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
Legal Notices

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:

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 with any questions and after you score each practice exam

Regulatory/Laws
Index
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
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 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
  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
  1. Must provide workers training in new OSHA standards within 90 days of implementation
  2. Must provide training free of charge and during working hours
  3. The failure to post MSDS is number one violation
  4. New employees must be trained in OSHA procedures upon hire
  5. Employees must receive OSHA training every 12 months or since last OSHA training session
3.2 – OSHA HAZARD COMMUNICATION STANDARD
  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
  1. 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 moreworkers 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
3.7 - YEAR END REPORT
  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 April30 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
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
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
  1. 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
  1. Educational requirements and employment tests must be relevant to requirements of doing a job
(cannot require a college degree for housekeeper)
  1. 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
  1. 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)
  1. Pre-Hire Restrictions
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
  1. 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