Specialized Information for:

Long-Term Care ConsumersFamily MembersAdvocatesCOVID-19

Long-Term Care Provisions in the Affordable Care Act

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 Consumer Voice 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 Consumer Voice 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).

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.

Return to Other Long-Term Care Issues and Resources