask whether he or she has the direct power to investigate complaints and to discipline or fire personnel who jeopardize resident health and safety.

In the end, keep in mind that nursing home residents receive better, safer care when facility administrators are aware that someone who cares is watching. The new ACA provisions provide an opportunity for residents and their families to send a positive message. Let your facility know that you are informed about the ACA’s new provisions related to resident safety and well being and that you expect full compliance with those provisions.