As the saying goes, growing old ain't for wimps, and caring for aging Americans also ain't for wimps these days, with the passage of health reform. The Patient Protection and Affordable Care Act (PPACA) passed earlier this year includes several nettlesome provisions for providers caring for elderly patients or residents, including:

These are just a few of the new governmental efforts focused on long-term care providers in health reform. While PPACA does include several workforce programs and grants that may actually benefit providers over the long haul, the law also contains many provisions that are punitive and burdensome (in terms of administration, staffing, and finances). The law also contains a plan to develop incentives for individuals to purchase long term care insurance, with somewhat limited per-day payment rates to facilities. Some have noted the irony of the Obama administration providing to the long term care industry another insurance-related product in legislation touted as curing abuses in the health insurance industry.

Ken Burgess of the Poyner Spruill health law team is serving on the Institute of Medicine Health Law Reform Fraud and Abuse task force charged with making recommendations to the N.C. Department of Health and Human Services about changes in state law, regulations and/or policies required to comply with various aspects of the reform legislation's fraud and abuse provisions. Currently, the task force is identifying all relevant fraud and abuse provisions in the reform legislation, determining which of these provisions require corresponding state laws or regulations, and determining whether North Carolina already has compliant statutes, regulations or policies and, if not, what changes need to be made. We'll keep you posted on the work of the IOM task force.

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