Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention

The Affordable Care Act (ACA) is the first comprehensive legislation since the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), to expand quality of care-related requirements for nursing homes that participate in Medicare and Medicaid and improve federal and state oversight and enforcement. Despite the 1987 reforms, beginning in 1997, the Government Accountability Office issued more than 20 reports documenting serious quality of care problems in nursing homes and inadequate enforcement of federal regulations to protect residents’ health, safety, and welfare. To help address these quality problems, the ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators’ ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes.

This issue paper describes the new ACA requirements, explains the background for their inclusion in the law, and outlines the Centers for Medicare & Medicaid (CMS’s) progress in implementing them to date.

 Report (.pdf)