Bill Overview
Title: Preventing Abuse and Neglect of Vulnerable Americans Act of 2022
Description: 2022 This bill requires the Centers for Medicare & Medicaid Services (CMS) to publish specified information on its website relating to deficiencies of Medicaid intermediate care facilities for individuals with intellectual disabilities, including information regarding inspections, complaints, and administrative actions. The CMS must also (1) develop and publish a standardized complaint form for such facilities; and (2) convene an advisory council to recommend ways to prevent abuse, neglect, and exploitation in such facilities. The bill also allows Medicaid and Medicare providers (e.g., skilled nursing facilities) to access, through the National Practitioner Data Bank, disciplinary information for affiliated physicians and other health care practitioners, as reported by state licensing authorities.
Sponsors: Rep. Gallego, Ruben [D-AZ-7]
Target Audience
Population: People living in care facilities, including those with intellectual disabilities, worldwide
Estimated Size: 3700000
- The bill targets Medicaid intermediate care facilities for individuals with intellectual disabilities, as well as skilled nursing facilities.
- These facilities provide care to individuals with intellectual disabilities, as well as the elderly and disabled who may be living in skilled nursing homes.
- The main focus is on enhancing transparency regarding deficiencies and improving complaint processes to reduce abuse, neglect, and exploitation.
- Estimates for global population of individuals with intellectual disabilities suggest about 1-3% of the worldwide population, which is roughly 70-210 million people.
- Additional target populations include elderly and disabled individuals who might be living in skilled nursing facilities globally.
- There are approximately 53 million people in the U.S. living with some form of disability, though not all are in such facilities. Estimates for the U.S. population with intellectual disabilities range up to 1.5% of the population.
Reasoning
- The policy targets individuals living in care facilities, particularly those with intellectual disabilities and in nursing homes, representing a significant but specific segment of the population.
- Given the focus on transparency and improving complaint mechanisms, the policy primarily impacts those directly engaged with care facilities, including patients and their families.
- Budget constraints limit the scale of interventions, focusing effects more heavily on regulatory improvements rather than large-scale direct financial benefits to individuals.
- Considering the target population includes both individuals with intellectual disabilities and the elderly in nursing homes, effects will vary based on the specific vulnerabilities and needs of these groups.
- Interviews with a broad range of individuals help understand varying impacts, from individuals with direct facility interactions to those only indirectly affected through relatives or societal changes.
Simulated Interviews
Facility Administrator (New York, NY)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- The policy will make our compliance tasks more transparent and holds us to higher standards, which is a positive step towards quality improvement.
- Improving the complaint process can help swiftly address issues.
- Resource allocation to comply with new reporting can be challenging on limited budgets.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired (Miami, FL)
Age: 78 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 8/20
Statement of Opinion:
- I hope that new transparency measures will prevent neglect and improve care quality.
- Access to disciplinary records is a good step for accountability.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 5 | 2 |
Healthcare Advocate (San Francisco, CA)
Age: 30 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- Improving the complaint system is crucial for families to ensure their loved ones receive proper care.
- Transparency is key to preventing abuse, but consistent enforcement is essential.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Family Caregiver (Columbus, OH)
Age: 65 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 7.0 years
Commonness: 11/20
Statement of Opinion:
- Greater transparency in facility operations will relieve some stress.
- The standardized complaint process will provide a structured way to report issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Nurse (Houston, TX)
Age: 40 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- The policy could lead to increased paperwork but improve care standards.
- Better management of complaints might improve team morale by addressing facilities' reputations proactively.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Director of Social Services (Los Angeles, CA)
Age: 50 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- This policy provides a framework to address issues that we've known but struggled to highlight in existing systems.
- Standardized information opens dialogues for better care practices.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 5 |
Healthcare Policy Researcher (Chicago, IL)
Age: 28 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 17/20
Statement of Opinion:
- Although I'm not directly affected, this policy is a constructive step towards protecting vulnerable populations.
- The focus on data publication could serve as a model for other regulatory actions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
Retired Social Worker (Phoenix, AZ)
Age: 61 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 6.0 years
Commonness: 10/20
Statement of Opinion:
- Policies like this could lead to more safety for residents, which I strongly support.
- If effectively implemented, it could be a game changer, but past experiences make me cautious.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Medicaid Inspector (Atlanta, GA)
Age: 52 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 13/20
Statement of Opinion:
- This policy gives us the teeth to enforce regulations we only wished for before.
- I foresee initial resistance, but the long-term benefits will justify the effort.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Student (Seattle, WA)
Age: 23 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- The policy could lead to improved care models that my future career might build upon.
- Transparency and accountability in healthcare are vital for public trust.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $15000000 (Low: $10000000, High: $20000000)
Year 2: $15000000 (Low: $10000000, High: $20000000)
Year 3: $15000000 (Low: $10000000, High: $20000000)
Year 5: $15000000 (Low: $10000000, High: $20000000)
Year 10: $15000000 (Low: $10000000, High: $20000000)
Year 100: $15000000 (Low: $10000000, High: $20000000)
Key Considerations
- Enhancing transparency in care facilities is expected to improve resident safety and care standards.
- The impact on disciplinary actions and quality of care will depend on how effectively the standardized complaint process and National Practitioner Data Bank access are implemented.
- Budget allocation will need to ensure that CMS and related agencies have adequate resources to implement and sustain the requirements.