“ As these provisions are implemented, long-term care facilities will become increasingly transparent not only to residents and family members, but also to plaintiff attorneys.”
Healthcare reform The goal of healthcare reform, known as the Patient Protection and
Affordable Care Act (PPACA), is to control spending while increasing access to affordable care for all Americans. To this end, the overriding theme of reform is efficiency. Theoretically, by breaking down the silos of care and building a more comprehensive, integrated, case- managed and client-centred delivery system, both savings and improved outcomes will be achieved. One mechanism to allow for increased integration is bundled payments. For certain episodes, a patient will be allocated a set amount of funds that would follow the patient from acute to post-acute settings. While the implementation date for this is not immediate, voluntary pilot programmes will begin in January 2011 for implementation in 2013. However, long- term care facilities risk losing out on reimbursement dollars by not positioning themselves properly during the pilot studies.
Of more immediate concern to captives is the section of PPACA
entitled ‘Nursing Home Transparency and Improvement Act’. This act requires nursing homes to provide consumers with a substantial amount of new information regarding ownership and operating performance designed to encourage improvements in quality standards. These changes can dramatically alter insurance coverage requirements and increase loss costs. The key provisions of this act and their implementation dates are as follows:
• Revamped staffing data submitted electronically from payroll records and other verifiable sources for the public reporting of hours per resident day of care, with turnover and retention rates (March 2011)
• Improved information available on Nursing Home Compare, including more timely and extensive staffing data; facilities’ survey reports and plans of correction; summaries of complaints
34 CAYMAN CAPTIVE
against facilities, including number, type, severity and outcome; a standardised complaint form; adjudicated criminal violations by facilities and their employees, including civil monetary penalties levied against the facility, its employees, contractors or other agents (March 2011)
• A requirement for nursing homes to make three years of surveys and complaint investigations available upon request, and post a notice in a prominent location at the facility that this information is available (March 2011)
• Streamlined complaint-handling, including a voluntary standardised form for filing complaints with the survey agency, and protection of residents’ legal representatives and other responsible parties from retaliation when they complain about the quality of care (March 2011)
• Institution of training programmes for dementia care and abuse prevention in nurse aide training programmes (March 2011)
• Public disclosure of nursing home owners, operators, and other entities and individuals that provide management, financing and services to nursing homes (June 2012)
• Establishment of compliance and ethics programmes that are reasonably designed, implemented and enforced to prevent and detect civil/criminal violations, while improving quality assurance (March 2013).
As these provisions are implemented, long-term care facilities
will become increasingly transparent not only to residents and family members, but also to plaintiff attorneys. Accordingly, this transparency will breed closer scrutiny and subject facilities to greater risk of litigation. From a captive’s perspective, the simple demand for full disclosure of ownership will hinder the opportunity to hide deep pockets. Add increased accessibility of survey
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