National Board and Care Reform Act of 1991

National Board and Care Reform Act of 1991 - Amends title XVI (Supplemental Security Income) (SSI) of the Social Security Act to define a "board and care facility" as a facility providing food, shelter, and personal assistance to more than one SSI or Old Age, Survivors and Disability Insurance (title II of the Social Security Act) (OASDI) beneficiary who is unrelated to the owner or operator of such facility. Lists the rights of facility residents, including the right to control his or her receipt of health-related services and the right to examine the most recent survey of the facility and any plan of correction in effect with respect to the facility. Requires that facility residents be given oral and written notice of such rights, including a written statement that a resident may file a complaint with a State survey and certification agency respecting resident abuse and neglect and misappropriation of resident property. Prohibits facilities from admitting or retaining residents who are bedbound, require skilled nursing care, or a level or type of care the facility is not equipped to provide.

Requires that each board and care facility: (1) employ at least one full-time administrator who has successfully completed a basic initial and ongoing training program approved by the Secretary of Health and Human Services and has not been convicted of any felony or defrauding the Federal Government; (2) be sufficiently staffed, with at least one staff member present at the facility at all times; (3) adopt certain measures to preserve facility safety and sanitation; (4) develop and implement a written medication policy and procedure that outlines in detail the procedures to be followed regarding the handling of medications at the facility; (5) fully meet each resident's dietary and nutritional needs, including those prescribed by a physician; (6) assure residents prompt and efficient access to health care; and (7) provide and actively promote resident participation in a program of daily activities which do not consist solely of television viewing.

Makes the States responsible for certifying that board and care facilities comply with this Act's requirements. Requires each State to: (1) conduct periodic educational programs for facility staff and residents regarding the requirements imposed on such facilities; (2) provide for the receipt, review, and on-site investigation of allegations of resident neglect and abuse and of misappropriation of resident property; (3) conduct an unannounced inspection of each facility at least once every 15 months (though the statewide average interval may not exceed 12 months) for compliance with this Act's requirements; and (4) maintain procedures and adequate staff to monitor, on-site, on a regular, as needed basis, the compliance of a facility with this Act's requirements if the facility was previously found out of compliance or the State has reason to question its compliance.

Directs the Secretary to: (1) provide for the comprehensive training of State inspectors; and (2) conduct sample onsite inspections of facilities within two months of State inspections to test the adequacy of State inspections.

Requires that: (1) certain information regarding facilities and their compliance with this Act's requirements be made available to the public; (2) the State long-term ombudsman be notified of a facility's noncompliance with any of this Act's requirements; and (3) State Medicaid fraud and abuse control units be given access to facility survey and certification information.

Requires that when a State determines that a facility's deficiencies immediately jeopardize residents' health and safety: (1) temporary management be appointed to oversee the closure of the facility or correction of its deficiencies; or (2) it be prohibited from keeping or admitting OASDI or SSI beneficiaries. Directs the Secretary to appoint temporary management for such a facility when the Secretary finds that its deficiencies immediately jeopardize residents' health and safety. Sets forth other remedies to be applied when the health and safety of facility residents is not immediately jeopardized. Authorizes the imposition of civil monetary penalties against facilities found to be in compliance with this Act's requirements but to have been out of compliance previously. Reimburses States for 90 percent of their inspection and enforcement activities.

Directs each State to maintain a program to aggressively seek out and identify unlicensed board and care facilities. Permits States to establish a program rewarding facilities providing the highest quality of care to residents who are OASDI or SSI beneficiaries.

Directs the Secretary to: (1) maintain a toll-free hotline to collect, maintain, and update information on board and care facilities and to receive complaints and answer questions regarding such facilities; and (2) maintain a Department unit to investigate such complaints.

Increases, by ten percent, the SSI benefit available to beneficiaries who reside in certified board and care facilities. Requires States to make supplementary payments to eligible facility residents whose income does not exceed the Federal poverty level.

Directs the Secretary to establish a system of monitoring and periodic review of a statistically significant number of all payments made under the OASDI and SSI programs to ensure that payments are being made to the proper parties. Sets forth reporting requirements.

Amends title XVIII (Medicare) of the Social Security Act to prohibit hospitals from discharging patients to board and care facilities which fail to satisfy this Act's requirements. Requires such hospitals to report facility noncompliance to the State.

Amends title XIX (Medicaid) of the Social Security Act to require State Medicaid fraud control units to monitor for, investigate, and prosecute illegalities and fraud in the provision of medical assistance to residents of board and care facilities. Sets the Federal matching rate for such activities at 90 percent.

Directs the Secretary to: (1) provide grants to States and localities to train operators and staff of board and care facilities and advocates of facility residents; (2) develop model training methods and supporting training material within one year after this Act's enactment; (3) provide grants to States, localities, and private nonprofit organizations to establish temporary emergency shelters for the abused elderly and disabled; and (4) arrange for the establishment of a National Commission on Board and Care Facility Quality to examine enforcement of requirements for board and care facilities for adequacy and effectiveness and to make appropriate recommendations to the Congress and the Secretary. Authorizes appropriations for such grant programs.