Regulatory and Laws

NURSING HOME ADMINISTRATOR LICENSURE EXAM REVIEW COURSE

National Exam ◘ MODULE 3 FORM B

referencsection Regulatory and Laws

▶Speed Reader Examination 1 Examination 2

Stan Mucinic, LNHA

Students enrolled in the “National Nursing Home Administrator Licensing Course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the national licensure exam administered by the National Association of Boards of Examiners (NAB). This is a 5-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely. THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM. An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted. The student is solely responsible for licensing exam registration/testing and retesting fees.

HOW TO USE THE STUDY GUIDES

Step 1 – VERY IMPORTANT - The personalized test organizer that comes with the program is the key to your success and sets this program apart from any other. It is critical you follow the instructions and score each exam, and file the completed exams into your binder. Try to keep to the schedule and email your test results to the instructor to stay focused.

Step 2. - Speed Reader – Read the speed reader for each module once or twice before taking the module exam(s). Read the speed reader over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU LOOK IT THE MORE LIKELY YOU ARE TO REMEMBER IT. Step 3 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over and over again until you score 100%. Make sure you score each exam and record the results in your organizer or you will not be able to gauge your progress. The exam questions are cross referenced to the speed reader to allow you to quickly find and review material you missed on the exam as follows:

Page Number Section number 2/1.8(13)

Thus, the specific material would be found on page 2 of the speed reader, section 1.8, subparagraph 13.

Contact Information

Email Stan Mucinic at [email protected] with any questions and after you score each practice exam

Section Topic Page

1 Medicare 4 2 Medicaid 5 3 OSHA 5 4 Safe Medical Devices Act 7 5 Rehabilitation Act of 1973 7 6 Vocational Rehab Act Of 1973 8 7 HIPAA 8 8 COBRA 8 9 Equal Employment Opportunity Act 8 10 Equal Employment Opportunity Commission 9 11 Americans With Disabilities Act 9 12 Fair Labor Standards Act 10 13 Equal Pay Act 10 14 Civil Rights Act of 1964 10 15 Consumer Credit Protection Act 11 16 Fair Credit Act 11 17 ERISA 1975 11 18 Hill Burton Act Of 1946 11 19 Mental Health Parity Act Of 1996 11 20 Immigration Reform Act 11 21 Ethics In Patient Referrals Act 12 22 Newborn And Mothers Protection Act 12 23 Kerr Mills Act 12 24 Comprehensive Health Planning Act 12 25 National Health Planning And Resources Act 12 26 Age Discrimination in Employment Act 12 27 Family Medical Leave Act 13 28 Pregnancy Discrimination Act 13 29 Women’s Health and Cancer Rights Act 13 30 Patient Self Determination Act 13 31 COBRA 14 32 Federal Income Contributions Act (FICA) 14 33 Federal Income Tax (F.I.T.) 14 34 State Income Tax (S.I.T) 14 35 State Disability Insurance 14 36 Federal Unemployment Tax Act (FUTA) 14 37 State Unemployment Insurance 14 38 Workers Compensation Insurance 15 39 Form I-9 15 40 Form 941 15 41 Form W-2 15 42 Form W-4 15

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 3 of 20 43 Clinical Laboratory Improvement Act (CLIA) 15 44 Robinson-Patman Act 15 45 New York Old Age Act 16 46 Military Selective Service Act 16 47 Uniformed Service Employment Act 16 48 Federal Employers Liability Act 16

Section Topic Page

49 Respondeat Superior 16 50 Older Americans Act (1965) 16 51 Norris LaGuardia Act 16 52 Wagner Act (1935) 16 53 Taft Hartley Act 17 54 Taft Hartley Act (1974) 17 55 Union Bargaining Units 17 56 National Labor Relations Board 18 57 Presidential Injunction power 18 58 Landrum Griffin Act (1959) 18 59 Union Relations 18 60 Main Reasons for Unions 18 61 Vietnam Era readjustment Act (1974 19 62 Union Organizations 19 63 Custodial versus Skilled Care 19 64 Miscellaneous 19 65 Conflict in Laws 19 66 Executive Order 11246 19 67 OBRA 1987 20 68 Miscellaneous Terms 20

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 4 of 20 Regulatory and Laws  SECTION 1 - MEDICARE 1.1 – MEDICARE INSURANCE PROGRAM 1. Medicare is a health insurance program available to any one 65 and over, regardless of income, and beneficiaries pay monthly premiums, co-pays and deductibles 2. Medicare is Title 18 (XVIII) of the Social Security Act of 1935 3. Medicare was enacted in1965 4. Medicare has two parts – Part A is for hospitalization/skilled nursing and everyone gets that coverage, and Part B is for non institutional care (i.e., visits to your family doctor, durable medical equipment) 5. Beneficiaries must elect Part B insurance and usually have to purchase a supplemental policy since Part B only pays 80% of costs.  Average Medicare Stay Is 30 Days  A Federal Program That Provides Economic Security For Individuals 65 And Over Is Social Security  The Center For Medicare And Medicaid Services Oversees The Medicare/Medicaid Programs

1.2 - PART A COVERED SERVICES

1. Hospital in-patient care 2. Home heath care (100% of costs covered)(Does not include house keeper services) 3. In-patient medications 4. Semi-private rooms 5. 100 days of skilled nursing care a) Requires a 3-day qualifying stay in hospital (day of discharge not counted) b) Day 1 –20 --Medicare pays 100% c) Day 21-100 Patient pays 20% co-pay d) Must be admitted to nursing home within 30 days from discharge from hospital e) Kidney transplant preparation costs f) Inpatient rehab g) Inpatient Medications

1.3 - PART A – NON -COVERED SERVICES 1. Liver transplant costs 2. Prescription drugs 3. Custodial care 4. Outpatient diagnostic tests 5. Dental/dentures 6. TV/Phone 1.4 - PART B – COVERED SERVICES 1. Non-routine exams and diagnostic exams 2. Durable medical equipment 3. Home health care (80% of costs are covered)(Does not cover house keeper services) 4. Lab tests – outpatient 5. Podiatrist 6. Hearing exam to determine if you need treatment but not for a hearing aid 7. Outpatient rehab 8. Home health care

1.5- PART B – NON-COVERED SERVICES 1. Routine exams and lab tests 2. Prescription drugs 3. Dental

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 5 of 20 4. Eye exams  SECTION 2 - MEDICAID (TITLE XIX) (TITLE 19) (BASED ON INCOME) 2.1 – MEDICAID PROGRAM 1. Medicaid is a health program for the poor and the elderly 2. Eligibility is based on income 3. Nursing home residents cannot have more than $2000 in assets 4. Medicaid is Title 19 (XIX) of the Social Security Act 5. Medicaid was enacted in 1965 2.2 - COVERED SERVICES 1. Custodial care in skilled nursing home 2. Burial expense 3. Food stamps 4. Health for the poor 5. Long term care benefit 6. Semi-private room 2.3 - NON-COVERED SERVICES 1. Skilled Intensive rehab 2. Prescription drugs 3. Dental care 4. Social services 5. Restorative nursing 6. Skilled nursing 7. Dental exams/services 8. Eye exams/glasses 9. Televisions/phones  SECTION 3 - OSHA (WORKER SAFETY LAW) 3.1 – OSHA 1. Occupational Heath and Safety Administration is under the U.S. Dept of Labor 2. OSHA administers the Occupational Health and Safety Act of 1970 3. OSHA protects full-time and part-time wage earners 4. OSHA is responsible for worker safety and infection control 5. Facility safety committee must meet at least montly 6. OSHA regulatory program is based on providing workers information about dangerous substances in the workplace so they can protect themselves and includes: a) Employers must meet safety standards to minimize worker injuries b) Employers must maintain records of illnesses/injuries c) Employers must cooperate with inspections d) Employers must provide access to the MSDS e) Employers must display the OSHA poster

7. Must provide workers training in new OSHA standards within 90 days of implementation 8. Must provide training free of charge and during working hours 9. The failure to post MSDS is number one violation 10. New employees must be trained in OSHA procedures upon hire 11. Employees must receive OSHA training every 12 months or since last OSHA training session

1. The main purpose is to inform employers/employees of hazardous chemicals in workplace a) Materials Safety Data Sheets (MSDS) b) The MSDS is the centerpiece of informing employees of risks of chemicals c) Must make MSDS available to all employees d) Must post the MSDS in the break room or near the time clock e) Manufacturers must provide hazardous information to employers in the form of the MSDS

3.3 - LOCKOUT/TAGOUT PROGRAM

1. Prevents injury by disabling devices that can produce unexpected hazardous energy by using energy isolating devices 2. Required Training a) Must train new employees in OSHA safety upon hire and then every 12 months thereafter b) Must provide employees training within 90 days of new published OSHA standards c) Must provide workers information free of charge and during working hours 3.4 - BLOOD BORNE PATHOGEN CONTROL PROGRAM (REQUIRES A WRITTEN PLAN)

1. Requires a written plan that identifies workers potentially exposed and a schedule of how and when the program will be implemented 2. Plan must specify action to be taken if worker exposed to pathogens 3. Must train exposed workers in BBP safety if a worker’s duties change

3.5 - REPORTING REQUIREMENTS

1. OSHA Reports

a) OSHA 300 Log (log all injuries and illness) b) Form 301 (Supplemental details to entries made in 300 log) c) Form 300A (year end report)(must post between Feb 1 and April 30) 3.6 - WORKER INJURIES/ILLNESSES 1. Employers with 11 or more employees must record injuries/illnesses in 300 log 2. Any injuries or illness that require medical attention or time off must be recorded in the 300A log within 7 days 3. Accidents that cause in hospitalization or death to 3 or more workers must also be reported to OSHA within 8 hours by phone (orally) 4. Injuries that only require first aid and no lost time are not recorded in the 300 log 5. Must complete Form 301 supplemental form for each entry in the 300 log that details specifics of each incident 6. A Year End Summary is prepared on Form 300A Form 7. A death resulting within 30 days of an injury previously recorded in Form 300 must be reported to OSHA 8. The person responsible for preparing the 300 log must also sign the OSHA Year End Report 9. OSHA medical records and injury reports must be kept during employment and 30 years after that

1. A Year end report is prepared Form 300A that is essentially the 300 log 2. The Year End Report is posted between Feb 1 and April 30 of each year 3. The person who prepared the 300 log must sign the year end report

3.8 - OSHA GENERAL DUTY CLAUSE

1. Employers must provide workers a workplace free of recognizable hazards that have or could cause injury to workers 3.9 - OSHA INSPECTIONS 1. OSHA inspectors have unrestricted access to facility and records 3.10 - OSHA COMPLIANCE CATEGORIES 1. Imminent danger (can close facility) 2. Non-serious violation (no harm, fine) 3. Deminimis violation (no harm, no fine) 4. Most often cited deficiency – failure to post MSDS 3.11 - PENALTIES/FINES 1. Max penalty is $70,000 for willful violation 3.12 - UNIVERSAL PRECAUTIONS 1. Mandated by the Dept of Labor in nursing homes (developed by the CDC) 3.13 - IMPORTANT FACTS ABOUT OSHA 1. 13,000 workers killed each year 2. 2 million workers disabled each year 3. OSHA’s color is green 3.14 – OCCUPATIONAL ILLNESSES 1. Occupational illnesses include any abnormal condition caused by exposure to environmental factors in the workplace such as Influenza (flu) contracted on the job, illnesses from contaminated food served in the facility, and a back injury from lifting patients into a bed

3.15 - LABELLING 1. Must label all hazardous chemicals  SECTION 4 - SAFE MEDICAL DEVICES ACT 4.1 – SAFE MEDICAL DEVISES ACT 1. Must report incidents of medical devices causing injury or death to a resident (wheel chairs, walkers, electric beds, contact lenses, dentures) 2. Must report incidents within a) 24 hours to FDA but not later than 10 days b) Must report incident within 10 days to the manufacturer

 SECTION 5 - REHABILITATION ACT OF 1973 5.1 – REHABILITATION ACT OF 1973 1. Cannot exclude a person with a handicap from participation in employment or benefits if facility Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 8 of 20 receives federal funds 2. Complaints are filed with EEOC

 SECTION 6 - VOCATIONAL REHAB ACT OF 1973 6.1 – VOCATIONAL REHABILITATION ACT OF 1973 1. Federal contractors required to recruit and hire the disabled  SECTION 7 - HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT)

7.1 - HIPAA 1996 (PROTECTS PRE-EXISTING CONDITIONS)

1. Workers can move from job to job 2. Limits exclusion of pre-existing health conditions to in a new job to 12 months 3. No exclusion waiting period if you have a certificate of coverage from a major medical health insurance from previous employer 4. HIPAA is enforced by the Department of Labor 5. Does not require insurance carriers to provide benefits for abortions 7.2 - HIPAA 2000 (INS. NON-DISCRIMINATION)

1. Prohibits group health plans from establishing separate eligibility rules or charging different premiums based on health factors or medical condition

7.3 - HIPAA 2001 (PRIVACY RULES)

1. Guarantees patient rights and protections against misuse or disclosure of health records  SECTION 8 - COBRA (EXTENDS HEALTH COVERAGE UPON DISCHARGE)

8.1 - COBRA

1. Employees are entitled to continue health insurance benefits up to 18 months from date of discharge 2. Employees have 60 days from termination to decide whether to continue health insurance coverage 3. Employees pay full cost of coverage 4. Employees must be provided a certificate of coverage upon termination if they participated in major medical insurance program 5. The employee can present that certificate to their new employer and it prohibits the new employer’s insurance carrier from imposing any exclusion for pre-existing conditions – must be fully covered when new insurance becomes effective 6. Without certificate of coverage, new hires subject to 12 month exclusion for pre-existing conditions  SECTION 9 - EQUAL EMPLOYMENT OPPORTUNITY ACT

9.1 – EEOA

1. The EEOA amended Title VII of the Civil Rights Act to expand coverage to employers with 15 or more employees 2. Enforced by the EEOC 3. Administrative Procedure for a complaint of discrimination a) The employee files a complaint with the EEOC b) The employer responds to complaints with a position statement Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 9 of 20 c) The EEOC investigates the complaint and issues a Right to Sue Letter d) The worker can then file suit in civil court only after receiving a right to sue letter from the EEOC e) The EEOC cannot determine guilt it can only find probable cause

4. Definition of discrimination – Adverse Impact under the EEOA is found to occur if the selection rate for a protected minority group is less than 80% of the selection rate for a majority group 5. Educational requirements and employment tests must be relevant to requirements of doing a job (cannot require a college degree for housekeeper) 6. Must display an EEOC poster in the facility and must have documentation of all discipline and job performance issues to justify termination or other discipline. That is why we need an verbal and 3 write ups prior to terminating an employee.  SECTION 10 - EQUAL EMPLOYMENT OPPORTUNITY COMMISSION 10.1 - EEOC

1. The commission enforces the following laws: a) Civil Rights Act of 1964 b) Age in Discrimination Act c) Rehabilitation Act of 1973 d) Americans With Disabilities Act e) Equal Pay Act

2. EEOC Administrative Procedures

a) Employers must report employment statistics to the EEOC b) IF EEOC receives a complaint it believes has merit, the EEOC may investigate further c) The investigation unit interviews all concerned parties d) If a complaint is substantiated, the EEOC will seek out of court settlement e) If parties do not settle, the EEOC will file a law suit and prosecute the case at its expense f) If the EEOC does not take the case, it will issue a Right to Sue Letter that clears the way for the claimant to file suit on their own g) A claimant cannot file a suit before filing a complaint with the EEOC. h) This is designed to cut down the number of cases litigated in court  SECTION 11 - AMERICANS WITH DISABILITIES ACT (ADA)

11.1 - ADA 1. The ADA applies to all employers 2. The ADA protects people with handicaps from discrimination in hiring and employment and requires equal access for all handicap persons to public places and the worksite by special construction standards that allow access to office buildings and public places (see ADA standards in Resident Care Section) 3. Full time and part time workers are covered 4. The ADA requires doorway threshold not rise over ½” 5. The ADA is enforced by the Architectural And Transport Barriers Compliance Board 6. The ADA requires employers to accommodate a handicap to allow a person to work unless such accommodation is unduly burdensome to employer 7. Protects only qualified disabilities so use common sense in answering a question and identify conditions that are medical conditions and true disabilities from those that are not. (i.e., a broken leg, pregnancy, heart condition, mental retardation, back injuries are covered)

A. Cannot ask applicants about:

a) Medical history b) Requirements for special accommodations c) Workers compensation history d) The nature of any disabilities e) If an applicant is pregnant or plans to be f) How often they get sick g) Require medical examination h) You can ask if they are able to perform the tasks of the job

9. Post-Hire

a) Can require medical exam once hired as a condition of employment b) Can ask if an individual requires any special accommodations c) If a post-hire medical exam reveals a handicap that is covered by the ADA, the person can work if accommodations are made, you must accommodate if it will not bankrupt you d) If a person has a medical condition that would keep them from being able to perform a job, but it is not covered under ADA, you do not have to hire

10. The ADA is Enforced by the EEOC

 SECTION 12 - FAIR LABOR STANDARDS ACT (WAGE AND HOUR ACT)

12.1 – FLSA

1. The Fair Labor Standards Act (1938) is administered by the Department of Labor 2. Overtime and Compensatory Laws a) Exempt not entitled to OT– supervisor, professionals, executives b) Non-exempt – hourly worker, aides, housekeepers c) OT rate is 1 ½ times regular pay rate d) OT paid over 8 hours in a day or 80 hours in single pay period e) Cannot accrue more than 240 compensatory hours (in lieu of paid overtime) annually

3. Child Labor -under 16 must get permit from Dept of Labor to work with restricted hours 4. Minimum Hourly Rate – Federal Minimum Wage 5. An allowance paid workers for uniforms may be considered wages 6. Hours and payroll data must be kept 2 years  SECTION 13 - EQUAL PAY ACT 13.1 – EQUAL PAY ACT

1. Prohibits paying male and female workers doing the same work a different wage rate 2. The EEOC enforces the Equal Pay Act

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 11 of 20  SECTION 14 - CIVIL RIGHTS ACT OF 1964 14.1 – CIVIL RIGHTS ACT 1. Applies to employers with 15 or more workers 2. Complaints are filed with the EEOC 3. The courts enforce the laws 4. The EEOC can investigate and negotiate settlement 5. The CRA prohibits a) Disparate treatment b) Disparate impact 6. Prohibits discrimination based on a) Race b) Religion c) National origin d) Gender e) Color 7. Cannot advertise a position based on preceding paragraph  SECTION 15 - CONSUMER CREDIT PROTECTION ACT

15.1 – CONSUMER CREDIT PROTECTION ACT

1. Limits the amount a creditor can garnish (deduct) from a worker’s paycheck each week pursuant to a court order requiring repayment of a debt in this manner 2. Limits deduction to the lesser of 25% of disposable income or 30 times the federal minimum wage 3. Enforced by the Dept of Labor  SECTION 16 - FAIR CREDIT ACT OF 1974 16.1 – FAIR CREDIT ACT 1. Must advise job applicant if credit report is basis for denial of employment  SECTION 17 - ERISA 1975 (EMPLOYEE RETIREMENT INCOME SECURITY ACT) 17.1 ERISA

1. Protects pension plans 2. Requires employers to protect funds and insure future payments through the Pension Guaranty Fund 3. Employers are not required to offer pension funds, but if they do they must follow federal laws in protecting contributions 4. Most pension funds not properly funded before ERISA was enacted  SECTION 18 - HILL BURTON ACT OF 1946 18.1 –HILL BURTON ACT 1. Funded construction of hospitals and nursing homes  SECTION 19 - MENTAL HEALTH PARITY ACT OF 1996 19.1 – Mental Health Parity Act

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 12 of 20 1. Requires health plans to provide same dollar limits and lifetime limits for mental health benefits as other health benefits  SECTION 20 - IMMIGRATION REFORM ACT

20,1 – IMMIGRATION REFORM ACT

1. Requires employers to verify worker citizenship status prior to hire (ID check)

 SECTION 21 - ETHICS IN PATIENT REFERRALS ACT

21.1 – ETHICS IN PATIENT REFERRALS ACT

1. Governs the referral of patients by providers for goods and services 2. Also known as the Stark Law  SECTION 22 - NEWBORN AND MOTHERS PROTECTION ACT

22.1 – NEWBORN AND MOTHERS PROTECTION ACT

1. Requires minimum stay of 48 hours after delivery 2. 96 hours for caesarian delivery

 SECTION 23 - KERR MILLS ACT

23.1 – KERR MILLS ACT

1. Precursor to Medicaid and required federal and state government fund medical care for elderly  SECTION 24 - COMPREHENSIVE HEALTH PLANNING ACT

24.1 – COMPREHENSIVE HEALTH PLANNING ACT

1. Mandated local planning councils to determine the need for hospital and nursing home beds

 SECTION 25 - NATIONAL HEALTH PLANNING AND RESOURCES ACT

25.1 – NATIONAL HEALTH PLANNING AND RESOURCES

1. Estimates the health care needs and LTC needs in a community to determine needs for more beds 2. Issues certificate of Need 3. Abolished in 1986

 SECTION 26 - AGE DISCRIMINATION IN EMPLOYMENT ACT

26.1 – AGE IN DISCRIMINATION IN EMPLOYMENT ACT

1. Applies to employers with 20+ employees 2. Protects workers 40+ years old 3. Cannot change a job description that negatively affects an employee because of age 4. Cannot force an employee to retire based on age

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 13 of 20 5. Designed to prevent employers from replacing older workers with younger ones 6. Complaints filed with the EEOC and enforced by the courts

 SECTION 27 - FAMILY MEDICAL LEAVE ACT

27.1 – FAMILY MEDICAL LEAVE ACT

1. Applies to employers with 50+ workers 2. Provides workers 12 weeks of unpaid leave each year 3. Covered reasons for leave

a. Pregnancy b. Childbirth c. Adoption d. Serious illness of worker or family (spouse, children, parents) e. Recovering from illness

4. Must work 12 months or 1250 hours prior to leave (do not have to be consecutive) 5. Employer must continue to pay health insurance while on leave (if worker does not return to job, must pay back premiums to employer) 6. Employer can require worker to use up all paid leave (vacation/sick time) 7. Can take leave in form of modified schedule (work blocks of leave time) 8. Entitled to return to former or equivalent job   SECTION 28 - PREGNANCY DISCRIMINATION ACT

28.1 – PREGNANCY DISCRIMINATION ACT

1. Protects pregnant women in hiring and employment benefits 2. Employer health insurance plans must offer pregnancy coverage 3. Health insurance plans cannot charge pregnant workers additional premiums for pregnancy related services 4. Employer insurance plan not required to offer or pay for abortions 5. Cannot refuse to employ a pregnant applicant solely on basis of their pregnant condition   SECTION 29 - WOMEN’S HEALTH AND CANCER RIGHTS ACT

29.1 – WOMEN’S HEALTH AND CANCER RIGHTS ACT

1. Provides health insurance coverage for breast reconstructive surgery due to breast cancer

 SECTION 30 - PATIENT SELF DETERMINATION ACT

30.1 – PATIENT SELF DETERMINATION ACT

1. Medicare and Medicaid certified facilities are required to advise residents of and provide written information to residents of the right to form advance directives 2. Cannot force residents to use a facility form 3. Residents have the right to refuse medical treatment 4. Cannot condition admission of a resident on that resident signing an advanced directive 5. Must have a patient acknowledge they received written info in writing 6. Must place advanced directives in medical chart

31.1 –COBRA

1. Employees have 60 days upon termination from job to decide whether to continue health benefits and pay full costs for coverage 2. Employer must provide insurance coverage for 18 months 3. Employer must provide workers a certificate of coverage that evidences unbroken major medical insurance coverage that the worker can then provide a new employer and exempts the worker from any waiting period for exclusions for pre-existing medical conditions

 SECTION 32 – FICA (FEDERAL INCOME CONTRIBUTIONS ACT)

32.1 – FICA

1. A payroll tax deducted from worker paychecks to fund the social security retirement fund and benefits paid to current retirees/beneficiaries  SECTION 33 - FEDERAL INCOME TAX (F.I.T.)

33.1 – FEDERAL INCOME TAX (F.I.T)

1. An income tax paid to the federal government on net income earned from wages

 SECTION 34 - STATE INCOME TAX (S.I.T.)

34.1 – State Income Tax

1. An income tax paid to the state for net income earned from wages

 SECTION 35 - STATE DISABILITY INSURANCE

35.1 –STATE DISABIILITY INSURANCE

1. A premium deducted from worker paychecks to pay weekly benefits if disabled and unable to work

 SECTION 36 - FEDERAL UNEMPLOYMENT TAX ACT (FUTA)

36.1 – FEDERAL UNEMPLOYMENT TAX ACT

1. The employer pays this tax if they have employees and funds unemployment benefits to terminated employees. 2. The premium is based on the number of former employees drawing benefits 3. The Social Security Act of 1935 requires the states to have an unemployment compensation program

 SECTION 37 – STATE UNEMPLOYMENT INSURANCE BENEFITS 37.1 – UNEMPLOYMENT BENEFITS 1. The states are required to maintain an unemployment compensation program to provide workers

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 15 of 20 terminated from a job 26 weeks of benefits (a percentage of their former salary) 2. Workers are not entitled to benefits if they are terminated for cause (stole money, etc.) or quit their job  SECTION 38 - WORKERS COMPENSATION

38.1 – WORKERS COMPENSATION

1. Imposes a legal liability on employers for medical costs and lost time due to injuries sustained by workers on the job 2. Benefits include hospitalization, medical treatment, lost wages while recovering from an injury 3. Employer premiums are experienced based on the number of workers receiving benefits 4. Can reduce benefit amount if you can document worker willfully disobeyed safety rules

 SECTION 39 - FORM I-9

39.1 –FORM I-9

1. An immigration form each job applicant must complete to verify legal U.S. citizenship status 2. Must retain 3 years or 1 year from termination 3. I-9 must be completed within 3 days of hire  SECTION 40 - FORM 941

40.1 – FORM 941

1. A form filed by the employer quarterly to file FICA, Medicare and Unemployment Compensation Taxes with the Federal government 2. Must be deposited in a bank authorized to collect tax money by the Federal Government 3. Employers fill out the Form 941 and deposit the payment into the account if taxes total more than $100 per quarter

 SECTION 41 – FORM W-2

41.1 – W-2

1. Annual statement of all wages earned and taxes paid by worker  SECTION 42 - FORM W-4

42.1 – FORM W-4

1. A form used to calculate number of dependents for tax deduction and marital status  SECTION 43 - CLINICAL LABORATORY IMPROVEMENT ACT (CLIA) 43.1 – CLIA 1. Nursing homes are required to obtain a waiver from the Food and Drug Administration to do glucose meter testing for diabetic blood sugar levels. 2. Must renew annually  SECTION 44 - ROBINSON-PATMAN ACT

44.1 – ROBINSON PATMAN ACT

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 16 of 20 1. Prohibits health care facilities from forming alliances to purchase and sell goods and services (price fixing concerns)  SECTION 45 - NEW YORK OLD AGE ACT

45.1 – NEW YORK OLD AGE ACT

1. The first legislation passed in New York City to offer home health care benefits – federal benefits plan modeled after this plan  SECTION 46 - MILITARY SELECTIVE SERVICE ACT 46.1 – MILITARY SELECTIVE SERVICE ACT

1, Requires employers to freeze the benefits and job position of employees in military service up to 90 days from discharge

 SECTION 47 - UNIFORMED SERVICE EMPLOYMENT ACT

SECTION 47 – UNIFORMED SERICE EMPLOYMENT AND RE-EMPLOYMENT ACT

1. Employers with worker’s in the guard or reserve called to active duty must allow them to return to their jobs upon completion of their service obligations  SECTION 48 - FEDERAL EMPLOYER LIABILITY ACT 48.1 – EMPLOYERS LIABILITY ACT 1. Employers are legally responsible to the worker for injuries suffered by the worker in the course of their employment  SECTION 49 - RESPONDEAT SUPERIOR 49.1 – RESPONDEAT SUPERIOR 1. An employer is legally liable for damage and injuries caused by a worker to a third party in the course of the worker’s employment  SECTION 50 - OLDER AMERICANS ACT (1965) 50.1 – OLDER AMERICANS ACT 1. The OAA essentially provides funding for services needed by the elderly that are not provided by Medicare and Social Security 2. OA funding pays for seniors centers, housekeeping, meals, activities, meals on wheels 3. Created the long term care ombudsman 4. For individuals 60 years and older 5. Program administered through Area on Aging agencies  SECTION 51 - NORRIS LAGUARDIA ACT (1932)

1. The Norris LaGuardia Act Limited the power of the federal courts to enjoin (stop) union strikes 2. First major federal legislation that recognized union workers right to strike 3. Outlawed Yellow Dog Contracts which prohibited workers from joining a union

1. Second major federal law established a worker’s right to organize unions and to bargain collectively 2. Prior to passage, employers refused to sign a collective bargaining contract that set wages and ebenfits for all workers 3. The National Labor Relations Board (NLRB) was created at this time as well.  SECTION 53 - TAFT HARTLEY ACT (1947)

1. Enacted to regulate the growing power of the unions 2. Prohibits employers from: a) Interfering with workers’ right to unionize b) Firing workers who vote for a union c) Hiring or firing based on union activity d) Refusing to bargain with union representatives 3. Prohibited unions from: a) Forcing non union workers to support the union b) Force employers to hire workers chosen by the union c) Bargain with employers in bad faith d) Charging excessive fees e) Forcing employers to hire unneeded workers (feather bedding) 4. Employers are only allowed to: a) Express personal views about the value of unions b) Take action against supervisory staff organizing a union  SECTION 54 - TAFT HARTLEY (1974 AMENDMENT) 54.1 – TAFT HARTLEY (1974)

1. Congress amended union laws to include nursing homes under scope of law previously exempted because they were predominantly nonprofits (Most nursing homes non-profit in 1974) 2. Congress gave the nursing home industry unique concessions such as:

a) A union cannot strike a nursing home without 10 days prior notice b) Nursing homes and unions must give the other 90 days notice of intent to change an existing contract c) Limited bargaining units to 2 units:

1. Professional 2. Non-professional d) Requires mandatory mediation  SECTION 55 - UNION BARGAINING UNITS

55.1 – UNION BARGAINING UNITS

1. The NLRB must approve each bargaining unit which is a group of workers who want to form a union 2. Must have a vote of 50% plus one vote of all workers to authorize a union in a facility 3. The NLRB made it harder to organize a union in nursing home by only allowing two bargaining units

Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 18 of 20 (professional and non-professional) 4. Previously there were as many as 12-14 units representing kitchen staff, nurses, accountants, housekeepers, maintenance employees, office workers, therapists 5. In 1994, the US Supreme Court ruled that nurses were supervisory staff and not protected by union laws and could not unionize (bargain collectively)  SECTION 56 - NATIONAL LABOR RELATIONS BOARD 56.1 – NATIONAL LABOR RELATIONS BOARD 1. The NLRB was created pursuant to a presidential executive order in 1933 2. The board has the following responsibilities a) Determine union bargaining units b) Conduct elections by secret ballot c) Investigate unfair labor practices d) Stop illegal strikes 3. The NLRB enforces the Wagner Act, Taft Hartley and Landrum Griffin Acts  SECTION 57 - PRESIDENTIAL INJUNCTION POWER 57.1 – PRESIDENTIAL INJUNCTION POWER 1. The president of the United States has power to enjoin or stop a strike or walkout for 80 days that may affect the nation’s safety or security  SECTION 58 - LANDRUM GRIFFIN ACT (1959) 1. Also known as the “Labor-Management Reporting and Disclosure Act” 2. Protects union members from their unions 3. Requires union members a bill of rights a) To nominate candidates for union office b) Vote in union elections c) Attend union meeting d) Examine union financial reports 4. Outlaws sweetheart deals between management and unions at members expense  59.1 – LABOR RELATIONS 1. The administrator and other managers cannot do the following

a) Cannot ask worker if he signed a union card or union meetings b) Cannot ask worker about union activities c) Cannot contribute or loan money to union d) Cannot attend union meetings e) Cannot punish workers from joining a union or give wage increases at time of union vote  SECTION 60 - MAIN REASONS FOR UNIONS 60.1 – MAIN REASONS FOR UNIONS  The Main Reason Workers Organize Union Is That Communication Between Management And Workers Breaks Down 1. Conditions favoring unionization a) Poor supervision b) Low job satisfaction and low wages c) Lack of grievance process or procedures d) Unsatisfactory management practices Regulatory/Laws Copyright © 2005-2012 by Stan Mucinic. All rights reserved. 19 of 20  SECTION 61 – VIETNAM ERA READJUSTMENT ACT (1974) 61.1 – VIETNAM ERA READJUSTMENT ACT (1974) 1. Requires all contractors receiving $25,000 or more in federal contracts to have a written affirmative action program to employ and advance Vietnam veterans.

2. SECTION 62 – UNION ORGANIZAIONS 62.1 – UNION ORGANIZATIONS 1. CIO – Congress of Industrial Organizations (First labor union organized in 1935) 2 AFL – American Federation of Labor 3 SEIU – Service Employees International Union (a member of the AFL-CIO and largest union representing nursing home employees) 4 AFL-CIO – American Federation of Labor-Congress of Industrial Organizations 5. Other nursing home unions include the teamsters, United Food and Commercial Workers’ Union and the American Federation of State, County and Municipal Employees

3. SECTION 63 – CUSTODIAL VS SKILLED CARE 63.1 – CUSTODIAL VS SKILLED CARE

1. Custodial care involves observing an individual and monitoring nutritional intake and hydration, assist with activities of daily living and administer medications while skilled nursing care involves skilled nursing such as tube feeding, wound care, IV’s and other services required of a licensed nurse.

4. SECTION 64 – MISCELLANEOUS 64.1 – MSCELLANEOUS

1. NFPA (National Fire Protection Association is responsible for developing the Life Safety Code) 2. Contract - An agreement between 2 or more persons with legally enforceable rights and remedies is called a contract 3. Intestate – Where an individual who dies without a will is said to die intestate 4. Negligence - Misconduct, improper care or treatment or failure to meet standards that harm a patient is called negligence 5. Malpractice - Failure to provide care in accordance with professional standards is called malpractice 6. Ordinances - Laws passed by local government 7. Regulations - Rules adopted by government agencies that interpret laws passed by a legislature 8. Statutes – Laws passed by a state legislature or the U.S. Congress 9. Tort - A wrong against an individual that results in injury to person or property and where there was a duty to prevent such injury

5. SECTION 65 – CONFLICT IN LAWS 65.1 – CONFLICT IN LAWS 1. In the event of a conflict between federal and state laws, the more stringent standard should be followed.

6. SECTION 66 – EXEUTIVE ORDER 11246 66.1 – EXECUTIVE ORDER 11246 1. Requires all contractors receiving $50,000 or more in federal contracts to have a written affirmative action program to ensure that they do not discriminate based on race, religion, color, national origin.

1. 1987, Congress passed the Ombudsman Budget Reconciliation Act that took effect in 1987 2. The law effectively changed the reimbursement system from retrospective (payment for full cost of services) to a prospective system which pays a pre-determined flat rate for all services based on a patient’s diagnosis. 3. The new system dramatically reduced profits and forced nursing homes to reduce overhead and administrative costs, and to operate more efficiently. 4. At the same time, OBRA ’87 imposed wide ranging regulatory requirements to improve resident care and safety, including minimum staffing requirements and uniform education and licensing requirements for administrators around the country.

8. SECTION 68 – MISCELLANEOUS TERMS Term Definition

Medicare training Medicare requires specific employee training

Employee Physicals OSHA requires employers to screen workers for Tuberculosis and Hepatitis B prior to starting work and then annually

ADA Title 1 Title 1 of the Americans with Disabilities Act is the title that most affects administrators

Provisional License A facility not in substantial compliance with federal and state nursing home requirements will be issued a provisional license

Standard license A facility in substantial compliance with federal and state nursing home requirements will be issued a standard licens

Tax Records Tax records must be kept for 4 years