The White House

Office of the Press Secretary

Statement by the Press Secretary on H.R. 4994

On Monday, October 6, 2014, the President signed into law:

H.R. 4994, the "Improving Medicare Post-Acute Care Transformation Act" or the "IMPACT Act of 2014," which creates a standardized Medicare assessment tool for comparing patient data across the various types of post-acute care settings for purposes of quality, payment, and discharge planning, and makes other changes to Medicare current law relating to post-acute care.

The White House

Office of the Press Secretary

FACT SHEET: Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries

Today, the Administration announced new executive actions and the President signed into law legislation that will improve the quality of care for nursing home and home health patients. The President signed the Improving Medicare Post Acute Care Transformation Act of 2014 (IMPACT Act), bipartisan legislation that puts in place new and streamlined quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare. The Administration also took additional steps to improve care for nursing home and home health patients through new executive actions that will:

  • Expand and strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare.
  • Improve quality home health care received by Medicare beneficiaries through a proposed rule that strengthens patient rights, improves communication, and focuses on patient well-being.

Actions to Improve Medicare’s Five Star Quality Rating System for Nursing Homes

Today, the Administration announced plans to expand and strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare.  The rating system is a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in Medicare or Medicaid.  Users may sort through nursing homes in their area through an online tool at CMS’ Nursing Home Compare website. 

The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health departments and CMS; Quality Measures submitted by the nursing homes is used to calculate certain quality measures, such as the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls; and information about the staffing levels in nursing homes.

While the onsite inspections form the core of the rating system, CMS has been concerned that the quality measures and information about staffing levels rely on self-reported data from nursing homes that have been difficult to verify.

Beginning in January 2015 CMS will initiate the following steps to improve the reliability and utility of data displayed on Nursing Home Compare as well as to help nursing homes improve: 

  • Nationwide Focused Survey Inspections:  In FY 2014 CMS piloted special surveys of nursing homes that focused on verifying performance on resident assessments and the data set that is used in the quality measures.  Effective January 2015, CMS and states will implement these focused survey inspections nationwide for a sample of nursing homes nationwide.  Expansion of these inspections will enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
  • Payroll-Based Staffing Reporting: Using new funding provided by the IMPACT Act of 2014, signed by the President today, CMS will implement a system of quarterly electronic reporting that is auditable back to payrolls to verify staffing information.  This new system will increase accuracy, improve the timeliness of the data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.  This data will not only allow for better information available to the public, but may equip nursing homes with better data by which to improve staffing and quality of care.  CMS expects that pilot testing will occur in fiscal year (FY) 2015, with nationwide reporting by all nursing homes by the end of FY2016.
  • Improved Scoring Methodology: CMS will revise the scoring methodology by which we calculate each facility’s Five Star rating. The revised scoring methods will place more emphasis on data that is verified by independent sources rather than data that is self-reported by nursing homes.
  • Timely and Complete Inspection Data: CMS will also strengthen requirements to ensure that states complete inspections of nursing homes in a timely and accurate manner, and maintain a user-friendly website for public viewing.
  • Additional Quality Measures: CMS will increase both the number and type of quality measures used in Nursing Home Compare.  The first additional measure starting January 2015 in the ratings system will be the extent to which anti-psychotic medications are in use. More measures will be added later, including data on re-hospitalization and rates of returning beneficiaries to home that use Medicare claims as the source of information. 

Actions to Improve Quality Home Health Care Received by Medicare Beneficiaries

In conjunction with today’s efforts to improve the quality of care received by Medicare beneficiaries in nursing homes, the Centers for Medicare & Medicaid Services today issued a proposed rule that strengthens patient rights, improves communication, and focuses on patient well-being. These rules are designed to improve the quality of home health services for Medicare beneficiaries.

These updates to home health agency conditions of participation (CoPs) make substantial revisions to the existing CoPs.  They focus on the care needs of patients and will clarify the operational and quality expectations for the approximately 12,500 home health agencies participating in Medicare. There are more than five million people with Medicare and Medicaid benefits who receive home health care services each year.

The proposed regulation, will include these proposed updates:

  • A clear explanation of patient rights, including a requirement to communicate with patients in a language and manner that they understand, and a requirement that home health agencies must take measures to assure and protect those rights.
  • An expanded comprehensive patient assessment requirement that focuses on all aspects of patient well-being.
  • An integrated communication system, increasingly enabled by health information technology, that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active, timely, needs-based communication between the home health agency and the physician.
  • A data-driven, agency-wide quality assessment and performance improvement program that continually evaluates and improves agency care for patients.
  • An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.

Comments and feedback are requested to inform final rulemaking in 2015.

IMPACT Act

The President signed the Improving Medicare Post-Acute Care Transformation Act of 2014, bipartisan legislation that puts in place new and streamlined quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare.

The Act will facilitate patients comparing outcomes across different care settings, supporting better choices and better outcomes for patients. In addition, the IMPACT Act funds a key improvement to nursing home oversight, the collection of staffing data. Nursing and other staffing levels are closely correlated with quality in nursing homes and current data collection efforts have produced data of uneven reliability. The IMPACT Act also institutes more routine surveys of hospice providers, ensuring program standards are met for the benefit and safety of patients.

The White House

Office of the Press Secretary

Readout of the President’s Meeting on the United States’ Ebola Response

The President met this afternoon with his senior health, homeland security, and national security advisors to receive an update on the Ebola case in Texas, broader domestic preparedness plans, and U.S. and international efforts to contain and end the epidemic in West Africa. The President and his team discussed the progress health officials in Texas have made in identifying and monitoring the contacts of the patient in Dallas. The team reviewed the measures that have been in place for weeks in preparation for this contingency, and underscored their confidence that the nation’s health infrastructure is prepared and able to prevent an outbreak here at home.  Participants also discussed options to enhance airport screening in the United States and the need to tackle Ebola at its source in West Africa, where the United States has launched a civilian-led whole-of-government effort that leverages the unique capabilities of the U.S. military to help bring the epidemic under control.  Finally, the President reiterated that the epidemic is a top national security priority, and that we will continue to do everything necessary to address it.

Participants:

  • The Vice President (via secure videoconference)
  • John Kerry, Secretary of State
  • Chuck Hagel, Secretary of Defense
  • General Martin Dempsey, Chairman of the Joint Chiefs of Staff
  • Sylvia Burwell, Secretary of Health and Human Services
  • Jeh Johnson, Secretary of Homeland Security
  • Rajiv Shah, Administrator of the U.S. Agency for International Development
  • Samantha Power, Representative of the United States of America to the United Nations
  • Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention
  • Denis McDonough, White House Chief of Staff
  • John Podesta, Counselor to the President
  • Susan Rice, National Security Advisor
  • Valerie Jarrett, Senior Advisor to the President
  • Neil Eggleston, Counsel to the President
  • Shaun Donovan, Director of the Office of Management and Budget
  • Dr. John Holdren, Director of the Office of Science and Technology Policy
  • Antony Blinken, Deputy National Security Advisor
  • Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism
  • Suzanne George, Executive Secretary and Chief of Staff of the National Security Council
  • Rand Beers, Deputy Assistant to the President for Homeland Security
  • Colin Kahl, National Security Advisor to the Vice President
  • Katie Fallon, Director of the Office of Legislative Affairs
  • Gayle Smith, Senior Director for Development and Democracy, National Security Council

The White House

Office of the Press Secretary

Readout of the President's Meeting with Independent Financial Regulators

President Obama hosted a discussion today in the Roosevelt Room with lead financial regulators and senior advisors on the economy and the ongoing implementation of Wall Street Reform.

Six years after the depths of the financial crisis, the President commended regulators for their efforts to further strengthen the financial system by continuing to implement the Wall Street Reform and Consumer Protection Act, which includes the most sweeping set of financial regulatory reforms since the Great Depression and the strongest consumer protections in history that have afforded millions of hard-working Americans new rights and protections within the financial sector. 

The President noted the leadership of U.S. banking regulators in raising capital standards and urged regulators to maintain focus on ensuring that prudent capital cushions are in place, particularly for the largest, most complex global firms, to provide further protection for the U.S. financial system. The President acknowledged the collaborative work of the regulators, specifically recognizing their work in finalizing the Volcker Rule, and also urged participants to consider additional ways to prevent excessive risk-taking across the financial system, including as they continue to work on compensation rules and capital standards. 

Participants discussed the importance of continued coordination through the Financial Stability Oversight Council to identify and mitigate risks to the financial system and address areas of overlap or gaps in oversight. The President asked regulators to evaluate where their agencies’ actions have been most effective and where standards could be tailored for the size and complexity of different institutions.

Finally, participants noted existing budgetary constraints for the market regulators and reiterated the need for additional resources and stability of funding to help protect middle class families, safeguard the financial system, pursue bad actors, and fulfill their missions.

Participants in today’s meeting included:

  • Janet Yellen, Chair of the Board of Governors of the Federal Reserve System
  • Mary Jo White, Chair of the Securities and Exchange Commission
  • Martin Gruenberg, Chair of the Federal Deposit Insurance Corporation
  • Mel Watt, Director of the Federal Housing Finance Agency
  • Richard Cordray, Director of the Consumer Financial Protection Bureau
  • Timothy Massad, Chairman of the Commodity Futures Trading Commission
  • Thomas Curry, Comptroller of the Office of the Comptroller of the Currency
  • Debbie Matz, Chairman of the National Credit Union Administration

White House and Administration Participants:

  • Jack Lew, Secretary of the Treasury
  • Shaun Donovan, Director of the Office of Management and Budget
  • Jason Furman, Chairman of the Council of Economic Advisers
  • Jeff Zients, Director of the National Economic Council and Assistant to the President for Economic Policy
  • Brian Deese, Deputy Director of the Office of Management and Budget
  • Neil Eggleston, White House Counsel
  • Sarah Bloom Raskin, Deputy Secretary of the U.S. Department of the Treasury
  • Seth Wheeler, Special Assistant to the President for Economic Policy

The White House

Office of the Press Secretary

White House Announces Jonathan McBride to Step Down as Assistant to the President & Director of Presidential Personnel

WASHINGTON, DC – Today, the White House announced that Jonathan McBride will be stepping down from his position as Assistant to the President & Director of Presidential Personnel in late November.

“As Director of Presidential Personnel, Jonathan McBride has helped ensure this Administration and the American people can count on the most talented, dedicated public servants who work diligently and effectively each day to move our country forward and uphold the public trust,” President Obama said.  “I’m grateful to Jonathan for his service, judgment and sound counsel.”

Jonathan McBride was appointed Director of the Presidential Personnel office in July 2013. He joined the administration as a Special Assistant to the President and the Deputy Director of the Presidential Personnel Office in August, 2009. In February, 2012 he was promoted to be a Deputy Assistant to the President. Prior to serving in the White House, Mr. McBride was the Chief Strategy Officer with Universum, a global Employer Branding company, and served as the company’s most senior consultant to companies and agencies looking to attract and recruit top talent. In 2000, Mr. McBride co-founded Jungle Media Group, an award-winning media company. Jungle’s magazines, websites, and live events served a variety of audiences including MBAs, JDs, college students, African American young professionals, and Hispanic young professionals. The content focused on the ‘career lifestyle’ and informed its readers about how to best navigate current and future career moves. Mr. McBride also worked for Goldman Sachs from 1997 to 2000 and U.S. Senator Herb Kohl from 1992 to 1995. He received his B.A. in Economics and U.S. History from Connecticut College and MBA in Finance from the Wharton School of Business at the University of Pennsylvania. He is a former Trustee of Connecticut College and the National Urban League.

Driving Development of Clean Energy

Since the President took office, we have made unprecedented progress transforming America into a clean energy economy built to last. The amount of electricity we get from the wind has tripled, and solar electricity production has increased by tenfold.

The Administration has permitted more than 50 utility-scale renewable energy projects on public lands, enough to power nearly 5 million homes and support more than 20,000 construction and operations jobs. The Departments of Energy and Interior are also moving forward on infrastructure projects that will bring clean sources of power online and improve the resilience of our electricity system.

Today, the Department of Energy finalized a Presidential Permit for the Champlain Hudson Power Express, a transmission line that will deliver renewable hydropower from Quebec to meet New York City's growing energy demand. The project developers estimate the 1,000-megawatt transmission line will save consumers $650 million each year and cut carbon pollution 2.2 million metric tons.

And we're taking action to drive reliable, affordable, and sustainable hydropower at home. Since the President took office, DOE has provided awards to support more than 30 hydropower projects.

President Obama firmly believes that the federal government should lead by example. That is why he has set aggressive targets for federal agencies to reduce their energy and water use, and cut greenhouse gas emissions.

In fact, last year the President announced a bold new goal for the federal government to consume 20% of its power from renewable sources by 2020 – and federal agencies are already stepping up to this challenge in a big way.

President Obama Speaks at the American Veterans Disabled for Life Memorial Dedication

Watch on YouTube

This afternoon, President Obama spoke at the dedication for the American Veterans Disabled for Life Memorial, honoring heroes who have sacrificed on behalf of our nation.

In his remarks, the President made clear that we must provide proper care for our veterans, noting: "When our wounded veterans set out on that long road of recovery, we need to move heaven and earth to make sure they get every single benefit, every single bit of care that they have earned, that they deserve."

"To every wounded warrior, to every disabled veteran -- thank you," he said.

Related Topics: Veterans, Kansas, Missouri

President Obama Speaks at the American Veterans Disabled for Life Memorial

October 05, 2014 | Public Domain

On October 5, 2014, President Obama delivered remarks at the dedication of the American Veterans Disabled for Life Memorial

Download mp4 (563MB) | mp3 (15MB)

The White House

Office of the Press Secretary

Remarks by the President at the American Veterans Disabled for Life Memorial Dedication

Washington, D.C.

12:21 P.M. EDT

THE PRESIDENT: Thank you so much. Good afternoon. Please be seated. To all our disabled veterans -- our extraordinary wounded warriors -- we gather here today, on this gorgeous autumn day in America, because each of you endured a moment that shaped the arc of your lives and that speaks to our debt as a nation.

Maybe it was there on the battlefield, as the bullets and shrapnel rained down around you. Maybe it was as you lay there, the medics tending to your wounds. Perhaps it was days or months later, in that hospital room, when you finally came to. Perhaps it was years later, as you went about your day, or in the midnight hour, when the memories came rushing back like a flood.

Wherever you were, whatever your story, it was the moment that binds each of you forever -- that moment of realization that life would not be the same. Your foot. Your hand. Your arm. Your leg -- maybe both. Your sight. Your peace of mind. A part of you was gone.

Speaking to his fellow veterans of the Civil War, the great Oliver Wendell Holmes, Jr. once said, “As I look into your eyes I feel…that a great trial in your youth made you different…different from what we could have been without it.” And he said, we learned “a lesson early which has given a different feeling to life” -- a sense of duty that burns like a fire in the heart.

To Lois Pope, Art Wilson and everyone at the memorial foundation and our incredible veterans service organizations who devoted so many years of effort, especially our friends at the Disabled American Veterans; to all the architects and craftspeople who lent your talents to bring this memorial to life; members of Congress, Secretaries Jewell and McDonald; distinguished guests; and most of all, to our veterans who have come to know “a different feeling to life,” and to your families -- it’s a great honor to be with you here today.

For more than two centuries, Americans have left everything they have known and loved -- their families and their friends -- and stepped forward to serve: to win our independence, to preserve our Union, to defend our democracy, to keep safe this country that we love. And when the guns fall silent, our veterans return home, ready to play their part in the next chapter of our American story. As a nation, we have not always fulfilled our obligations to those who served in our name. This is a painful truth. And few have known this better than our veterans wounded in war.

In the first years after our Revolution -- when our young nation still resisted the idea of a standing army -- veterans of the Continental Army returned to towns that could be indifferent to their service. One veteran -- his hand mangled by a British musket ball -- was deemed, like many veterans, as “unfit for labor.” And frustrated by his inability to secure a disability pension, he wrote that “many of those who aided in conquering the enemy are suffering under the most distressing poverty.” After the Civil War, and again after the First World War, our disabled veterans had to organize and march for the benefits they had earned. Down the decades, our nation has worked to do better -- to do right by these patriots. Because in the United States of America, those who have fought for our freedom should never be shunned and should never be forgotten.

So, today, we take another step forward. With this memorial we commemorate, for the first time, the two battles our disabled veterans have fought -- the battle over there, and the battle here at home -- your battle to recover, which at times can be even harder, and certainly as longer. You walk these quiet grounds -- pause by the pictures of these men and women, you look into their eyes, read their words -- and we’re somehow able to join them on a journey that speaks to the endurance of the American spirit. And to you, our veterans and wounded warriors, we thank you for sharing your journey with us.

Here we feel your fears -- the shock of that first moment when you realized something was different; the confusion about what would come next; the frustrations and the worries -- as one veteran said -- “that maybe I wouldn’t be quite the same.”

And then here we see your resolve -- your refusal, in the face of overwhelming odds, to give in to despair or to cynicism; your decision, your choice, to overcome. Like the veteran who said, “It’s possible for a man to lose half his physical being and still become whole.”

It is here we can see your perseverance -- your unyielding faith that tomorrow can be better; your relentless determination, often through years of hard recovery and surgeries and rehab, learning the simple things all over again -- how to button a shirt, or how to write your name; in some cases, how to talk or how to walk; and how, when you’ve stumbled, when you’ve fallen, you’ve picked yourself up, you’ve carried on, you’ve never given up.

Here we get a glimpse of the wounds within -- the veteran who says, “I relive the war every day.” Because no matter what war you served in -- and whether they called it “shell shock” or “battle fatigue,” or the “1,000-yard stare” or post-traumatic stress -- you know that the unseen wounds of war are just as real as any other, and they can hurt just as much, if not more.

Here we’re reminded that none of you have made this journey alone. Beside each of you is a wife or a husband, mothers and fathers, brothers and sisters, sons and daughters, and neighbors and friends -- who day after day, year after year, have been there, lifting you up, pushing you further, rooting you on -- like the caregiver who said, “I loved him for who he was in his heart. And he still had that.” Today we salute all your families, and the love that never quits.

And, finally, here we see that our wounded veterans are defined not by what you can’t do, but by what you can do. Just ask Captain Dawn Halfaker. In Iraq, her Humvee was hit by an RPG. She suffered burns and broken bones, lost her right arm. She struggled physically and emotionally. But with the help of her fellow wounded warriors she came to focus, she said, “not on what I had lost, but on what I still had.” And today what she has is the respect of her fellow veterans that she mentors; a business of her own -- one that hires veterans; and a beautiful 6-month-old son. Dawn’s picture -- this member of the 9/11 Generation -- now graces this memorial, and we are honored that she is here today. And, Dawn, please stand up. (Applause.)

I’ve seen Dawn’s story over and over and over again -- in all the wounded warriors and veterans that I have the honor to meet, from Walter Reed to Bethesda to Bagram. I know in Dawn’s life, many of you see your own. Today, I want every American to see it. After everything you endured, after all the loss, you summoned the best in yourself and found your strength again. How many of you learned to walk again and stand again and run again. How you’ve competed in races and marathons and the Paralympics, on Team USA. How you found joy and love -- getting married, raising children. How you found new ways to serve -- returning to your units or starting new businesses, or teaching our children, or serving your fellow veterans, or leading in your communities.

America, if you want to know what real strength is, if you want to see the character of our country -- a country that never quits -- look at these men and women. And I’d ask all of our disabled veterans here today -- if you can stand, please stand; if not, please raise your hand so that our nation can pay tribute to your service. We thank you. We’re inspired by you. And we honor you. (Applause.)

From this day forward, Americans will come to this place and ponder the immense sacrifice made on their behalf; the heavy burden borne by a few so that we might live in freedom and peace. Of course, our reflection is not enough. Our expressions of gratitude are not enough.

Here, in the heart of our nation’s capital, this memorial is a challenge to all of us -- a reminder of “the obligations this country is under.” And if we are to truly honor these veterans, we must heed the voices that speak to us here. Let’s never rush into war -- because it is America’s sons and daughters who bear the scars of war for the rest of their lives. (Applause.) Let us only send them into harm’s way when it’s absolutely necessary. And if we do, let’s always give them the strategy, the mission, and the support that they need to get the job done. When the mission is over -- and as our war in Afghanistan comes to a responsible end in two months -- let us stand united as Americans and welcome our veterans home with the thanks and respect they deserve. (Applause.)

And if they come home having left a part of themselves on the battlefield, on our behalf, this memorial tells us what we must do. When our wounded veterans set out on that long road of recovery, we need to move heaven and earth to make sure they get every single benefit, every single bit of care that they have earned, that they deserve. (Applause.)

If they’re hurting and don’t know if they can go on, we need to say loud and clear, as family and friends, as neighbors and coworkers, as fellow citizens, and as a nation: You are not alone, it’s all right to ask for help, and we’re here to help you be strong again. Because our wounded warriors may have “a different feeling to life,” but when we are truly there for them, when we give them every opportunity to succeed and continue their enormous contributions to our country, then our whole nation is stronger, all our lives are richer.

So if you’re an American, and you see a veteran -- maybe with a prosthetic arm or leg, maybe burns on their face -- don’t ever look away. Do not turn away. You go up and you reach out, and you shake their hand, and you look them in the eye and you say those words every veteran should hear all the time: “Welcome home, thank you. We need you more than ever. You help us stay strong, you help us stay free.” (Applause.)

To every wounded warrior, to every disabled veteran -- thank you. God bless you. God bless these United States of America. (Applause.)

END
12:35 P.M. EDT

Weekly Address: We Do Better When the Middle Class Does Better

President Barack Obama tapes the Weekly Address at Millennium Steel Service, LLC in Princeton, Indiana

President Barack Obama tapes the Weekly Address at Millennium Steel Service, LLC in Princeton, Ind., Oct. 3, 2014. (Official White House Photo by Chuck Kennedy)

In this week’s address, the President highlighted that six years after the Great Recession, thanks to the hard work of the American people and the President’s policies, our economy has come back further and faster than any other nation on Earth. With 10.3 million private-sector jobs added over 55 straight months, America’s businesses have extended the longest streak of private-sector job gains on record.

But even with this progress, too many Americans have yet to feel the benefits. The President reiterated the vision he set out earlier this week for steps that can lay a new foundation for stronger growth, rising wages, and expanded economic opportunity for middle-class families.

Transcript | mp4 | mp3