Nursing Home Quality Reform Act of 1986

Summary

Nursing Home Quality Reform Act of 1986 - Title I: Medicare and Medicaid Programs - Amends title XIX (Medicaid) of the Social Security Act to require intermediate care facilities (other than mental health institutions) to meet skilled nursing facility requirements established under title XVIII (Medicare) of the Act. Makes changes in the conditions placed upon skilled nursing facilities' Medicare participation relating to: (1) the quality and fairness of care; (2) patient participation in facility decision-making; (3) the extent to which care approximates a patient's particular needs; (4) facility reprisals against patients or employees utilizing complaint procedures; and (5) the access of patients, their guardians and relatives, and the public to information regarding patients' rights and facility policies and procedures. Substantiates such objectives by providing a nonexclusive list of patients' rights at such facilities. Prohibits State agencies which have agreed to survey nursing facilities' compliance with Medicare participation conditions from providing such facilities with consultation services regarding such conditions. Requires that nursing facility survey results be posted in a place accessible to patients. Amends part A (General Provisions) of title XI of the Act to authorize the Secretary of Health and Human Services to make provider performance reports available to the public after giving the provider 30 days (currently, 60 days) to review and comment on such reports, but removes time restrictions on the release of such information to ombudsmen. Amends the Medicare program to require that nursing facility surveys be: (1) unannounced; (2) conducted by a multidisciplinary team of professionals tranined and tested for their duties; (3) focused on the quality of care provided to patients; and (4) performed for each facility on a regular basis, the frequency of such surveys depending upon the facility's record. Directs State agencies to provide for the investigation of complaints against nursing facilities and to use specialized survey teams to survey and carry out enforcement action against chronically substandard facilities and other facilities posing an immediate threat to patients' well-being. Directs the Secretary to establish criteria and procedures for evaluating an institution's plans for the correction of its violations of nursing facility standards. Directs the Secretary to conduct a random annual sample of skilled nursing and intermediate care facilities in order to validate State determinations regarding provider compliance with Medicaid requirements. Directs the Secretary to develop and implement intermediate sanctions applicable to Medicare nursing or Medicaid intermediate care facilities which do not substantially satisfy the requirements placed on such facilities, but which do not immediately jeopardize the health, safety, and well-being of their patients. Authorizes the Secretary to appoint a receiver to establish and oversee the implementation of a plan to bring such facilities into compliance with applicable requirements when they chronically fail to satisfy requirements or their deficiencies immediately jeopardize patients' health and safety. Gives such facilities the right to a hearing after a deficiency determination is made. Amends part A (General Provisions) of title XI of the Act to give an individual entitled to inpatient hospital services in a nursing or intermediate care facility the right to bring an action in an appropriate Federal district court when such facility's failure to meet the requirements of the Act adversely affects such individual. Title II: Additional Provisions Relating to Long-Term Care - Eliminates the requirement that the extended care services covered by part A (Hospital Insurance) of the Medicare program be post-hospital extended care services. Directs the Secretary to study and report to the Congress regarding the feasibility of replacing the separate categories of long-term care facilities under the Medicare and Medicaid programs with a facility of single designation which provides and is reimbursed for various levels of long-term care. Title III: Amendments to the Older Americans Act of 1965 - Amends the ombudsman program of the Older Americans Act of 1965 to: (1) authorize an ombudsman to designate a representative to perform ombudsman functions; (2) immunize ombudsmen and their representatives from liability under State and Federal law in the performance of their duties, so long as such duties are performed with due care; and (3) provide technical assistance and training for ombudsman and their representatives. Establishes the National Long-Term Care Ombudsman Program Advisory Council in the Department of Health and Human Services to advise the Secretary regarding the development and operation of the ombudsman program. Requires the Secretary to report annually to the Congress regarding data collected on compliants and conditions in long-term care facilities.

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• Introduced in Senate

  summary · EN · 26 June 1986

  Open at official source

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