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Bill Would Strengthen Nursing Home Care

By Emily P. Walker, CQ Staff

November 16, 2007 -- North Dakota Democrat Earl Pomeroy recently introduced legislation that aims to revitalize nursing homes by restructuring payment policies and strengthening the long-term care workforce.

According to the Department of Health and Human Services, about 40 percent of all people 65 and older will require long-term care at some point.

"Our nation's long-term care facilities are facing a looming crisis with workforce shortages, aging infrastructure, and outdated technology," Pomeroy said in a statement.

The bill (HR 4082) would create a commission that would develop and enact a national plan to improve nursing home care. The commission would launch a two-year pilot plan at five sites in five different states. During that time, care providers and state surveyors would be trained on ways to increase transparency and to better comply with Medicare care quality regulations.

The bill also would allow for the time a patient spends in observation status in a long-term care facility to count for the three-day stay required for Medicare services. Currently, patients must spend three days in a hospital to qualify for skilled nursing facility services.

The bill contains several provisions to combat shortages in the long-term care workforce among nurses and physical therapists. The bill would allow loan repayment for nurses working in for-profit nursing homes under the Nurses Reinvestment Act. The bill also would create a national database to forecast future supply of nurses, and create a grant program to help recruit and retain physical therapy faculty and students.

The bill would amend several payment rules to allow Medicare to reimburse a physician for specific diabetes tests administered in nursing home. The bill also would update CMS' payment policies so Medicare could directly reimburse providers for magnetic resonance imaging, radiation therapy, ambulance services, and certain chemotherapy medications for nursing home patients.

The bill aims to modernize long-term care facilities by expanding telemedicine services to nursing home patients who may be too ill to leave their facility for doctor appointments and emergency room visits. In addition, the bill would amend an IRS code to establish a 15-year improvement period for long-term care facilities that have been operated for at least three years at the time of the bill's enactment.

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