The Nursing Home Improvement and Accountability Act of 2021

A group of Democratic Senators introduced legislation on August 10, that aims to improve the quality of care nursing home residents receive and provide oversight of nursing homes. The bill proposes changes regarding nursing home staffing, monitoring and enforcement, to the website Care Compare managed by the Centers for Medicare and Medicaid Services, and many other issues. The legislation would apply to nursing homes receiving reimbursement from Medicare and Medicaid for the services the homes provide their residents.

According to The Center for Medicare Advocacy, some of the key features of the bill are:

• Each nursing home facility must have a registered nurse on staff 24 hours a day.
• The Secretary of the Department of Health and Human Services (DHHS) must prepare and submit regular reports to Congress. DHHS must “implement nursing staff ratios,” and require that the facilities using Medicare and Medicaid meet those staff ratios.
• Requirements that the covered nursing homes have an “infection preventionist at least 40 hours per week.”
• Requirements that the DHHS Secretary study and improve survey and enforcement practices “to ensure their effectiveness, appropriate classification of deficiencies, timely correction of deficiencies, timely investigation of complaints and reported allegations of abuse and neglect, the ability of state survey agencies to hire, train, and retain surveyors, and more.”
• Additional Medicare funding to support the staffing requirements (better wages and benefits) and to support better quality of nursing home care. The DHHS will provide independent reviews and reports to Congress – regarding the increased funding.
• Better reliability and accuracy of nursing home data – including requiring audits. The bill proposes financial penalties if inaccurate data is submitted.
• Specifically prohibits pre-dispute arbitration agreements. This will ban agreements requiring claims against the nursing home be tried before arbitrators instead of before juries or judges.

It is expected that the US House of Representatives will introduce a companion bill. To learn more about the bill, including the text of the bill, a bill summary, and a section-by-section summary, you can view the Senate Finance link. The full text of the Senate bill is also available online.

Why was the nursing home bill introduced?

The Senate bill was introduced by Senate Finance Committee Chairman Ron Wyden, D-Ore. And Senate Aging Committee Chairman Bob Casey, D-Pa., along with Senators Richard Blumenthal, D-Conn., Michael Bennet, D-Colo., Sheldon Whitehouse, D-R.I., and Sherrod Brown, D-Ohio.

The bill was initiated, in part, due to the tragic toll COIVD-19 took on nursing home residents and workers. Senator Widen said:

Families must have faith that loved ones receiving long-term care or care after a hospital stay will be safe and receive good-quality care…The pandemic, myriad reports of abuse, and critical failures during natural disasters have shattered that foundation of trust and safety. This legislation represents a big step towards nursing home care that is safer, higher quality, more accountable and more supportive of the workers who care for our most vulnerable.

Senator Casey added, “This legislation provides the transparency and accountability that families deserve, expanding staffing, technical assistance and oversight efforts across the board. I look forward to working with my colleagues on making these proposals a reality and preventing another tragedy like this from occurring.”

Title 1 - Transparency and accountability

This part of the bill includes the following provisions:

• Improving the Accuracy and Reliability of Certain Skilled Nursing Facilities. This provision penalizes skilled nursing facilities that submit inaccurate data by reducing their payments by two percentage points. The section includes additional validation and quality standards.
• Ensuring Accurate Information on Cost Reports. This section requires that DHHS, starting in 2022, conduct an audit of a representative sampling of the “Medicare cost reports Skilled Nursing Facilities SNFs are required to submit.” The section includes additional requirements for the Inspector General of HHS to conduct cost reports every two years. The section also provides information on the funds used to achieve the goals of this section.

Additional transparency and accountably sections include:

• Requiring a Surety Bond for Skilled Nursing Facilities and Nursing Facilities.
• Survey Improvements.
• Prohibiting Pre-Dispute Arbitration Agreements.
• Improvements to the Special Focus Facility Program.

Title II—Staffing improvements

The key provisions of this section are:

• Nurse Staffing Requirements. This section, among other requirements, provides a timeline for conducting a study “on the appropriateness of establishing minimum staff-to-resident ratios in Skilled Nursing Facilities (SNF) and Nursing Facilities (NF).”
• Improving Nursing Home Compare Staffing Data. This section provides requirements for displaying staffing information for weekend and weekly hours of licensed nursing staff – excluding their hours working on administrative duties.
• Ensuring the Submission of Accurate Staffing Data. This section authorizes civil monetary penalties (up to $10,000) for submitting inaccurate direct care staffing information.
• Requiring 24-Hour Use of Registered Professional Nurses. This section calls for the use of a registered nurse 24 hours a day, seven days a week.
• Provision of Infection Control Services. This section requires that the DHHS Secretary set minimum hours/week requirements (at least 40) that SNFs and NFs must have “for the provision of infection control services overseen by an infection preventionist.”
• Enhanced Funding to Support Staffing and Quality Care in Nursing Facilities. This section sets conditions for when and how states can receive “temporary enhanced federal Medicaid match to fund certain workforce and care improvements.”

Title III—Building modification and staff investment demonstration program

The one section of this title provides as follows:

• Establishing a Skilled Nursing Facility Building Modification and Staff Investment Demonstration Program. This section (among other provisions) “requires the Secretary of HHS by January 1, 2023, create a demonstration program to test the impact of providing the covered facilities additional funding to “modify the built environment of pursue resident-centered care approaches.”

At Gainsberg Injury and Accident Lawyers, our Chicago nursing home abuse and neglect lawyers have been fighting for nursing home residents and their families for more than 20 years. We represent residents who suffer physical, emotional, sexual, or financial abuse. Many abuse and neglect cases are due to understaffing and underfunding, which is why this legislation is critical to the health of seniors. To discuss neglect, abuse, or the death of a loved one in a nursing home, call us at 312.600.9585 or fill out our contact form to schedule an appointment.