Making it easier for the public to understand about quality of care in nursing homes

By Jennifer A. Stiller
December 20, 2009
Revised March 23, 2010

Consumer website

"Nursing Home Compare" is a website operated by the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the Medicare and Medicaid programs, in order to provide information obtained through the government's regular oversight of nursing home operations and quality to consumers.

Under the Health Reform law, there will be a number of changes designed to improve the timeliness of information on the "Nursing Home Compare" website.

Faster submission of data to the federal government. Oversight of nursing homes is actually carried out by the States under contracts with the federal government. Effective March 23, 2011, States will be required to submit nursing home survey and certification information (including any enforcement actions taken by the State or that the State has recommended a federal agency to take) to CMS at the same time the State sends notice of the same to the affected facility. CMS will use this information to update the website as expeditiously as practicable (not less than quarterly).

More information on the website. The website itself will be enriched by incorporating the following additional information "in a manner that is prominent, easily accessible, readily understandable to consumers of long-term care services, and searchable":

• Staffing data for each facility, including resident census data and data on the hours of care provided per resident per day, and information on staffing and turnover. The website must display this staffing information in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing among facilities and with applicable State and national averages.
  
  
• Links to State websites with information regarding State survey and certification programs, links to Form 2567 state inspection reports on such websites, information to guide consumers in how to interpret and understand those reports, and the facility plan of correction or other response to each report.
  
  
• The standardized complaint form developed under the new law, including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman.
  
  
• Summary information on the number, type, severity, and outcome of substantiated complaints.
  
  
• The number of adjudicated instances of criminal violations by employees of a nursing home that were committed inside the facility, showing how many of those were for abuse, neglect, exploitation, criminal sexual abuse, or other violations or crimes that resulted in serious bodily injury.
  
  
• Information on the Special Focus Facility program, including information with respect to, and the names and locations of, those facilities that, since the previous quarter (1) were newly enrolled in the program; (2) are enrolled in the program and have failed to significantly improve; (3) are enrolled in the program and have significantly improved; (4) have graduated from the program; and (5) have closed voluntarily or no longer participate in Medicare.
  
  
• The number of civil monetary penalties levied against the facility, employees, contractors, and other agents.

Information on residents or complainants may not be displayed on the website.

Most of this information must be up on the website by March 23, 2011. An exception to this deadline is the staffing data, which must be on the website within one year of such data having been reported to HHS.

In addition to making these specific changes to the Nursing Home Compare website, the Secretary is required to establish a process to review the accuracy, clarity of presentation, timeliness, and comprehensiveness of the information reported on the website as it existed on the day before enactment, and to modify or revamp the website in accordance with that review by March 23, 2011.

Disclosure of nursing home ownership and management

Since 1977, federal law has required that entities such as nursing homes that participate in Medicare and/or Medicaid must disclose the identity of those who have an ownership or control interest in the facility. Under current law, that includes anyone who has a direct or indirect ownership interest of 5% or more, who owns a mortgage, deed of trust, note, or other obligation secured by all or part by the entity or any of the property or assets, anyone who is an officer or director (if the entity is a corporation) or a partner (if the entity is a partnership.

The health care reform statute expands upon existing law for nursing homes (skilled nursing facilities and "nursing facilities") by broadening the list of those whose names must be disclosed to include corporate entities and to require that additional information about them (such as job title and period of service) be provided. In addition, the identities of a more sweeping list of people and entities with financial or managerial power in the entity must be disclosed. For the first time, those with specified ownership interests in limited liability companies, limited liability partnerships, limited partnerships, and trusts must be disclosed. (Previously this requirement applied only to corporations and general partnerships.)

Within 2 years, the HHS Secretary is to adopt regulations setting reporting requirements and imposing a standardized format for reports. Until those regulations are adopted, the facility must maintain the required information and update it as necessary to reflect changes. It must make such information available upon request to the public, as well as to the Secretary, the HHS Inspector General, the State in which the facility is located, and the State's long-term care ombudsman. During this time period, the facility must also prominently post a notice of the availability of this information in its lobby.

One year after the regulations are adopted, the information that is reported will be made public by HHS.