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⭒ New Developments

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 (;

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 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 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 legislation:

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 (D-IL).

Key Provisions:

  • 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 rates.
  • 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 ombudsman.
  • A review of Nursing Home Compare’s accuracy, clarity, timeliness, and comprehensiveness and modifications of the site based on the review.
  • A Government Accountability Office study of the Five Star Quality Rating System.
  • Improved timeliness of survey information made available to the public.
  • 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 facility program.
  • 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 self-reported,non-repeat violations.)
  • Sixty-day advance notification of facility closure and authorization to continue Medicaid payments pending relocation of all residents.
  • Dementia care and abuse prevention in nurse aide training programs.
  • 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 EJA,

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 waiver.
  • 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 ( for updates and details on the legislation.