Thursday, May 7, 2009

Nursing Home Transparency Bill Reintroduced

Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) have decided to give
the Nursing Home Transparency & Improvement Act of 2009 another try at
passing. Their goal with the bill...increase accountability in the
nursing home industry and sort out the network of owners that run many
facilities.

The bill comes out of growing concerns about homes owned by
large private equity firms who often build complex corporate structures
to shield them from liability. Under this legislation nursing homes
would have to name the members of the groups that own them, give the
organizational structures of all affiliated entities and give
information about those involved in the management, operation and
financing

The bill would require a real time system for reporting
staffing information to the US DHHS cutting down on a facility trying to
manipulate its staffing numbers. The CMS website would be able to
provide more information on its Nursing Home Compare website including
the ownership information, staffing data and a standardized complaint
reporting form.

The legislation would also give the government more
enforcement options including flexibility in assessing penalties and
collecting money sooner. It would require facilities to come up with
compliance and ethics plans to prevent civil, criminal and
administrative violations. Facilities would also have to develop
internal quality assurance standards.

The last thing the legislation would do is require HHS to
come up with a national monitoring program to watch over multi-state and
large intrastate nursing home chains.

The goal is more transparency, better enforcement and
improved staff training according to Sen. Grassley. Currently the bill
is pending before the Finance Committee.

Tammy Schroeder

tjs@knudsenlaw.com

www.knudsenlaw.com

Nursing Assistant Regulations Updates

The State of Nebraska has recently revised its Nursing
Assistant Regulations. (For continuity with licensure regulations, they
have also been transferred to the Health Professional and Occupational
Licensure Title of the Nebraska Administrative Code (172 NAC).) The new
regulations pertain primarily to training, approval of training courses,
and the Nursing Assistant Registry. A summary follows.

Nursing assistant training programs must now be approved
through application to the Department (using the Department's form)
outlining the curriculum of the course. The curriculum must be in
compliance with the regulations, including 75 hours of instruction, 16
hours of supervised practical training and focus on the prescribed
topics including at least one hour of instruction on the responsibility
to report suspected abuse or neglect. (The specifics are outlined in
172 NAC 108-003.01.)

The application for approval of a training course must
include the names and authors of all textbooks to be used (including
publisher and edition), or if no textbooks will be used, a list of
written materials that will be used including the source of such
materials. Applicants must specify the specific topic units to be
covered in the course as set forth in the regulations, and the hours to
be spent on each. The method of instruction for each unit has to be
specified (e.g. lecture, demonstration, simulation, slide presentation,
film strip, etc.) as well as a description of the practical training
provided for each unit required by the regulations. Reading
assignments, evaluation methods (written exams, demonstrations,
competency check-off, etc.), an explanation of the grading system to be
used, and other matters must be specified in the application, which must
be submitted by the Executive Director at least 30 days prior to when
the courses are to start.

Once approved, the courses do not require re-approval unless
the course, or the law, are changed. If a nursing assistant training
course is not approved, or such approval is suspended or revoked, the
regulations provide notice and opportunity to be heard for the
applicants. Attendance records are subject to review by the Department
upon request and must be maintained for at least two years from the date
of completion of each course. The nursing assistant training courses
are also subject to on-site periodic review by the Department, and
sponsors must provide written notices to the Department of the dates and
location that a basic course will be held at least five working days
before it is scheduled to begin.

In addition to other requirements, Nursing Assistants have
to successfully complete an approved training course within 120 days of
employment. Interestingly, a Nursing Assistant who becomes a Licensed
Practical Nurse or a Registered Nurse his/her Nursing Assistant
registration become null and void. Subsequently, if the Registered
Nurse or a Licensed Practical Nurse nurse's license is revoked,
suspended, or voluntarily suspended in lieu of discipline, he/she cannot
act as a Nursing Assistant in a nursing home either.

Of course, Nursing Assistants cannot have been convicted of
a crime involving moral perpitude rationally related to his/her
practice, and the Department documents such convictions on its Registry,
making the Nursing Assistant ineligible for employment in a nursing
home. The Department will give written notice of the reasons for the
proposed finding and will place the name on the Registry 30 days after
receipt of the notice unless a hearing is requested. Notably, after a
year has passed from the date the Nursing Assistant was placed on the
Registry, he/she may petition the Department to have the finding
removed.

Nursing homes should become fully conversant with the
training approval program requirements and organize accordingly. For a
copy of the regulations, or to discuss any of the implications, feel
free to contact the Knudsen Law Firm.

Kevin McManaman

krm@knudsenlaw.com

www.knudsenlaw.com