Nursing home partners in the ownership and operation of hundreds of nursing homes are fighting and suing each other for the fraud they have perpetuated for the last decade.   New York real estate investor and nursing home owner/operator Rubin Schron is suing his partners (in fraud) Troutman Sanders, Leonard Grunstein, and Murray Forman.  See Complaint here.

Schron accuses Troutman, Grunstein, and Murray Forman of breaching their fiduciary duties to benefit themselves at Schron’s expense, according to this report by Bloomberg.  The Am Law Daily reported on federal charges against Schron, Grunstein, and Forman over their involvement in a $50 million kickback scheme with nursing homes and pharmaceutical providers. In February all three reached a $14 million civil settlement with federal prosecutors in Boston. 

"This case is about the systemic exploitation by self-interested attorneys and bankers of clients who entrusted them to devise and implement the terms of complex business deals that these defendants arranged and advocated for their clients," states Schron in his 97-page complaint.  Grunstein served as principal outside legal adviser to the real estate investor and his companies from the 1980s until late last year. The suit accuses Grunstein of causing "hundreds of millions in dollars of damages" to Schron.  Also named as defendants are Grunstein’s brother and business associate, Harry Grunstein, and Troutman M&A and project finance partner Lawrence Levinson. 

"Grunstein facilitated his tortious conduct by his association with these firms," states Schron’s complaint. "Grunstein frequently used their letterhead for his schemes, and he was assisted by the active complicity of several partners, including defendant Levinson. In reward for facilitating Grunstein’s misdeeds, these law firms received tens of millions of dollars in legal fees from Schron and the Schron Entities."

The complaint further claims that Grunstein and Forman brought investment opportunities to Schron that they themselves took stakes in without contributing cash or assuming risk. Schron claims that he alone bore the risk from these transactions, with Grunstein and Forman later becoming involved in a series of deals in the nursing home business that drew the attention of federal prosecutors.

The trio have been caught up in a tangle of litigation. Grunstein and Forman filed suit against Schron in March, claiming he misappropriated funds from entities created by the two business partners and failed to keep and maintain audited financial statements.  "Underlying all of the claims in this action is Schron’s pattern of betraying the trust placed in him," state Grunstein and Forman in their 38-page complaint,. Grunstein and Forman are seeking $100 million in damages from Schron, several of his relatives, and their affiliated holding companies. 


The Business Journal reported an incredible story about Sunrise Senior Living giving bonuses to executives who have lost $16 million in the last year.  This is what is wrong with Corporate America.  Sunrise takes taxpayer money through Medicaid and Medicare; provides poor care while stuffing their pockets, and then before declaring bankruptcy siphon the rest of the money by paying themselves bonuses for poor performance.. 

Sunrise Senior Living, Inc., is paying 2010 bonus payments to its executive officers, equal to one-third of their respective target annual bonus amounts, according to a filing with the Securities and Exchange Commission. The compensation committee of the company’s board will pay CEO Mark Ordan $325,000, while CFO Julie Pangelinan and CIO Gregory Neeb will receive $133,333 each.


As stated in the SEC filing, the "compensation committee" awarded the bonuses to these executive for their “extraordinary work” during the recession. Sunrise reported a net loss of $16 million during the first quarter of 2010. The company is also in default on $241 million of debt.


All three executives remain eligible to receive the remainder of their 2010 bonuses at the discretion of the compensation committee.


A new publication from the Robert Wood Johnson Foundation (RWJF) that focuses on a number of efforts at the state level to increase the number of nurses in the United States.  Experts predict that by 2025, the nation will facing a nursing shortage of about a quarter of a million nurses.  


The most recent issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation (RWJF) publication series focused on policy ideas with the potential to transform patient care. In particular, it focuses on state-level partnerships that have created promising models and actual results.


The partnership efforts have included:


· Bringing the business community and others into a coalition supporting expansion of capacity to secure a bigger state appropriation.

· Strong gubernatorial leadership to coordinate a series of reforms, including web-based management of clinical placements for nursing students, and the creation of a statewide nursing corps to rapidly educate faculty and students;

· Multi-state partnerships among community colleges and baccalaureate programs to bridge the gaps between programs offering associates degrees and BSNs;

· Alliances of nursing programs from institutions around the state, including an alliance of rural programs, to share curriculum, administrative resources, faculty, admissions standards, and relying on web-based instruction and mobile simulators to maximize reach; and

· A focused program of distance-learning, web-based simulation and other approaches to overcome geographical challenges.


Using a broad range of tailored approaches, these and other state-level partnerships are creating more effective advocacy for policy and regulatory change; redesigning educational programs by deploying revised curricula, new technology and updated clinical education models; and increasing faculty capacity and diversity.


In this effort, the Center to Champion Nursing in America, a joint initiative of AARP and the Robert Wood Johnson Foundation, is providing technical assistance to 30 states now implementing efforts to expand nursing school capacity.  If you’re interested in more information, contact  202.371.1999.



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The News & observer had an article about the tragic death of nursing home resident Rachel Holliday.  Angela Almore was arrested and accused of murdering Holliday after an investigation found that Almore gave Holliday morphine that was not prescribed or needed. The indictments allege that Almore intentionally caused each to "ingest morphine that proximately caused serious bodily injury."  Almore has been a registered nurse for four years, and was responsible for taking care of  84-year-old Alzheimer’s patient holliday at Britthaven of Chapel Hill.

A medical examiner reported that Holliday died of pneumonia from asphyxiation, and that the levels of morphine in her system likely contributed to her death.  The report listed "morphine toxicity" as a contributing factor to her death, noting that tests done at UNC Hospitals before her death determined she had a morphine level of more than 50,000 nanograms per milliliter of urine.

Almore was also charged with six counts of felony patient abuse related to other Britthaven patients who were hospitalized after they became lethargic. Tests indicated they had been given morphine, even though none had been prescribed the powerful pain medication. All but Holliday survived.

Nursing homes that receive Medicare and Medicaid funding must follow specific regulations about how medications are bought, stored, ordered and distributed. If the nursing home’s oversight was lacking, it must correct the problems and could face fines and be held liable for the death of holliday.

See other article about these incidents here and here.

The Winston-Salem Journal had an article about Clemmons Nursing and Rehab Center possibly losing the ability to be reimbursed by Medicaid and Medicare for failing to follow OBRA regulations and other standards of care.  Clemmons is facing federal and state claims that it isn’t properly caring for residents after investigators found that employees injured a patient by carelessly picking her up out of a wheelchair and throwing her onto her bed.  The state’s investigation cited concerns about residents’ physical and mental health and said the nursing home failed to comply with its policies and procedures, such as filing timely reports on incidents.  The center also was cited by the state for not properly observing residents’ medication regimens and not properly cleaning some female residents’ genitals.

Medicare may no longer make payments to the center for new inpatient services, and would only make payments for up to 30 days for patients admitted before June 19.  However, federal and state agencies have in the past extended the compliance deadline, depending primarily on whether the facility shows initiative in addressing deficiencies.

Clemmons is operated by Forsyth Health Investors LLC. The center has 120 beds and 71 residents.  The center also received a notice, dated June 1, that its state certification was in immediate jeopardy. 

The state agency recommended to Medicare that the center be fined a civil penalty of $10,000 for each incident.  A survey by the federal Medicare and Medicaid agency, released in December, gave the center two out of five stars, with five being the highest. The rankings focus on three categories — health inspections, staffing and quality measures.

See full report here.

The Democrat and Chronicle had an article about the licensed practical nurse admitted that he had sexual contact with a mentally incapacitated patient at a Rochester nursing home. Kipper Allen Stevens pleaded guilty to a misdemeanor of endangering the welfare of an incompetent or physically disabled person for assaulting the patient on Dec. 21, 2008, at Shore Winds nursing home.  Stevens admitted to a police investigator that he had sex with the woman. 

A co-worker witnessed sexual contact between Stevens and the woman and notified the nursing home’s management a week later. During the investigation, Stevens told an investigator that he and the woman "were two consenting adults having a relationship" and denied having forcible sex with the woman. But he acknowledged it was improper for a caregiver to have a relationship with a patient.

Stevens also had been charged with second-degree rape, a felony which could have sent him to prison for up to seven years. Stevens only faced a maximum penalty of one year in jail for the misdemeanor but will receive nine months in jail with one-third off the sentence for good behavior, he’ll be free in six months.




There have been numerous media outlets including WSPA that have discussed the incident involving an assisted living resident who died because of the neglect of the home. The Laurens County Coroner concluded that the resident died of heat stroke at an assisted living facility should not have been allowed to sit in the sun for hours.

Frances Louise Farmer, 67, died from symptoms of heat stroke, according to Coroner Nick Nichols after finding Farmer unresponsive in a chair outside the facility.  Farmer was a resident at La Forrest Community Care, an assisted living facility   Paramedics arrived at 1:13pm,  Farmer’s body temperature was 107.8 degrees.  The temperature on that day was over 90 degrees.  Farmer was in the sun "for at least a couple of hours, based on statements given by different witnesses.

Nichols says Farmer had heat blisters all over her upper body and upper legs. “I’m not saying this was anything beyond an accident, but I also wonder how someone who is known to be on this type of medication could be allowed to sit outside in the hot sun for two hours without a nurse or someone making them come inside," says Nichols.

The State Law Enforcement Division confirms it is investigating the death along with the Department of Health and Environmental Control, which has oversight of all registered residential care facilities. No charges have been filed yet and knowing the competency and enforcement history of DHEC, none will be filed.


Milwaukee-Wisconsin Journal Sentinel had an article about the horrible care and fraudulent documentation at Mount Carmel Health and Rehabilitation including 35 violations of regulations for minimum care.  "Records also show, however, that the 35 citations issued so far this year to Mount Carmel are close to the 40 citations issued in all of 2009 and more than the 25 issued in 2008, according to the state Department of Health Services."

Staff at the state’s largest nursing home recorded on charts that a 41-year-old brain-damaged resident was in his bed watching TV when he was sitting in jail. The man spent five days in custody,  Staff had continued to mark on charts that he was at the facility through the night and into the morning of May 17. 

The man wandered away from Mount Carmel and was arrested for "prowling" more than four miles away.  The nursing home was aware that he was a wandering risk and were ordered by phyisicians to check on him every 15 minutes. The other violations cited this year include failing to communicate with a recent amputee and failing to provide for five residents at risk of falling, including one who was hospitalized for a broken jaw after falling out of his wheelchair.

Licensed for 473 beds, Mount Carmel is the largest of the 397 nursing homes in Wisconsin, according to the Department of Health Services. In January 2009, Kindred Health Care, a Louisville, Ky., for-profit company resumed operation of Mount Carmel. After operating with a probationary license for one year, Kindred was given a full license in January of this year.

The citations issued this year include two identifying "actual harm" to residents and five for violations that constitute a "direct threat to health, safety and welfare," state records show.

Other citations
Among other things, Mount Carmel was accused of:

• Failing to provide appropriate supervision and assistive devices to five out of 10 residents identified by Mount Carmel as being at risk for falls.

Three of the five had fallen since last December, including one who suffered a broken jaw and an eye socket "blowout." A hospital that treated the woman reported the incident to the state but Mount Carmel, which was required to report the incident, did not.

• Failing to assess and treat pain, depression and other problems experienced by a 51-year-old woman.

• Sixteen of 32 residents reviewed were not treated "in a manner that maintained their dignity."

Two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; and an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

The September inspection also found that after a resident complained of hip pain, Mount Carmel did not notify a physician for two hours and 15 minutes. The doctor ordered an X-ray, but the order was not relayed by a nurse for 2 1/2 hours. The X-ray revealed a broken hip.

The article had a Summary of violations Mount Carmel Health and Rehabilitation Center in Greenfield was cited for 35 state and federal violations so far this year. Among them:

March 2010: A 51-year-old resident who had her right leg amputated below the knee in December 2009 did not have staples removed as of March and no adequate assessment or treatment of the resident’s "phantom pain" in the leg had been done.

Mount Carmel also was cited for failing to communicate with the resident, who did not speak English, in Spanish. Among other things, staff was not aware that the resident experienced phantom pain and that she had been dropped by staff. A registered nurse told an investigator she didn’t need a Spanish interpreter because relied on documents and the resident’s gestures and facial expressions.

Also in March, an investigator found that 16 of 32 residents reviewed were not treated "in a manner that maintained their dignity." Two had been transported in shower chairs with bare legs or buttocks exposed; two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

January 2010: A federal investigator finds that, going back to December, five out of 10 residents identified by Mount Carmel as being at risk for falls did not receive appropriate supervision and assistive devices, and that three of them fell. A 92-year-old resident who needed supervision was dropped off at a medical appointment by herself. .

Dec. 3, 2009: A resident who lacks the ability to move in bed, is found on the floor next to her bed. She suffers a broken jaw and an eye socket "blowout," according to a federal investigator. The hospital reported the injuries to the state Office of Caregiver Quality, but Mount Carmel, which is required to make a report, did not. When the investigator asked a Mount Carmel administrator on Jan. 11, five weeks after the incident, whether Mount Carmel had reported the incident to the state, the administrator said no report had been made because Mount Carmel "felt they knew how the incident occurred."

Nov. 5, 2009: Resident suffers laceration to left palm requiring sutures in a hospital emergency room. Hospital reports the injury to the state, but Mount Carmel did not. Mount Carmel could not determine how the incident occurred.


Contra Costa Times had an article about the class action lawsuit against Skilled Healthcare Group Inc that has been in trial for 7 months.  The case is to insure proper staffing in nursing homes which benefit the residents and the overworked employees of the nursing home.  The main issue in the trial is how to properly count the number of hours a person works.

Skilled Healthcare, along with its subsidiary Skilled Healthcare LLC, owns 22 nursing homes currently under scrutiny.  Whether the nursing homes maintained staffing levels required by the state is at the heart of the trial, which lasted more than 100 days. California law mandates that nursing homes provide a minimum of 3.2 hours of care per resident, per day.

One of the plaintiffs’ attorneys, Michael Thamer, who specializes in corporate abuse, said that the case is not about documents, but a matter of patients getting their needs met. Thamer said that if one thing controls the activities of a major corporation, it is the budget.

”The message from the top is simple: Stay beneath the budget,” Thamer said in his closing argument before making way for Wroten. “This corporate greed is what has kept the defendant from adequately staffing their facilities.”

Skilled Healthcare, which filed for bankruptcy in 2001, has been growing steadily over the past five years. The company has since bought up nursing homes in Texas, Kansas, Illinois, Missouri, New Mexico, Nevada and California.


The Center for Medicare Advocacy has been publishing a series of alerts regarding the Patient Protection and Affordability Care Act of 2010 and Health Care and Education Reconciliation Act of 2010. See link to their most recent one which focuses on the nursing home provisions of the bill.

Title IV, Subtitle B, of PPACA – Nursing Home Transparency and Improvement – addresses a variety of nursing home issues.


Part 1: Improving Transparency of Information


PPACA § 6101. Disclosure of Ownership and Additional Disclosable Parties. Effective immediately and upon request, skilled nursing facilities (SNFs) and nursing facilities (NFs) must make available to the Secretary of Health and Human Services (HHS), HHS Inspector General, the state, and the state long-term care ombudsman information about nursing home ownership (specifically, each member of the governing board, additional disclosable entities [which are defined as persons or entities that (1) exercise operational, financial, or managerial control over the facility or part of the facility or that provide policies and procedures or financial or cash management services; (2) lease or sublease real property to the facility; or (3) provide management or administrative services, management or clinical consulting services, or accounting of financial services to the facility]). Two years after enactment of the law (March 2012), the Secretary of HHS must publish final regulations. Ninety days after final regulations are published (June 2012), SNFs and NFs must report the information to the Secretary in a standardized format. One year after final regulations are published (March 2013), the Secretary must make the information available to the public.


PPACA § 6102. Accountability Requirements for Skilled Nursing Facilities and Nursing Facilities. Two years after enactment of the law (March 2012), HHS must publish final regulations for an effective compliance and ethics program, which may include a model compliance program. Three years after enactment of the law (March 2013), SNFs and NFs must have compliance and ethics programs in operation to prevent and detect criminal, civil, and administrative violations of the Act and to promote quality of care. Three years after final regulations are promulgated (March 2015), HHS must evaluate whether the compliance and ethics programs changed deficiency citations or made other changes to measures of quality, and must submit a report to Congress. HHS must also implement, by regulations, a Quality Assurance and Performance Improvement Program (QAPI) by December 31, 2011, which facilities must implement one year later.


PPACA § 6103. Nursing Home Compare Medicare Website. HHS must add to the official nursing home website, Nursing Home Compare, information about:

(1) Staffing data, including staffing turnover and tenure;

(2) Links to state internet sites, including links to the statements of deficiencies (reported on form #2567 and referred to as "2567s") and facility plans of correction;

(3) Standardized complaint form;

(4) Summary information on the number, type, severity, and outcome of substantiated complaints;

(5) Number of adjudicated instances of criminal violations by a facility or its employees that were committed in the facility, including those that involve abuse, neglect, exploitation, "or other violations or crimes that resulted in serious bodily injury."

The information must be presented "in a manner that is prominent, updated on a timely basis, easily accessible, readily understandable to consumers of long-term care services, and searchable."


HHS must establish a process to review the "accuracy, clarity of presentation, timeliness, and comprehensiveness" of information on Nursing Home Compare and make appropriate changes a year after enactment (March 2011).


To improve the timeliness of information on Nursing Home Compare, states must submit survey information to HHS no later than the date they send such information to facilities, and HHS must use the information to update the website "as expeditiously as practicable but not less frequently than quarterly."


The Special Focus Facility (SFF) program is mandated by statute. SFFs, defined as facilities that have "substantially failed to meet applicable requirements," must be surveyed at least every six months.


SNFs and NFs must have, and make available to anyone on request, reports about surveys and complaint investigations conducted within the prior three years. SNFs and NFs must post notice in a prominent and publicly accessible place that these reports are available.


HHS must provide guidance to states on establishing links to survey reports (2567s). States must maintain "a consumer-oriented website providing useful information to consumers," including 2567s, complaint investigation reports, and facility plans of correction.


HHS must develop a Consumer Rights Information Page on Nursing Home Compare that includes information and links on consumer rights and the survey process and state-specific information about services available through the state long-term care ombudsman.


PPACA § 6104. Reporting of Expenditures. Within one year after enactment (March 2011), HHS must redesign Medicare cost reports to require separate reporting of SNF expenditures for wages and benefits for direct care staff, including nurses and other medical and therapy staff. SNFs must begin using the new cost reports within two years of enactment (March 2012). Within 30 months of enactment (September 2013), HHS must categorize annual expenditures into four functional categories:

(1) Direct care staff;

(2) Indirect care (including housekeeping and dietary services);

(3) Capital assets; and

(4) Administrative services costs.

HHS must make the information available to interested parties on request.


PPACA § 6105. Standardized Complaint Form. Within one year after enactment (March 2011), HHS must develop a standardized complaint form that residents or persons acting on their behalf may use to file a complaint with a state survey agency or long-term care ombudsman program. States must establish a complaint resolution process that includes

(1) Procedures to assure accurate tracking of complaints,

(2) Procedures to determine the severity of complaints

(3) Procedures for complaint investigations, and

(4) Deadlines for responding to complaints.

In addition to the standardized form, complaints may still be submitted in other ways and formats, including orally.


PPACA § 6106. Ensuring Staffing Accountability. Within two years after enactment (March 2012), SNFs and NFs must submit, electronically to HHS, direct care staffing information (including agency and contract staff), "based on payroll and other verifiable and auditable data in a uniform format." Staffing information must:

(1) Specify the category of worker;

(2) Include information on resident census and case mix;

(3) Include a regular reporting schedule;

(4) Include information on employee turnover and tenure and hours of care per resident per day for each category of worker.


PPACA § 6107. GAO Study and Report on Five-Star Quality Rating System. Within two years of enactment (March 2012), the Government Accountability Office must submit a report to Congress on the Centers for Medicare & Medicaid Services’s (CMS) Five-Star Quality Rating System, addressing how the system is being implemented, problems, and suggested improvements.


Part 2: Targeting Enforcement


PPACA § 6111. Civil money penalties. HHS may reduce a civil money penalty (CMP) by not more than 50% if a SNF or NF "self-reports and promptly corrects a deficiency for which a penalty was imposed." A reduction is not available for (1) a deficiency if HHS had reduced a CMP in the previous year with respect to a repeat deficiency and (2) a deficiency reflecting a pattern of harm or widespread harm, immediate jeopardy, or a resident’s death. HHS must publish regulations providing for independent informal dispute resolution (IIDR). HHS may require placement of CMPs in an escrow account. SNFs or NFs that succeed on their appeals may receive the amounts collected plus interest.


CMP funds may be used for (1) activities "that benefit residents," including protecting residents whose facility closes or is decertified; (2) projects supporting resident and family councils and other consumer involvement in assuring quality care in facilities; and (3) facility improvement initiatives approved by HHS, including joint training of facility staff and surveyors, technical assistance, and appointment of temporary management firms.


Note: In an apparent drafting error, the law provides that per-day CMPs "may not be imposed" for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the [independent] informal dispute resolution process is completed. It is presumed that Congress meant that penalties would not be required to be placed in escrow accounts until completion of the IIDR process.


PPACA § 6112. National Independent Monitor Demonstration Project. Within one year of enactment (March 2011), HHS must begin a two-year demonstration project "to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains" of SNFs and NFs. HHS will choose chains from among those that apply for the project, focusing on chains with "serious safety and quality of care problems." The independent monitor analyzes the chain’s compliance; conducts sustained oversight; analyzes management; reports his/her findings to the chain, HHS, and relevant states; and publishes the results. A chain must respond to the monitor’s findings by submitting a report within 10 days, indicating corrective actions it will take or the reasons it will not implement the recommendations. A chain is responsible for "a portion of the costs associated" with the monitor. HHS must evaluate the demonstration in a report to Congress.


PPACA § 6113. Notification of Facility Closure. A SNF or NF administrator must provide written notice of a voluntary closure to HHS, state long-term care ombudsman, residents, and legal representatives 60 days in advance of the closure. Advance notice of a termination will be at the discretion of HHS. The administrator must ensure that no new residents are admitted after the date that written notice of closure is provided. The notice of closure must include (1) a plan (approved by the state) for the transfer and adequate relocation of all residents and (2) assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident. HHS may continue payments until all residents are successfully relocated. An administrator who fails to comply with these requirements may be subject to a CMP of up to $100,000 and may be excluded from federal payment programs.


PPACA § 6114. National Demonstration Projects on Culture Change and Use of Information Technology in Nursing Homes. Within one year of enactment (March 2011), HHS will implement two three-year demonstration projects, one on "culture change" and the other on the use of information technology in nursing homes.


Part 3: Improving Staff Training


PPACA § 6121. Dementia and Abuse Training. Initial training for nurse aides must include "dementia management training and patient abuse prevention training." HHS may also require such training in aides’ ongoing training.




PPACA § 6201. Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers. HHS must establish a nationwide program "to identify efficient, effective, and economical procedures" for background checks of workers with direct patient access, modeled on the pilot program conducted under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The procedures must include search of state-based abuse and neglect registries, state and Federal criminal history records, and a fingerprint check. States must:

(1) Conduct the screening and criminal history background checks;

(2) Monitor compliance by long-term care facilities and providers;

(3) Provide for provisional employment, up to 60 days, for employees and for direct on-site supervision for employees pending completion of an appeal process;

(4) Provide for an independent appeal process for a provisional employee or employee to dispute the accuracy of information;

(5) Provide for a single state agency to be responsible for overseeing the process (including specifying the disqualifying offenses).

The federal match for a state program must be three times the state amount, not exceeding $3 million. The nationwide program applies to SNFs, NFs, home health agencies, hospice providers, adult day care providers, and residential care providers that arrange for or directly provide long-term care services, "including an assisted living facility that provides a level of care established by the Secretary." The Office of Inspector General must evaluate the nationwide program and submit a report to Congress.


PPACA § 6703. Grants and Training to the Ombudsman Program on Abuse and Neglect. This provision, part of the Elder Justice Act, provides grants and training to the ombudsman program on abuse and neglect. It also establishes a National Training Institute for Federal and State Surveyors to improve surveyor training in abuse and neglect, provides for grants to improve state survey agencies’ complaint investigation systems, and requires a study on establishing a national nurse aide registry.


PPACA § 10325. Revision to Skilled Nursing Facility Prospective Payment System. Revisions to the Medicare prospective payment system (PPS) for SNFs are delayed from October 1, 2010 to October 1, 2011, except for changes to concurrent therapy and the look-back period, which were published in the final PPS regulations on August 11, 2009 (74 Fed. Reg. 40288). The Minimum Data Set 3.0 will become effective October 1, 2010.