CARE QUALITY ASSURANCE

The Role of State and Federal Governments in Long Term Care Quality Assurance

The Role of State and Federal Governments in Long Term Care Quality Assurance

Public payers of long-term care services are constantly faced with the challenge of ensuring the quality of services purchased with taxpayer dollars. This focus of this report on the financing of long-term health care services, partly due to the fact that the major political initiatives aimed at improving the quality of publicly-funded long-term care has recently been implemented, in particular, in accordance with the provisions of the Omnibus Budget Reconciliation Act of 1987. Nevertheless, the discussion of federal and state spending on long-term care should always be presented in the context of what is bought these public dollars.

Nursing homes that receive reimbursement from Medicare and or Medicaid must comply with federal and state certification. Relevance Medicaid certified hospitals and Medicare certified skilled nursing facilities with regulatory standards is estimated, on average, every 12 months through surveys conducted by government agencies. The federal government also conducts its own investigation to determine the validity of assessments of the state. Surveys to explore, at a minimum, the following dimensions: (1) the quality of care, (2) residents assessment and care plan, and (3) the rights of patients.

Non-compliance and certification standards may lead to the introduction of various remedies, including those directed plans of correction, denial of payment for new admissions, civil monetary penalties (CMPS), the temporary seizure of control, expansion of state control and / or termination of certification. The federal government can also reduce its contribution to the state administrative costs when the state examination performance unsatisfactory.

The process of determining compliance with Medicare certified Home health agencies (HHAs) with certification standards similar to the nursing home survey process described above. In addition, ...