Senators Introduce Bill to Improve Nursing Home Staffing Data
WASHINGTON -- Sens. Chuck Grassley, John Breaux and John Rockefeller have introduced legislation to improve the accuracy and the accessibility of nursing home staffing data for consumers.
“Nursing home quality and staffing go hand-in-hand,” said Grassley, ranking member of the
Finance Committee and former chairman of the Special Committee on Aging. “Consumers need all
the staffing information they can get to be able to choose the best nursing home for their loved ones.”
Breaux, chairman of the Senate Special Committee on Aging, said, “There is a clear link
between staffing levels and the quality of care in nursing homes. But available data on staffing levels
is, too often, inaccurate, outdated, not reported in a uniform manner, or inaccessible to the public.
Our bill addresses these problems by bolstering a CMS quality initiative while requiring nursing
facilities to improve delivery of staffing information.”
Rockfeller said, “Every day thousands of American families must face the task of finding the
right nursing home for their loved one. We have a responsibility to make sure that these families
have accurate information about staffing levels so that they can make an informed choice about
where to get the best care.”
The senators late last Thursday introduced the Nursing Home Staffing Accountability Act of
2002 (S. 2879). The bill builds on the current requirement for nursing homes to post daily nurse
staffing information beginning Jan. 1, 2003, by requiring facilities also to report such daily nurse
staffing information quarterly to the Centers for Medicare and Medicaid Services (CMS) through
electronic data submission. The information from this improved reporting system must be made
The bill also builds on a six-state pilot program that CMS began this year to provide
consumers with new information about quality of care at individual nursing facilities. The pilot
program is scheduled to expand into a national program in the fall of 2002.
The Nursing Home Staffing Accountability Act of 2002 directs CMS to include a staffing
quality measure in its quality initiative for the duration of the pilot and/or national program. The
staffing measure would include the average daily total of nursing hours worked for the quarterly
reporting period, which should be consistent with the quarterly period from the first provision of this
bill. This provision also requires CMS to develop consumer-friendly information comparing staffing
data among nursing facilities in individual states (shown on a percentile scale).
A detailed summary follows.
The Nursing Home Staffing Accountability Act of 2002 (S. 2879)
Section 1 -- Bill title
Section 2 -- Improving the Accuracy of Data on Nursing Facility Staffing
Background: Experts find data on nursing home staffing to be incomplete, inaccurate and often outdated.
Staffing information, including staffing levels, is self-reported by nursing facilities and
transmitted to CMS. CMS compiles staffing data in the Online Survey and Certification Reporting
System (OSCAR), and such data is not audited. In an analysis by CMS that compared OSCAR data
to payroll records, the OSCAR data was found to be inaccurate.
In an effort to improve the availability and accuracy of self-reported data, Congress enacted a new
requirement as part of BIPA 2000 to require nursing home providers to post in their facilities daily
nurse staffing information -- broken down by shift -- beginning January 1, 2003.
Provision in bill: Sec. 2 amends Medicare and Medicaid by requiring submission and posting of
nursing facility staffing data.
This provision builds on the current requirement for facilities to post daily nurse staffing information
beginning January 1, 2003, by requiring facilities to report such daily nurse staffing information
quarterly to CMS through electronic data submission. Such data shall be submitted to the Secretary
as of July 1, 2003. Additionally, information from this improved reporting system must be made
In its implementation of this provision, CMS shall report to Congress the most appropriate manner
for reporting additional nurse staffing variables, such as unit worked, day of week (weekday and
weekend), and type of care provided (direct or administrative), and effective auditing procedures.
This provision also establishes an annual audit of reported nurse staffing information. This audit
would be conducted as part of the regular inspection process and should ensure that hours reported
are consistent with actual hours worked.
Section 3 -- Creating a Staffing Quality Measure for Consumers to Compare Nursing Facilities
Background: A large body of research exists on the relationship between staffing levels and quality
of care, including a two-part study conducted by the Department of Health and Human Services.
Consumers of nursing home care and their families place a high priority on availability and reliability
of staffing data. Currently, OSCAR staffing data is available on the CMS web site on “Nursing
Home Compare.” This resource is helpful and important, but there are limitations in its utilization
due to the flaws of the underlying OSCAR data.
Under the leadership of Secretary Thompson, CMS launched a six-state pilot program this year to
provide consumers with new information about quality of care at individual nursing facilities.
Government-sponsored advertisements directed consumers to access this information on the CMS
web site when choosing a nursing home for a family member. The pilot program is scheduled to
expand into a national program in the fall of 2002.
Nine quality measures for every nursing home in each of the six pilot states are posted on the
“Nursing Home Compare” site. Quality measures include various clinical outcomes that measures
percent of residents with infections, pain, weight loss, etc. There is no information regarding staffing
Provision in bill: This provision directs CMS to include a staffing quality measure in its quality
initiative for the duration of the pilot and/or national program. The staffing measure would include
the average daily total of nursing hours worked for the quarterly reporting period, which should be
consistent with the quarterly period from the first provision of this bill. This provision also requires
CMS to develop consumer-friendly information comparing staffing data among nursing facilities in
individual states (shown on a percentile scale).
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