Bill Overview
Title: Ensuring Seniors’ Access to Quality Care Act
Description: This bill repeals certain restrictions under Medicare and Medicaid that prohibit the approval of nurse-aide training and competency evaluation programs in skilled nursing facilities that have been subject to specified regulatory actions (e.g., civil penalties) for substandard quality of care. The Centers for Medicare & Medicaid Services (CMS) must still disapprove such programs for up to two years; however, the CMS must rescind the disapproval upon completion of corrective action and may require additional oversight of the program for purposes of rescission. 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. Connolly, Gerald E. [D-VA-11]
Target Audience
Population: Seniors relying on skilled nursing care under Medicare and Medicaid
Estimated Size: 5000000
- The bill impacts seniors who are beneficiaries of Medicare and Medicaid programs as it directly relates to the care received in skilled nursing facilities.
- The bill has a direct influence on the training and competency evaluation of nurse-aides, which is crucial for the quality of care in these facilities.
- Given that the bill repeals restrictions that could limit the number of trained nurse aides, it may increase the availability of competent nurse aides, thereby potentially impacting the quality of service provided to seniors.
- The bill affects skilled nursing facility operations by changing compliance requirements related to nurse-aide programs, potentially impacting staffing and care quality.
- The access to the National Practitioner Data Bank allows for better oversight of healthcare practitioners, which could indirectly benefit seniors by improving the quality of healthcare provisions.
Reasoning
- The policy primarily affects seniors who utilize Medicare and Medicaid services due to their need for skilled nursing care. By allowing nurse-aide training programs in facilities previously penalized, the bill seeks to increase the availability of trained aides, potentially improving care quality.
- The budget constraints imply a finite extent of program expansion. Therefore, while the immediate impact may be limited to certain areas or facilities, over time, more facilities might benefit as corrective actions are completed, enabling earlier disapprovals to be rescinded.
- The access to the National Practitioner Data Bank can enhance the screening of healthcare providers, indirectly benefiting the quality of care seniors receive at skilled nursing facilities. However, the overall impact depends on how proficiently facilities use this information and adhere to improved screening processes.
- People who are not directly residing in a skilled nursing facility or do not have immediate family members in such facilities might experience little to no change, whereas those directly connected will likely notice greater differences. Therefore, the impact ranges from none to high depending on proximity and dependence on skilled nursing care.
Simulated Interviews
Retired (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- I hope this policy brings more trained caregivers to my facility.
- It's important that any wrongdoing by a facility doesn't completely cut off their ability to improve.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Retired engineer (California)
Age: 65 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- This policy sounds good, but it won't affect me personally since I don't need a nursing facility.
- I'm supportive of more oversight in healthcare.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Former teacher (New York)
Age: 68 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I feel more secure knowing there will be better trained aides in the future.
- The ability to monitor facility staff via the data bank is reassuring.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 5 |
Retired military (Texas)
Age: 82 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- The changes could offer more support to my fellow veterans in these facilities.
- Access to staff information is crucial for maintaining quality care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Retired nurse (Ohio)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 12/20
Statement of Opinion:
- As someone who is a caregiver, I appreciate efforts to improve aide training.
- This doesn't directly affect us now, but it sets a good future precedent.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Retired lawyer (Illinois)
Age: 74 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- Changes will not affect our current situation massively.
- I'm skeptical of how much change will come from this.
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 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Retired housewife (Arizona)
Age: 78 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 9/20
Statement of Opinion:
- Not too many skilled nursing facilities nearby, but better nurse training is always good.
- This sounds beneficial long-term, maybe not immediately.
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 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired factory worker (New Jersey)
Age: 69 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 7.0 years
Commonness: 4/20
Statement of Opinion:
- The denser training and evaluations might mean better care for me after a year or so.
- I hope they take swift actions on facilities with bad records.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired bank clerk (Georgia)
Age: 77 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 11/20
Statement of Opinion:
- Sound policy, but does not currently change much for me personally.
- Over time, might contribute to wider care improvements.
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 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Retired machinist (Pennsylvania)
Age: 85 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- I value that this might offer better care should I need nursing support in the future.
- Hopefully, facilities improve as they claim to.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $37500000 (Low: $30000000, High: $45000000)
Year 2: $37500000 (Low: $30000000, High: $45000000)
Year 3: $38000000 (Low: $30500000, High: $45500000)
Year 5: $39000000 (Low: $31000000, High: $47000000)
Year 10: $40000000 (Low: $32000000, High: $48000000)
Year 100: $50000000 (Low: $40000000, High: $60000000)
Key Considerations
- The need to ensure that increased access to nurse-aide training does not compromise training quality.
- Changes in regulatory compliance may require adjustment periods for skilled nursing facilities.
- CMS oversight mechanisms will be crucial to ensure quality is maintained even as training restrictions are lifted.
- Data security and privacy considerations associated with increased access to the National Practitioner Data Bank.